Katy Fulfer addresses concerns about the approval of “female Viagra”

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On June 5 a panel at the US Food and Drug Administration (FDA) recommended approval for a “female Viagra” pill in an 18-6 vote for cisgendered women. My first thoughts were: “It’s about time!” and “Why does the pill have to be pink?” The FDA will make a final decision about whether to approve the drug, flibanserin, by the end of the summer. This vote seemed to me to be good news because women’s sexuality, if acknowledged at all, often takes a backseat to men’s. Viagra (sildenafil) has been on the market since 1998. Sprout Pharmaceuticals, the manufacturer of “female Viagra” (flibanserin), market themselves as being after “meaningful breakthroughs for women,” and is led by a woman CEO, Cindy Whitehead. Two previous applications to approve flibanserin were turned down by the FDA, and prompted a response by Sprout Pharmaceuticals with a campaign alleging that the FDA’s decision was sexist. (See here for an argument why such claims about sexism miss the FDA’s problem with the drug—its safety and efficacy.)

But maybe my initial optimism about the little pink pill was misguided. The name “female Viagra” strikes me as misleading. Although flibanserin, like sildenafil, is designed to treat sexual dysfunction, the two drugs are quite different. Flibanserin, an antidepressant, seeks to balance cisgendered women’s brain chemistry in a way that is correlated with sexual desire. Dopamine and norepinephrine are increased, and serotonin decreased. Sildenafil, on the other hand, treats erectile dysfunction.

Sandro Botticelli, The Birth of Venus (c.1486)

This difference raises a question about what counts as “sexual dysfunction” or as “sexual desire.” The case of erectile dysfunction seems relatively clear. But sexual desire, the target of flibanserin, is difficult to pin down. Some skeptics doubt that flibanserin treats a legitimate condition. Its manufacturers say it aims at treating hypoactive sexual desire disorder. But this condition was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V). It was merged with another condition and is now referred to as “female sexual interest/arousal disorder,” a diagnosis characterized by low sexual desire or arousal, causing “clinically significant distress” that is not better explained by other factors, such as “severe relationship distress.” Further, while sexual desire is typically understood to occur spontaneously—and arise prior to stimulation—emerging research suggests that sexual desire may also be responsive in some people, meaning that it follows rather than precedes stimulation.

Other critics argue that flibanserin may be another case of over-simplifying women’s sexuality and over-medicalizing women’s bodies. Still others are concerned that Sprout Pharmaceuticals has not provided enough information about the potential side effects of flibanserin (such as dizziness, fainting, and nausea) and the drug’s interaction with other substances such as other prescription medication, oral contraception, or alcohol.

Martha Kempner argues for a middle ground: If the medication is proven to be safe and efficacious (even minimally), trust women about their experiences of sexual desire to make good decisions for themselves and their relationships. Kempner urges, “If a drug can help a woman want and enjoy sex again, that is not in of itself a bad thing. It seems almost cruel to deny her pharmaceutical relief on the grounds that she’s a victim of society’s unrealistic expectations about female sexual desire. It is dismissive to suggest that her feelings on the issue are not at all her own. And it is demeaning to suggest that a woman didn’t notice her lack of sexual desire until drug companies came along with a solution.”

In an interview on NPR, Carla Price shares that her low sexual desire was a point of tension in her marriage. Although Price had no serious health issues or stress factors and reports that “she’s still totally crazy about her husband,” she also admits that her husband took her low sex drive to be an indication that she did not love him any longer and that perhaps divorce was the best option for them.

When I listen to Price’s story, I am moved to accept that flibanserin may be a good option for some women. However, the concern about the over-medicalization of women’s sexual health re-emerges. I can imagine a story similar to Price’s but with a more sinister twist: If a woman is deemed “sick” or “diseased” for having an “abnormal” sexual desire, it may be taken as a justification for a partner to pressure her to take flibanserin. A “disorder” may be taken to be the cause of a bad relationship instead of social factors. I’m all for options that affirm women’s sexual agency. But a pill alone cannot do the work of addressing social problems that render women’s sexuality as homogenous or as untouched by the patriarchal societies in which we live. One reader comment seems to say it best: “If someone could invent a pill that would get my SO [significant other] to help more around the house, that would improve BOTH our sex lives.”

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Katy Fulfer is a Professor in the Women’s and Gender Studies Program and the Department of Philosophy & Religious Studies at Hood College. @katyfulfer