Sex used to be a rather intimate affair. What happened between the sheets was strictly confidential. You had a problem? Mainly, you kept quiet about it. If you got help from your doctor, you would only have done so if, first, you could overcome your embarrassment. Problem pages in magazines were written in ambiguous code, and people never kissed and told. However, now we must not suffer in silence. Low libido, erection problems, premature ejaculation - out with it all. For now, the implication is that there is a solution for just about anything.

And we are not just talking about sage advice. Since the bad old days a generation ago, sex - or at least talking about it - has changed. Now, we don't just have it - we have good sex or bad sex. We have TV programmes where people willingly copulate and are assessed by therapists, or we can watch as people appear on reality shows, chosen for the likelihood they will have sex with relative strangers. But there is another offer being made; someone else has got into bed with you and your loved one. This mini-revolution - where we got past merely talking about it in public only to start doing it in public - has been accompanied by a pharmaceutical one. Even in the privacy of your own home, the pharmaceutical companies have got under the sheets and in beside you, asking if it's going OK.

Is this a good thing? If we are experiencing problems in our sex life, shouldn't we be pleased that not only can we talk about it with much less embarrassment, but also that we know there may be a pharmaceutical product to help get it fixed?

Asparagus and ginseng are one thing: hormone replacement therapy is quite another. HRT coyly promised that tiresome libido problems could be resolved while the other symptoms of the menopause - hot flushes or mood swings - dissipated. And then came Viagra: the mighty small blue triangle that spawned a billion spam emails, not to mention - officially - a 100m prescriptions. Hot on the trail of Viagra came the "me-too drugs" - as other pharmaceutical companies got in on the act with drugs such as Uprima and Levitra, or the less gaudily named Cialis.

The NHS made it clear that it could only stave off bankruptcy by allowing just people with conditions such as diabetes or prostate cancer free prescriptions, but that has not stopped an awful lot of blanket advertising. Earlier this year, billboards proclaimed that erectile dysfunction could be "sorted" in 10 minutes, while clipboard wielding drug reps visited doctor's surgeries to promote the latest medication for all-weekend, on-demand, spectacular engorgement.

While male impotence has always been of concern - it may be a sign of diabetes or heart problems - "female sexual dysfunction" (FSD) has been the source of much dispute. First, because of objections over its appearance in official disease classifications and, second, because there is an emerging potential pharmaceutical solution. An astonishing 43% of American females were claimed to be suffering from "FSD" in surveys undertaken in the late 1990s. Widely cited by the popular press, the survey was run with teasers about the mooted treatment - a testosterone patch called Intrinsa. The drug's creators, Procter and Gamble, applied but did not get approval to license it in the US late last year. Spokeswoman Elaine Plummer says that studies continue in order to satisfy the licensing authorities. "It is our desire to have a therapeutic option for women who are looking for one."

Currently they are running longer term trials of the patch in women who have reached a natural or surgical menopause, and she says they are in dialogue with the licensing authorities about what other work needs to be done in order to produce a marketable product. But of course the female sexual response is more difficult to measure than the obvious physical outcomes of sexual desire in a man. This makes the whole matter more subjective and, overall, this means that finding a proven treatment is rather more difficult.

But is a pharmacological solution best? Clearly, there are some women who do have a physical cause for sexual difficulties - for example, having had pelvic radiotherapy or extensive surgery. But there are more common reasons. If a woman is tired, harassed, or her relationship isn't working well, isn't that likely to impact on her sex drive? The US survey, apart from finding sexual dysfunction nationwide, also reported that large numbers of women felt that they suffered from low self esteem. Isn't it more important to sort that out first? Does using a testosterone patch mean that we are "medicalising" the normal ups and downs of life and sexual desire? Surely half the population can't be abnormal. Is female sexual dysfunction really an "illness" at all?

"Of course, it is important to treat a women holistically," says Plummer. "The suggestion that this is a created condition doesn't help the sufferers who have a clear need for medical treatment. Instrina is not for every woman and not every woman is distressed by her loss of desire - it's only for those women that want to take something."

Ann Tailor, director of the Sexual Dysfunction Association says there are many women who aren't having sex but there isn't anything necessarily wrong with them. "They may be too knackered - too tired and can't be bothered - whereas there are some women who do have real problems. I don't think there will be a lot of women rushing for it - but among some women there is a real need."

While antidepressants have been used "off licence" for refractory cases of premature ejaculation - ones that have not responded to conventional treatment - in the UK for some time, the latest treatment on the cards was revealed at the annual American Urological Association meeting recently. Dapoxetine, an anti-depressant in the same class of drugs as Prozac and Seroxat, has been filed for patent in the US as a treatment for premature ejaculation. Clinical trials had shown that instead of lasting less than a minute, the drug could prolong intercourse to over three minutes. Is this really such a major breakthrough?

"We talk to lots of men who are looking for something - and this would be another option for men who have tried the exercises or find psychotherapy difficult to access through the NHS," says Tailor. "These men are desperate for something. It may be difficult in new relationships - if there are mismatches in expectations, for example. There are cases when men have tried everything and nothing works - and it can lead to a great deal of frustration."

Does she think that the use of drugs that will not work for everyone are counterproductive? Are we simply raising the barrier to "normality"? And by making it potentially possible for penetrative sex to always take place, are we in danger of overemphasising it as the only sexual outcome worth having?

However, even Viagra, which led the pharmaceutical side of the sex revolution, has its critics. Annie Potts, senior lecturer at the University of Canterbury, New Zealand, interviewed couples who had used Viagra and found that it did not always turn out to be problem-free. In the journal Sociology, Health and Illness, she concludes: "While the publicity surrounding Viagra may potentially facilitate more positive attitudes to sexuality in old age, it may also produce a societal expectation that "healthy" and "normal" life for older people requires the continuation of "youthful" sex lives focused on penetrative intercourse."

Drugs for erectile dysfunction have been a great advantage in many lives, and there may be a role for other pharmaceuticals to help deal with refractory problems.

However, drugs may prove to be the cheaper quick fix where other issues - physical or psychological - are more time consuming and difficult to address. And there are wider repercussions of medicalising normal variations.

Even at the moment, we are simply under too much pressure to have constantly perfect sex. When these new drugs arrive, the barrier of perfection will be raised, not just for those with problems, but also those without. We need to clearly and properly put people first in the face of the glut of expectation which will no doubt follow.