As many of you know, there’s now a drug that some claim can help women feel more sexual desire. That’s been a very difficult thing to prove, though, since sex is multifaceted and the drug’s effect (if any) on desire appears to be subtle.

A German pharmaceutical company discovered this drug by accident, while looking for something else. They‘d tested it as an antidepressant and it proved ineffective. But researchers noted some interesting effects on sexual behavior, and an idea was born. After extensive testing in human subjects, the company sought FDA approval for the drug in 2010 as a treatment for what was known then as “Hypoactive Sexual Desire Disorder” (HSDD).

The FDA turned them down, and the company lost interest in the project. But then a new US company, Sprout Pharmaceuticals, was formed specifically to work on getting this drug approved. They bought the rights to it, and early in 2015 they plan to re-apply to the FDA.

This drug’s chemical name is flibanserin. But it’s more often referred to in the press (erroneously) as “Pink Viagra.” If it’s approved, it will get a snazzy new brand name. There will be TV ads saying, “Ask your doctor about (insert snazzy brand name here)”. And there will be the kind of tempest in the press that inevitably accompanies anything new having to do with sex.

As a physician who is both a sex therapist and an avid student of popular culture, I’ve been closely following the lead-up to “Pink Viagra’s” 2015 FDA submission. Many in the sex therapy community have worried that this drug may harm women—either medically, or by reducing the complexity of women’s sexual experience in people’s minds to something that just requires a pill.  Groups such as the New View Campaign have decried the so-called “medicalization of sexuality.” Advocates on the other side such as Even The Score point out that drugs to help with sex have been approved for men but not for women, and that this is unfair.

The Los Angeles Times recently published an editorial, “The sham drug idea of the year: ‘pink Viagra” by Ellen Laan, associate professor of sexology at the University of Amsterdam, and Leonore Tiefer, clinical associate professor of psychiatry at NYU School of Medicine. The article correctly points out distorted statements made by the pro-drug groups. It’s just not true, for example, that 43% of American women have a sexual dysfunction, as some flibanserin advocates have claimed. And claims that the FDA has approved 26 medications for sexual dysfunction in men versus none for women rely on a system of counting medications that many have questioned. A more realistic score, though still uneven, would be less dramatically lopsided.

But there are distortions in the Laan-Tiefer article as well. Its authors write that low sexual desire in women is not a medical condition, but instead “typically reflects a difference in desire between two partners.” The word “typically” here is misleading. Sore throats typically are caused by viruses, but every once in awhile it’s strep. Sometimes the issue may be a difference in desire between two partners, but sometimes it’s that one partner has lost all interest in sex.

The Laan-Tiefer article also incorrectly states that the International Society for the Study of Women's Sexual Health (ISSWSH), of which I’m a member, is largely funded by the pharmaceutical industry. In fact, ISSWSH is largely supported by its members’ annual dues.

But the biggest problem with Laan and Tiefer’s article is that it over-simplifies an extremely complex subject. The authors write, “The scientific community regards most sexual problems in healthy people as related to what is going on in the bedroom, the relationship, the partners' individual lives and shifts in cultural norms. The incentives for sex — or for avoiding sex — are far more important in understanding a couple's issues than one partner's biology.”  

Yes, that’s true. Most sexual problems have more to do with a woman’s environment than her biology. But “most” is not “all.” There are many women with loving, sexy, considerate partners who lose all erotic interest and we have no idea why.

Yes, drug companies do over-simplify women's sexual problems by calling them "disorders" in need of pills. But to state the opposite -- that a woman's sexual concerns are inevitably environmental -- is also an over-simplification.

Few things in our field are either/or. The Laan-Tiefer article in the L. A. Times forces a dichotomy where none should exist. Tiefer is the founder of an organization called The New View Campaign, whose tag-line reads, “Sex for our pleasure, or their profit?” I wonder -- why the word “or”? What if flibanserin, the so-called “Pink Viagra,” were to change some women’s sex lives for the better? Those women would experience greater pleasure, and the company would make a profit. The two aren’t mutually exclusive. In fact, they usually go together. Companies don’t typically make money by denying people pleasure.

On the other hand, if Laan and Tiefer are correct that flibanserin doesn’t work, then what are they worried about? People aren’t stupid, and new drugs are expensive. If this one is ineffective, I don’t think we’ll have to worry about its maker getting rich off it.

So let’s drop the either/or thinking. If the FDA approves flibanserin for women, then we’ll get a chance to see if it works in the real world -- and for whom. Until then, let’s not pretend that we know more than we do about what causes sexual problems. We still have a lot to learn.

In the meantime, let’s trust individual women to decide whether or not they want to take a pill.

© Stephen Snyder, MD
www.sexualityresource.com
New York City

 

See related articles:

The FDA Wants to Hear More About Women and Sex

Pink Viagra and the Riddle of Female Sexual Desire

Simplicity, Complexity, and the Hunt for Pink Viagra

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