Female Viagra. Now that would be a thing. A pink sibling to the famous blue pill, to magnify the mojo of the fairer sex. Well, female viagra has been invented. More, it's on sale now across the United States. However, in the face of those who claim it a triumph for women and their libidos, critics assert it is a triumph of lobbying: a cynical effort to seam a lucrative new market with a questionable drug.
This new drug posing as female viagra is called flibanserin, but sold as "Addyi". It purports to cure women who suffer from low sexual desire: after centuries of powdered rhino horn and pickled ox penis, this is the first ever government-approved drug designed to conjure libido. Whether it actually achieves this aim is, well, complicated.
In 2010 the US Food and Drug Administration (FDA) deemed the drug no more effective than a placebo. Undeterred, pharmaceutical firm Sprout bought flibanserin and tried again for a licence. This time it was rejected on the grounds that side effects such as dizziness and nausea outweighed the benefits. So what persuaded the FDA to greenlight it last August?
The most obvious answer is a campaign named Even The Score. It was launched last year to assert that the lack of drugs for female sexuality was a feminist issue. That's correct. Not fighting, for example, for the universal right to foreplay, but taking up arms to combat our lack of sex medicine.
"It's time to level the playing field when it comes to the treatment of women's sexual dysfunction," sounded its website. "There are 26 FDA-approved drugs to treat various sexual dysfunctions for men... but still not a single one for women's most common sexual complaint." Some of Even The Score's funds came from Sprout.
The campaign started to gain traction. It also attracted controversy. Its claim that "one in ten women suffers from HSDD" came under fire - when does a withered sex drive tip from being, say, a reasonable reaction to a stressful job and become an actual disorder?
"We need to err on the side of caution in pathologising people's sex lives," says sexual psychologist Glenn Mason. "Many factors impact upon a woman's libido. Rather than a quick fix, it is worth exploring the underlying issues." Interestingly, anyone presenting such factors would not be able to take flibanserin: it can only be prescribed for women in robust mental and physical health. Adds Dr Petra Boynton, "If you don't desire sex or struggle to achieve orgasm, these are increasingly being presented as clinical conditions. Before considering medication people could address masturbation, sex toys or lubricants."
Boynton also voiced fears about the nature of Sprout's campaign. "Sprout has used paid patients to address the FDA in emotional terms, which some of the FDA panel are on record as saying they found difficult to cope with.
"Meanwhile, drug companies have attempted to influence medical education: when Boehringer was developing flibanserin it offered practitioners, including me, training events - where no data was yet available, but where we'd be told about the HSDD - and money to put our names to pre-written articles for doctors to read about the high prevalence of HSDD."
A of organisations led by the Women's Health Network voiced a more specific concern: "The problem with flibanserin is not gender bias at the FDA but the drug itself." Viagra is a simple fix. It is taken only when needed, before sex. It expands arteries in the penis, sending more blood through to give a proud erection. By contrast, flibanserin is taken daily, and affects the balance of neurotransmitters such as serotonin and dopamine in the brain. The side effects persist, putting women who take it at risk of low blood pressure and even loss of consciousness. These can be exacerbated by taking the contraceptive pill or drinking alcohol (oddly, in the alcohol safety test submitted to the FDA, 23 of the 25 participants were men).
However, one of the 11,000 women involved in the trials is delighted by flibanserin - and Sprout readily put me in touch with her. Says Amanda Parrish, 52, from Brentwood, Tennessee, "My husband felt emasculated when I wasn't wanting or initiating sex. I had lost interest in sex and I'd often turn away. During the trial I was suddenly the one who'd suggest we skip dessert to go home. Because I really wanted Ben, he responded differently and we found whole new levels of intimacy."
It's safe to say that women would like more and better sex. And the success of Even The Score points at least to the truth that women are as disappointed by those nights when their bodies refuse to respond as their partners are. But the efficacy of flibanserin is currently opaque, and the facts that are most clear are these. The annual sales of Viagra are around £1.5 billion. Companies have long hoped to market a similar drug for women. Shortly after flibanserin won its licence, Sprout was sold to Canadian pharma giant Valeant for $1bn. For the moment, a bottle of Ruinart, a Henry Miller novel, and an afternoon of admiration leading to a night in a hotel might be a more reliable solution.
Original article published in GQ.com, in December, 2016
