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Can't Talk | October 18, 2019

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It’s Not Called Female Viagra!

It’s Not Called Female Viagra!
Andrew

A Food and Drug Administration advisory panel recommended the approval of flibanserin in June. You may not recognize the name since it is difficult to pronounce, and whenever it’s been discussed in the media it is commonly referred to as “Female Viagra,” a drug designed to “Treat Hypoactive Sexual Desire Disorder in women.” Let us be clear though: Flibanserin is not Viagra.

Viagra was originally developed as a vasodilator to treat heart conditions in men and women. It only became famous when it became the great penis pill that allowed men with prostate problems (or other causes of erectile dysfunction) to get stiff again. Making men happy everywhere and the people at Pfizer even more wealthy than they were before. I make this distinction with Viagra because it does absolutely nothing to boost low sexual desire in otherwise healthy men. All it does is fix blood flow problems; sexual desire isn’t necessary for a man to become erect.

So, Andrew, what is your problem with the term “Female Viagra”? Well, it has to do with how each drug works in the human body, the implications that it can have on how people perceive sexuality, and the distinction of how sexuality is already perceived differently between men and women. This new drug does little to change those stereotypes. I am not doctor, a pharmacologist, chemist, or even a health care professional. What I write here is my opinion based on my personal experience with some of the medications that I will mention as well as secondhand knowledge after consulting with both my personal physician and pharmacist.

Let’s talk about the media label firs, and why it is poor use of language and could lead to many misconceptions about flibanserin. First, Viagra works on the body; it has physical and visible effects. A man gets an erection after the blood vessels expand as a result of taking the “Little Blue Pill.” Flibanserin has no effect on blood flow and will not produce any physical effects (and it takes weeks, not hours, to take effect). What flibanserin does is affect the neurotransmitter levels in the brain. It builds up over a period of three to six weeks for any significant change. Viagra you take once, when you need it, and has no effect on brain chemistry. Viagra works on a man’s body; flibanserin works on a woman’s mind.

Clearly we are talking about two very different drugs that do two very different things and share only the similarity that they are used to treat a sexual dysfunction. Also, there is a further distinction that can be inferred through the marketing of these drugs—the implication is that sexual dysfunction in men is a physical problem and sexual disfunction in women is a mental problem. In fact, flibanserin was first developed as an antidepressant. This is where I start seeing problems in how people perceive sexual differences between men and women. Men don’t have problems with desire; it’s all hardware. Women don’t have hardware problems; they have a lack of desire.

This isn’t to say that there aren’t women who have had great sex lives and then experience a change in desire levels. While there are hormone therapies to help with this, there are significant and dangerous side effects in long-term hormone treatments. If this drug does work the way it is being touted to, it could be a significant improvement in the lives of these women. However, the idea that an antidepressant has the ability to increase sexual desire when a quick Google search of common side effects of antidepressants includes “loss of sexual desire and other sexual problems” is confusing. In fact, here’s the Web MD article that discusses it and coping with those problems.

So where does this leave flibanserin? There were concerns on the panel that recommended approval that 18 months wasn’t long enough to assess risks on a multitude of issues, including cancer risks and interactions with other drugs. There were also concerns that the numbers were off; after 24 weeks the reported 46-60 percent of women that benefited from flibanserin was, when considered with placebo effects, closer to 10 percent. While it has been recommended for approval, there are many issues that may result in the FDA rejecting it when it gets to that step in the process. I don’t think this is a bad thing.

I feel that women need to have equal access to medication to treat sexual dysfunction; however, I think that it needs to be better, and I think that there needs to be more work done to determine causes of sexual dysfunction before any pharmaceutical company can properly address it. Sexual desire in people is complicated, and not having any does not, in my mind, equal dysfunction. Let’s not erase asexual people. A loss of existing desire could have many causes and tossing pills at the problem hoping that one of them will stick isn’t the answer either. More time, more studies, and better understanding of how sexual desire works are the best solutions, as sexuality is as unique as the individual.

Yes, there are more than 20 sexual dysfunction drugs for men and zero for women, but the common aspect in all of those is that they do not affect desire, just plumbing. They don’t assume that there is something wrong with the mind, just the body.  What needs to be determined first is why is there a lack of sexual desire in the patient, then doctors should treat the causes. I am not trying to discount women who have lost existing sexual desire or in any way marginalize their problems, I just want it done right. We already treat women poorly enough in society without compounding it by suggesting that whatever the issue they are having are all in their head. It wasn’t all that long ago when women could be dismissed as having “female hysteria” to explain away all kinds of real problems.

A loss of sexual desire is a real condition that affects real women in so far as there is documentation and studies that call it a disease. It even has a fancy name: hyposexual desire disorder. A quick Google search will lead you to a short “Psychology Today” article saying it is a predominantly female disease. I wondered why this disorder is being addressed by psychologists, so another Google search led me to the Wikipedia entry that also calls it a mental disorder. Why is a lack of sexual desire in women a mental health issue? Why is it whenever we discuss sex, if it doesn’t fall into heterosexual norms, it is something wrong with the brain?

This article was supposed to be about drug regulation and the correct labeling of a drug in media as to not to confuse the public, but the more I look into it the more I grow concerned about erasing asexuality or gaining more control over a woman’s sexual identity than figuring out if there is a problem to begin with. Women losing sexual desire is a real problem for many, and there could be a multitude of causes each as different as the woman experiencing the loss. So shouldn’t the cause of the problem be better understood before we pathologize it and start treating it with more medication? Is the cause of the distress that is being felt by these women a symptom of society’s views on sexuality and a lack of education and understanding of human sexuality? Shame surrounding sexual behavior continues to be the norm and sexual education in America is a giant mess, which could make understanding what is going on a major hurdle for individuals who suffer from this lack of desire. Perhaps if it is a psychological issue time spent with a clinician rather than medication could be just as good a solution.

Perhaps what I am trying to say is this: Sexuality is complicated, and we learn more about it all the time. Medication can certainly help these women but the question should be is it necessary? Can anything else help? Better sexual education, therapy, better communication with their partners? There may be other options, but it doesn’t seem that any of them are being explored, and I have spent two months trying to find out using everything from Google to speaking with my personal physician. This is an important issue. Something needs to be done. I just want it to be done responsibly.

 

Addendum: Since the writing of this article the FDA has approved flibanserin for use in the treatment of Hypoactive Sexual Desire Disorder under the trade name Addyi. In an interview with International Business Times the CEO of Sprout Pharmaceuticals dismisses concerns that interaction with alcohol; while I’ve linked the entire interview this excerpt is something of a concern of mine.

Excerpt from IBT interview of Cindy Whitehead CEO Sprout Pharmaceuticals

Excerpt from IBT interview of Cindy Whitehead CEO Sprout Pharmaceuticals

Had I been the interviewer my follow up question would have been: “Why was there so little interest from women in the study if this drug is specifically designed for them?” Also: “Why were men a part of the study at all?” And finally “Were the male subjects of the study also suffering from HSDD, and if so did the drug have any effect on them?” While I can’t fault a business journalist for not following up on what were medical questions I have to wonder if these questions have been posed by the FDA and what the answers were. I do hope that in 18 months, when the advertising campaign starts up, there is sufficient education provided by the 10 minute company-created course that people who do consult their doctor about Addyi are given good information and that when Addyi is being advertised it’s not called Female Viagra.

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