The Controversy Over The Pill For Female Libido: How Much Desire Is Enough But Not Too Much?

Margie Nichols, Ph.D.by Margie Nichols   

Daniel Bergner’s new book, ‘What Do Women Want?’, is getting a lot of attention, with glowing reviews on Salon.com and the cover of a recent  New York Times  Sunday Book Review section.  Not all reviews have been positive, but it’s pretty clear his book has shaken up some people.  One take-home message from the book that has been discussed at length is Bergner’s suggestion that women are less suited for monogamy than men.

But perhaps the aspect of the book most blogged about is the attempts to develop a drug that will increase a woman’s desire – but not too much.   Bergner writes that the pharmaceutical companies   are afraid of a drug that is ‘too good,’ one that would presumably  turn women into crazed sex maniacs.  It should not come as a surprise to anyone either that this is most newsworthy – it was the section of Bergner’s book made into a Sunday Times  article at the beginning of June,2013,  and it does smack of social manipulation through science.  And it certainly shouldn’t surprise anyone that Big Pharma, ever eager to spin their efforts as serious, addressing a ‘medical problem,’ fears the bad publicity that would come from ‘Girls Gone Wild.’

What is surprising to me is that everyone assumes that this would be the outcome of such a pill’s release on the market, assuming that one is developed that is both effective and safe.  Few commentators have noticed that this worry accompanied the discovery of Viagra, as well.  What are the chances Viagra would become a ‘party drug,’ or that it would disrupt marriages because of husbands demanding more sex from their wives? Well, the former of course has come to be – there is widespread use of the PDE5 Inhibitors by 20 something men – but hasn’t really hurt Viagra’s image.   As for  the latter, undoubtedly this has happened in some marriages but it doesn’t appear to be a big trend.

What has happened that is unexpected is the rate at which these drugs are ineffective –for about 30% of the men who try them – the number who develop side effects- 15% or more have headaches, for example – and the low rate of compliance for the PDE-5 Inhibitors, which some studies place at 50%.  In other words, there are a lot of men for whom they don’t work or who discontinue use either because of side effects, high price, or unknown reasons. Viagra-like drugs have not caused an upsurge in aggressive male sexual behavior or a dramatic increase in sexual partners or sexual behavior.

Why wouldn’t these numbers be even higher for a female libido drug?  The side effect numbers might be no different, but how about the percentage who discontinue for unknown reasons or decline to use it at all?  Remember PDE5 inhibitors just mess with the plumbing – the men, presumably, already have sufficient desire and sexual stimulation. But desire, perhaps especially female desire, is a trickier issue.    The women Bergner interviewed who were part of the drug studies were highly motivated to regain desire.   For them, it might be true that a drug that would help rekindle lust for their husbands would be a godsend.  But how about more complicated situations?  How many women will decide that they just don’t care enough about their husbands to try to regain desire?  How many will take the drug once and realize that even when they are lust-driven – it’s not for their partner?  How many others will find that their increased desire upsets the balance of the relationship – perhaps the partner was hiding their own lack of interest behind that of their mate?

Beyond that, how will women experience this drug?  After all, it will undoubtedly be tinkering with the brain, not the genitals.  Will women have the experience that some have on antidepressants – that the drug makes them feel ‘better than good’ and thus unnatural, not authentic? It will be especially interesting to see if women, straight, bi , or gay, use this drug as a party drug in the same way that many men, especially gay men, use Viagra.  I have uncomfortable inklings of women using it, not to enhance their own experience, but to be more appealing to prospective male partners.

What seems certain is that the drug is coming.  And that it will have not only side effects, but also personal, relationship, and even social consequences we might not even be able to imagine now.  Let’s hope the good outweighs the bad, on balance.

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