via Anqa  Flickr Creative Commons

via Anqa
Flickr Creative Commons

What is a normal level of sexual desire? How are our conceptions about appropriate sexual desire shaped by culture? By gender norms? Is pharmaceutical intervention the best method for dealing with low libido? These are among the questions raised early last month, when an advisory committee voted in favor of conditional FDA approvel for the drug Flibanserin, often know as the “female Viagra.” The FDA has rejected Flibanserin twice in the past, citing significant side effects which are believed to outweigh the drug’s potential benefits.

As The Guardian notes, Flibanserin must be taken daily. This makes it different from Viagra, which is taken occasionally, and only in advance of a desired sexual encounter. Viagra isn't acting on the male libido – it's intervening in the physical process of arousal. Additionally, while drugs like Viagra work almost immediately, Flibanserin is similar to antidepressants in that any positive effects might take weeks of daily use to manifest. Moreover, in clinical trials for the drug, women had an average of only one more “satisfying sexual event” per month than women on placebo. Women taking the placebo reported that their sex lives also improved, making some question whether Flibanserin has any quantifiably positive effects.

Negative effects, on the other hand, run rampant. Women taking Flibanserin were more likely than women taking the placebo to experience dizziness, sleepiness, nausea, fatigue and insomnia, and to withdraw from the study as a result. The risk of adverse side effects increases if a woman drinks alcohol, takes oral contraception, or takes any of a number of common medicines, making injuries and next-day driving impairment a concern. Forbes notes that the most worrisome potential side effect of Flibanserin is syncope, or loss of consciousness and posture due to a sudden or substantial drop in blood pressure. Danger of syncope increases when the drug is combined with alcohol, especially in women who don’t regularly drink, and could lead to hospitalization of an otherwise healthy woman.

In exchange for a minimal increase in sexual satisfaction, women taking Flibanserin would have to abstain from alcohol, find alternative means of birth control, and possibly be unable to safely drive a car. Many advocates for women's health continue to question whether the purported benefits of such a drug outweigh the risks. At the June hearing, Flibanserin developers at Sprout Pharmaceuticals noted that after 24 weeks, 46-60% of the women in the trials had benefited from the drug. Some committee members said, however, that after taking the placebo effect into account, the drug helped only roughly 10% of women. Susan Wood, Associate Professor of Health Policy and Director of the Jacobs Institute for Women’s Health at George Washington University, said, “We do not have a product with particularly high efficacy, comes with risks, has to be taken on a daily basis for weeks or months or years, and in my view would be widely marketed off-label, putting women at risk who would see no benefit at all. I think the FDA has made the right decision two times before.” Liz Canner, a filmmaker who produced Orgasm, Inc. a documentary about sexuality and the pharmaceutical industry, warned that Sprout Pharmaceuticals had “deceived women into taking a drug that doesn’t work better than drinking a glass of wine or two, and could end up killing [women].”

Another important question is the cause behind this so-called crisis of low libido in women, and whether it is something which can be cured by any drug. Sexual desire is complex and multi-faceted. “With every new try to market a drug for women’s sexual problems, we have had a new definition of what causes the problem,” said drug safety researcher Dr. Barbara Mintzes, Senior Lecturer at the University of Sydney and former Assistant Professor at the University of British Columbia. Flibanserin was originally developed as an antidepressant, and Mintzes says there is no evidence women with low sexual desire have abnormal brain chemistry. She and others emphasize that the issue of low libido in women is shaped by cultural and social messages about female sexuality. There is worry that drugs like Flibanserin are a means to enforce a sexual “norm” for women which might be unacheivable for many.

It is well-known that some women report loss of libido as a side-effect of taking hormonal birth control. The hormonal fluctuations caused by pregnancy and peri-menopause can also contribute to loss of desire, as well as more intangible triggers like depression or increased stress. Kinsey Institute research fellow and sexologist Prof. Ellen Laan, and Leonore Tiefer, professor of psychiatry at NYU School of Medicine argue that, "No diagnostic test has identified any biological cause - brain, hormone, genital blood flow - for most women's sexual problems," and that low sexual desire in women likely reflects a difference in desire among partners which does not support the 'unmet medical need' theory Sprout Pharmaceuticals has touted.

As this New York Times article suggests, loss of libido in women might even be a direct result of the cultural institution of monogamy itself, or the differing messages men and women receive about appropriate sexuality. “If boys and men tend to take in messages that manhood is defined by sex and power, and those messages encourage them to think about sex often, then those neural networks associated with desire will be regularly activated and will become stronger over time. If women, generally speaking, learn other lessons, that sexual desire and expression are not necessarily positive, and if therefore they don’t think as much about sex, then those same neural networks will be less stimulated and comparatively weak. The more robust the neural pathways of eros, the more prone you are to feel lust at home, even as stimuli dissipate with familiarity and habit.”

Companies like Sprout Pharmaceuticals are attempting to blame the lack of a magic pill to cure female sexual dysfunction on sexism and a lack of equal choices for women. “Any time a drug comes around as the female Viagra, that framing of sexism comes up,” says Amy Allini, Deputy Director of the National Women’s Health Network. NWHN sent a letter to the FDA urging them tonot approve Flibanserin. “[W]hile the Network agrees with Sprout’s assertion that women deserve to have our problems with sex taken seriously, we do not believe that a minimally effective drug that must be taken daily, causes significant side effects and has not been evaluated for long-term safety offers women a serious solution,” the letter reads.

The causes of sexual desire – or loss of it – are multi-faceted. While our consumerist culture may desire a quick-fix, there does not seem to be strong evidence that the “little pink pill,” Flibanserin, has all the answers. Is our culture trying to fit women into a male model of sexual desire? Does the focus on abstinence before marriage lead to marriages plagued by sexual incompatibility, where both partners have a natural level of desire, but their libidos are mis-matched? Are modern women, who still complete the bulk of child-rearing duties and household chores, just too exhausted and stressed to have sex? In the wake of studies showing increased incidents of blood clots in women taking hormonal birth control, it wise to market another daily pill for women whose long-term negative side-effects are still unknown, all in the name of sexual liberation? While it's important to be aware of how insidiously sexism can worm its way into our daily lives, does the pharmaceutical industry really have women's best interests at heart? Until we know the answers to all these questions and more, perhaps Flibanserin is better left off the shelf.

This article was originally published by The Horn on 07/03/2015.

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