Pill-popping Approach To Female Libido

Flibanserin's makers promise help for 'hypoactive sexual desire disorder'. It suits drug companies to medicalise in this way

by Christine Ottery
guardian.co.uk,
Monday 23 November 2009

Before everyone jumps on the hype bandwagon by calling flibanserin a drug recently announced as a solution to female sexual dysfunction "the female Viagra" … oops, it's too late. Last week, flibanserin was hyped as such across the media, the Guardian included.

Let's be clear about this, flibanserin is not like Viagra, and female sexual dysfunction is not like erectile dysfunction. Flibanserin is a drug that was initially tested as an antidepressant. It didn't work but trial participants noticed its aphrodisiac properties. The German pharmaceutical company manufacturing flibanserin, Boehringer Ingelheim, must have had visions of rolling around in euros.

The results of large-scale trials of flibanserin show a slight increase in what Boeringer Ingelheim term "sexually satisfying events", which could be any kind of sex act from masturbation to intercourse deemed to be gratifying by the participant. Self-evaluation is tricky, as sexual satisfaction is highly subjective and notoriously hard to measure. Regardless, the trial found an increase was 0.8 more of these instances per month on average, compared with the placebo group.

Boering say that's statistically significant. Maybe if you're only having a happy kind of sex event 2.8 times a month, as the volunteers were on average, then that extra 0.8 might seem like a sweet deal. But if you were a man taking 100mg of Viagra every day, you might expect more action than an extra couple of events a month. Boering Ingelheim would say this is not a fair comparison as flibanserin treats a condition, and it is not just focused on the actual sex, but even so.

At least it is known how Viagra works. In contrast, it is not exactly known how flibanserin enhances sexual desire. Does it, as Boering Ingelheim hypothesise, work by upping levels of dopamine and norepinephrine neurotransmitters in the brain, which have an aphrodisiac effect, while dampening down the seratonin, which inhibits sexual function?

The reasons for women's lack of libido can be complex, and less is known about the process of female sexual arousal than men's – it isn't just a simple case that sending more blood to the clitoris and labia will turn a woman on.

Women's sex drive can be affected by various factors such as stress, tiredness, self-esteem and body image. There are also medical conditions, including vaginisimus, that can make sex painful, but can be treated. Psychological issues such as depression may also affect a woman's libido, and can also be dealt with therapies.

But according to Boering Ingelheim one in ten women suffer from hypoactive sexual desire disorder (HSDD), which is the most common form of female sexual dysfunction (FSD). HSDD means having very low levels of sexual desire for long durations, and is defined as a psychiatric condition if it causes distress.

One large study from the US into sexual dysfunction concluded that 43% of women suffer from it at some point. However, some are concerned that FSD has been fabricated to monetise women's sexual insecurities. An article in the journal Sexualities posits that the pharmaceutical industry was looking to replicate the £1bn success of Viagra and so introduced the concept of FSD. In PLoS (Public Library of Science), a peer-reviewed science and medicine journal, an article called FSD "a textbook case of disease mongering". Also in PLoS, scientists argue that corporate-sponsored researchers are defining pseudo-diseases.


In Victorian times, female sexuality was judged to warrant repression and clitorectomies; now the trend is for chemical bolstering to keep up with our hypersexualized society. But sex and relationship psychologist Dr Petra Boynton says it is normal for women to experience a lack of desire at some time in their lives.

Boynton also tells me: "Sometimes desire is absent not because a woman is older, or less sexual, but because she's very sexual but can't convey this to a partner."

The disempowering message that women who are having sexual problems are all ill is the bitter irony of the FSD controversy. Relate, a relationship counselling service, says the primary cause of a loss of desire is relationship issues, so feeling empowered to communicate what you want could be crucial in resolving this.

Nevertheless, some women will want a magic bullet solution to their sex life problems. It is a tempting idea in our time-poor lives to pop a pill and not take the time to work out the root cause of issues and address them. The latter could mean talking with our partners, spending more time relaxing or finding a fun new sex toy. Or, if the problems are more serious, seeing a GP or counsellor. When flibanserin comes onto the market in about 18 months, it should be the last port of call for women with problems in their sex lives.