Recently the an advisory panel for the Food and Drug Administration (FDA) recommended against approval for what has been nicknamed the "little pink pill" designed to address a lack of sexual desire for females (as opposed to Viagra, the "little blue pill" for men). The FDA could approve it anyway, but it rarely if ever decides differently than the advisory panel. Clinical trials sponsored by the drug's maker, Boehringer Ingelheim, reported that pre-menopausal women on Flibanserin experienced a small increase in satisfying sexual activity, compared with women taking a placebo; however, the panel decided that the amount of increase did not outweigh the negative side effects.

Why the "little pink pill?" In typical fashion, we have identified a problem (some number of women don't feel like having sex) and attempted to address it expediently with medical intervention. (There must be a pill for that!) But it turns out that when trying to peer into the pool of sexuality we discover it's actually a vast ocean that we have explored little of.

There has been a paucity of studies about women's sexuality. What few studies there are vary wildly in their results, estimating between approximately 10% and 50% of women experience problems related to sexual desire (a considerable difference) and provide no conclusive evidence about what the cause may be. The debate over Flibanserin has highlighted how little we know about the mechanics of female sexual desire or lack thereof. Experts have guessed that the causes range from hormones, to body image and self-esteem, to lack of a skilled sexual partner, but these are all guesses and so far no pill has been able to do what Viagra does: bypass further understanding about the psychological or emotional causes of dysfunction of male sexuality and simply increase blood flow to the necessary parts (in Viagra's case, the penis).

In truth, there is much more we don't understand about sexuality and the mechanics of desire than we do understand. We have taken a preliminary stab at identifying what dysfunction looks like (lack of desire, desire for the wrong thing/person) but these definitions are for the most part subjective and based largely on the negative effect it has on others. But what causes sexual dysfunction remains as elusive as what causes sexual function and sexual desire to begin with.

Clearly there is a hunger for sex - sexual connection, sexual desire, sexual energy. Pfizer claims on its web site that nine Viagra pills are dispensed every second - nearly 300 million tablets per year. There aren't any good statistics about it, but it is questionable how many of those pills are related to biomechanical dysfunction on the part of the man who takes it versus any number of other reasons he might not be able to achieve or maintain an erection. Additionally, there is an explosion in the media about the phenomenon of "sex addiction" - an experience of lack of control over compulsive sexual desire/behavior wreaking havoc in lives.

The study of sexuality and "sexual energy" has been around for a long time - Tantra emerged in India more than 6,000 years ago with an understanding of how sexual energy can be used to benefit health and reach enlightenment. Chinese Taoist sexual practices have been around since the Han Dynasty (200 BCE). But these practices take learning, patience, and time, just as talk therapy and reducing stress, anxiety, and fatigue through meditation do. These techniques might all work to create a rich, satisfying sex life, but they would require us to slow down and investigate what is working and what isn't; and to talk to people and evaluate their experiences in a quantitative way. Perhaps the "failure" of drug companies to thus far find a "magic pill" that would increase sexual desire and functioning in women is not because women are sexually hopeless but more points a need for us to slow down and investigate the mechanics of sexual energy and desire; not just for women, but for us all.

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