The Flap About Flibanserin

Margie Nichols, Ph.D.by Margie Nichols, Ph.D.

It seems a bit anti-climatic now, since the FDA Advisory Panel decided yesterday to advise against the approval of what was touted as the ‘female Viagra.’ The fact that they turned down approval because they found no convincing evidence that it worked better than placebo didn’t surprise anyone who studies female sexuality.  We know that female desire is a lot more complicated than the ‘plumbing problems’ involved in male erectile dysfunction.  But for a while, when it looked like the drug might actually work, the debates got pretty intense.

On one side, there were feminists warning against the medicationalization of female sexuality and the consequent pressure on women to live up to a male standard. On the other, medical people were trying to prove there really is a ‘disease’ called Hypoactive Sexual Desire Disorder in women, and that this drug is a cure for it.

I find myself in agreement with both sides. Yes, there are grave sociocultural implications to the classifying of a women as ‘diseased’ when for the most part what we are really describing is age taking its inevitable toll on body and mind. And these dangers are at least in part connected with the traditional sexual oppression of women – there are women who will feel pressured by the disease label -and by their male partners – to TAKE a pill when they might not be unhappy with the lowering of desire that often accompanies menopause and perimenopause.  There are plenty of women, we don’t know how many, who don’t care or are even relieved when sex becomes less important to them.

On the other hand, there really are  many women in  genuine distress about their low or sharply decreased sexual desire, who would give anything to have a lusty desire. For these women, a medication that helped would be a blessing.

But I think we could reconcile these positions by taking a different stance about drug use, and by admitting that people, more and more, will want medications for ‘enhancement’ purposes, much like surgery for cosmetic purposes. This has already happened with Viagra and this new drug, if it were deemed effective, has the same potential. If it is shown in future research to work, I’d expect to see Flibanseran as a party drug within a year of approval.

If we could even discuss the merits of medications/”good drugs” used for enhancement, we might be able to give up the pretense that, for example, the desire to increase sexual desire has to be a ‘disease.’ There is a thin line between ‘distress’ and ‘i really really really want this to be different’, and there is a very subjective aspect to many of these ‘disorders.’ Unfortunately, i doubt this conversation can take place in the Prohibitionist mentality of the United States. Not only are Americans suspicious of anything that makes you feel TOO good (hence the term “guilty pleasure”) – if we label something an illness we can get health insurance to pay for it.  And if health insurance pays for it, people will buy more.  So there is very big money involved in labeling ‘Hypoactive Sexual Desire Disorder’ in women a disease.

It’s too bad we are so uptight as a culture about drug use, because if we could have real conversations about how real people use chemicals to enhance mood, appearance, and performance, this practice could be brought into the light of day instead of in the illegal shadows.

Acknowledging the potential usefulness of chemicals for enhancement purposes would bring a host of new issues with it. But it would at least avoid some of the problems inherent in a system where you can’t just invent a drug that would increase female sexual desire, you have to create a disease and a whole category of ‘ill’ people who need ‘treatment’ first.  When a phenomenon is pathologized, people feel pressure to ‘fix it,’ and it becomes impossible to distinguish ‘distress’ from ‘I should want to have sex because I’m told it’s a disease not to want sex.” If a pharmaceutical is developed that DOES increase female sexual desire – why can’t we just admit that some women will want it, some women won’t – and neither group is ‘ill.’

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