Do we really need female viagra?

shutterstock_177526304Hypoactive sexual desire disorder (HSDD) – lack of female sexual desire – is a controversial condition. Many cite it as an example of ‘disease mongering’ – the widening or construction of diagnoses to expand the market for existing drugs.

How pervasive is sexual dysfunction? A 1999 study sought to find out. It posed seven questions, including: ‘Have you experienced low sexual desire?’ or ‘Failed to find sex pleasurable?’, and an affirmative response to any one of these led to the classification of ‘sexually dysfunctional’. We may laugh at a model that labels 43% of women as sexually dysfunctional, but the study is extremely influential; cited nearly 2300 times since publication.

It emerged that two of its three authors had connections to Pfizer which – having reaped astronomical profits manufacturing Viagra – was preparing to launch an HSDD treatment. Exerting subtle influence on scientific publications was just one approach, along with bankrolling conferences and producing learning resources, pharmaceutical companies took to reclassifying HSDD as a widespread condition in need of a ‘cure’.

Meanwhile, the medical consensus was moving in the opposite direction. In 2013, the Diagnostic and Statistical Manual of Mental Disorders replaced HSDD with a more loosely defined disorder; merging libido and arousal disorders. Sexual desire was less standardised; responsive to individuals’ circumstances. Dr John Bancroft, Director of the Kinsey Institute at Indiana University, warned that “the danger of portraying sexual difficulties as a dysfunction is that it is likely to encourage doctors to prescribe drugs to change sexual function when the attention should be paid to other aspects of the woman’s life.”

Screen Shot 2016-07-01 at 09.28.35Allegedly, the cure for this dysfunction is flibanserin. Originally developed as an antidepressant, flibanserin is not really a ‘female Viagra’. Its precise mechanisms are unknown, although the manufacturer claims that it rebalances the neurotransmitters responsible for sexual excitement. In 2010, UK pharmaceutical company, Boehringer Ingelheim, submitted an early version of flibanserin to the FDA. It was rejected; its risks outweighing its benefits. Boehringer passed the rights to Sprout Pharmaceuticals.

Flibanserin’s clinical trials involved women with HSDD taking flibanserin or a placebo, and counting the number of ‘satisfying sexual events’. The results were disappointing: it increased the number of these events by an average of 0.5 to 1 per month over the placebo, and more women experienced awkward side effects than meaningful benefits. When Sprout submitted flibanserin to the FDA in 2013, it was rejected again. Sprout Pharmaceuticals responded not by adapting flibanserin, but by adapting their strategy.

At first glance, the Even the Score campaign looked like a grassroots organisation of women wanting to ‘even the score’ on sexual function. It was, however, brought together by a Sprout consultant, funded by Sprout and managed by an elite PR firm. No wonder it was so invested in campaigning for flibanserin’s approval. Its main line of argument was centred on the injustice of the FDA approving multiple treatments for male sexual (erectile) dysfunction, but none for women. In framing the FDA’s decision as an issue of sexual politics, Even the Score detracted attention from the questionable efficacy of the drug.

Even the Score boosted flibanserin’s media profile (such as with its spurious #WomenDeserve campaign), and persuaded members of Congress to write to the FDA backing the drug. Their timely activism paid off. In August 2015, flibanserin, marketed as ‘Addyi’, gained qualified approval.

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Unlike Viagra, Addyi comes with strict safety requirements, including complete abstention from alcohol. Addyi costs the same per pill as Viagra, but must be taken daily. For $780 per month, a woman with sexual difficulties may benefit more from therapy, or a romantic weekend away.

Useless and most likely unnecessary, flibanserin only made it to market through persistent manipulation of scientific and public discourse. Rendering lack of sexual desire as a dysfunction narrows the definition of ‘normal’ sexuality, and brushes away the social, psychological and personal roots of the difficulties which need addressing. This only serves the interests of Big Pharma, doubling the size of its market for sexual dysfunction treatments.

Images: pink pill rte.ie; hand starts; sprout forbes.com; addyi, www.ourbodiesourselves.org.

Hilary Lamb is studying for an MSc in Science Communication.

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