Polar Vortexes aside, February was a steamy month for us gals. On Valentine’s Day the silver screen turned Fifty Shades of Grey, debuting a movie that’s been called Mommy Porn, a genre seemingly purpose-built for women who’ve come to associate feeling “hot and bothered” with spending too much time baking, steam-cleaning carpets or trooping around Disney World with cranky kids.
Three days later, Sprout Pharmaceuticals announced it had resubmitted for FDA approval a drug designed to increase sexual desire in women who suffer from what’s called Hypoactive Sexual Desire Disorder or HSDD. (1) If the third time’s a charm and the FDA approves it, Flibanserin will be the first drug of its kind, hitting the market some 17 years after Viagra debuted in 1998. (2)
There’s just so much in this last sentence that it’s worthwhile taking a moment to — at the risk of sounding modish — unpack it.
If you frequently resort to any of these dodges because you can’t muster the lust for sex — and not because, say, you’re super pissed because your partner never ever fills up the Britta.
Let’s start with the 17-year-lag between Viagra and its would-be gal pal, Flibanserin. On this topic, most media coverage has focused on an anti-female bias at the FDA, which can boast just two women commissioners since its founding in 1907 (3) and which dithered for more than a decade over the so-called “morning after pill.” (4)
“I dunno guys, I say we leave it to the old, white men to decide this one. They seem to know what’s best…” was one sarcastic comment left on NPR’s Facebook page,after it posted an article about the twice-foiled Flibanserin.
“All things being the same, if a man can get a pill that makes his erection last longer then there should be a pill that allows his wife to at least be interested in looking at it,” opined another.
This comment — while ignoring the fact that two penis-free people might be trying to have sex — gets to the crucial difference between Viagra and Flibanserin.
Viagra assumes the desire to have sex already exists in the man and he just needs help with the hydraulics, which the drug achieves by increasing the flow of blood to his genitals. So-called vasodilators (blood-flow-increasing drugs) were also tried on women, following the old “what’s good for the gander is good for the goose” line of thinking. They failed.
What Sprout Pharmaceuticals is offering in the form of Flibanserin is a daily-use drug that works to alter your brain chemistry rather than blood flow. More specifically, it changes the balance of three brain chemicals, elevating dopamine and norepinephrine and suppressing serotonin. Per Sprout, the drug has resulted in a 53% increase in sexual desire and a doubling of the number of satisfying sexual events (SSEs) as compared to the placebo.
Not to sound like an FDA apologist, but is the drug’s slow march toward approval simply a case of the Administration doing its job, challenging manufacturers to prove their drugs are safe and effective before they can, in this case, mess with our brains? Are we really to believe that the FDA’s commish is dragging his wingtips because he quails at the thought of a slew of suddenly sex-crazed older gals (hey, is there a movie script in this? Night of the Living Lady Bits, maybe?).
Per the FDA, the reason it’s been sent back for further data is “the combination of …not very robust effectiveness, and the fact that the safety profile had not been really characterized very well at all made us reach that conclusion, that it really wasn’t ready for approval,” the FDA’s Sandra Kweder told NPR. (5)
Sprout does admit to some side effects, including dizziness, nausea and sleepiness — which sound eerily like those caused by that third glass of Merlot, many women’s de facto pre-sex drug of choice. But what Sprout can’t tell us is what will happen when some portion of the 30% of all women reported to have low sexual desire (6) start taking the drug — daily and indefinitely. As with any new medication, it’s only after its long-term and widespread use by the general population that all of its impacts, good and bad, are known.
So even upon approval, the debate over whether Flibanserin is a good idea can’t be quickly resolved. Maybe the most interesting aspect of this debate is this: Why do 30% of all women simply lose interest in sex?
A pause, a detour into fiction that I happen to be writing, posted as a serialized novel at the blog TheCarolineProblem.com. I mention it only because Caroline, as a character, needed to be struggling with low libido — a complete absence of lust — and for her to do that, I needed to know what long-married, perimenopausal, low-libido women said and did.
Turns out, researchers who run clinical trials related to low libido solidly agree on what counts as “avoidance behavior.” (7) And if you frequently resort to any of these dodges because you can’t muster the lust for sex — and not because, say, you’re super pissed because your partner never ever fills up the Britta before returning it to the fridge — you might qualify for a trial yourself: going to bed earlier than your partner, feigning sleep or an engrossment in a book or an entertainment playing on your laptop (excluding such desire-inducing fare as pornography and the PBS series Grantchester featuring a crime-solving clergyman I call Hottie McVicar) or that old cliché, a “headache.”
Women in these trials report not wanting to hurt their partners’ feelings with a frank discussion about their lustlessness, a tendency that may prevent them from actually taking a drug for it. Or so muses Daniel Bergner in an excellent article on female desire, published two years ago in the The New York Times Magazine(“Unexcited? There May Be a Pill For That”). “Men…might not be so happy about the reminder, as their partners reach for the pill bottle, that their women need chemical assistance to want them,” Bergner writes.
Put another way: Her needing to pop a pill could quash the man’s desire, even as it elevates the woman’s.
What might make this easier for couples is the fact that low female desire, like “low T,” have been medicalized. “It’s not you sweetie, it’s my disease,” a woman might offer up as she reaches for her little pink (surely they will be pink, just as Viagra is blue) pill. And if we can agree on anything here, it’s that pharmaceutical companies capitalize on this and will, at some point, medicalize absolutely everything: If Restless Leg Syndrome gets a drug, why not low female desire?
And so the discussion — and this blog post — circles back on itself, alternatively arguing for and against a drug to treat a disease that might not be a disease at all. And it comes to rest on the question no one can answer: what do women want?
Instead of attempting to do so, I offer this little story. A few weeks ago, a long-married colleague told me about what will sound like the smallest of good deeds done by her husband. He arranged to be dropped off at the train station, grabbed her car from the station parking lot and texted her to look for him when she stepped off the train, thereby sparing her a longish walk on a frigid night.
“He got some that night,” my colleague said with a smile. “It was just so kind — kind in a way only someone who knows you well can be kind.”
I’d wager if the way my friend was made to feel could be pressed into a pill, we might be able to solve this thing once and for all. And, perhaps, save a few marriages in the process.
As published on Tue/Night: http://tuenight.com/2015/03/the-new-drug-to-increase-womens-libido-is-no-viagra/