So why has it been so hard for me to write about flibanserin, the so-called female Viagra? The topic seems a natural fit for a
sex-crazed horny frisky intellectually curious blogger: it’s got sex, it’s got science, and it goes to the heart of a subject that I dance around when I’m writing about dating and marriage and monogamy and polyamory. What I’m really talking about when I talk on the internet is desire.
And flibanserin is supposed to deal with desire, or rather, the lack of desire, in women. Among those who believe this is an actual medical condition (many don’t; hang on, I’ll get to them in a moment), it’s called hypoactive sexual desire disorder. Or it used to be called that. HSDD is the name the shrinks came up with back when they classified this as
crazy a psychiatric disorder. Then they decided it wasn’t. Now the DSM-V has something called “female sexual disinterest/arousal disorder” which is not quite the same thing, and does not lend itself as easily to an acronym.
Anyway, the people who are trying to sell the pills have resurrected HSDD as a sort of nom de guerre, no doubt in preparation for their
military marketing campaign, having learned from Pfizer that initials (“ED”) sell way more little blue pills than phrases like “limp dick.”
Speaking of that marketing campaign, I imagine a television commercial something like this: An attractive couple of indeterminate age hold hands and smile at one another as the sun sets behind them. Then, a soothing voiceover.
With the help of flibanserin, she won’t have a headache tonight.
Flibanserin. For Really Great Sex.™
Well, maybe not quite “really great sex.” Sprout Pharmaceuticals, the company that acquired the rights to the drug after Boehringer Ingelheim, the original developers, threw up their hands in despair, promises only that their research shows an increase of satisfying sexual events (SSEs) of .5 to 1 per month when using the drug over taking a placebo.
Perhaps you, like me, wonder, “What’s an SSE?” Is it an earth-moving, make-the-neighbors-call-the-cops (“Officer, I swear I thought he was killing her!”), I-can-die-happy-now orgasm? No, it’s not that. An SSE is whatever the participant in the study finds satisfying. That definition makes sense to me, as I can understand how an SSE would be different for different people, and might be different even to the same person, depending upon their stage of life. Back when I was younger, any sexual event that didn’t end up with me pregnant was satisfying. Now that I’m married, any sexual event that isn’t interrupted by my kids is satisfying.
But is an increase of 1/2 to 1 more SSEs a month enough to justify altering your body’s chemistry? From the Sprout Pharmaceutical website, here’s what the drug does.
Flibanserin is believed to work on key neurotransmitters, or chemicals, in the brain that affect sexual desire. More specifically, it is thought that flibanserin corrects an imbalance of levels of these neurotransmitters by increasing dopamine and norepinephrine (both responsible for sexual excitement) and decreasing serotonin (responsible for sexual inhibition).
For a long time, the opponents of the drug argued against it based on efficacy: “minimal results” did not outweigh the potential risks (fatigue, low blood pressure) and, for a long time, that argument won the debate. The FDA refused to approve the drug in 2010, and then again in 2013.
Now, last week, after all this time saying “No! No! No!” to flibanserin, sounding just like that Catholic girl back in high school who wouldn’t let you under her sweater, an FDA panel has done a complete reversal, and not only lifted up the sweater, but also spread its legs (metaphorically!) and said, “Yes!” to flibanserin. It looks like the government agency will follow the panel’s adivce and ultimately approve the drug for sale.
What brought about the change of heart? Did some new study show flibanserin really is super effective, and now women everywhere can have as many SSEs as their hearts desire? Nope. Still only 1/2 to 1 more SSEs per month from the group that didn’t take the placebo. What changed is that Sprout Pharmaceutical lobbied hard for the drug and enlisted the media in the effort (Google and you’ll find a news story in the Washington Post that reads like it was written by the company’s PR department) and appealed to feminism and fairness: men have twenty-odd drugs approved for male sexual dysfunction and women have nada.
I’d be lying if I said Sprout Pharmaceutical’s argument doesn’t sway me. Why hasn’t more effort been made toward solving the sexual problems of women? I’ve been called (derisively, but I wear the label with pride) a sex-positive feminist and it pains me that, out of necessity, so many feminist discussions of sexuality center around rape, abuse, and exploitation. I wish there were more opportunities to celebrate female sexuality, because it’s an aspect of my life where I’ve found a lot of joy as a woman. Maybe if more women were having great sex, there would be.
So why didn’t the FDA approve flibanserin sooner? Could it be that as a society we’re still uncomfortable with the sexuality of women? Did the rejection of flibanserin amount to the FDA saying “Nice girls don’t”?
Even as a sex-positive feminist, I see the problems with treating lack of sexual desire in women, because from there it’s a very short walk to that icky place where we find ourselves having sex when we maybe don’t really want to have sex.
And is “hypoactive sexual desire disorder” even a thing? The American Psychiatric Association said no, it’s not. Sexual desire varies in humans, there is no norm from which one can be “hypo” or “hyper” and anyway, it’s not something that can be measured like blood sugar level. In addition, there’s is a long and tortured (literally!) history of the medical industry treating people (especially women) for “diseases” that they did not have. Normal female behavior has been pathologized in the past, and the story of flibanserin sounds an awful lot like something we’ve seen before.
After all that I’ve written here, perhaps you can see why I’ve struggled so long with writing this post. I don’t know how I feel about flibanserin. I guess I’m okay with the FDA’s recent decision, and I do believe women should have the choice to get relief from their situation if it’s troubling them. Anyway, it’s not my place to tell other women what’s good for them or not. If I could, I would wave a magic wand so that every woman gets to experience sex with caring, thoughtful, respectful partners and they’re so full of desire nothing else ever gets done in their lives.
How’s that for an unintended consequence?
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