Holy Hormones Journal: It has been my honor to belong to a prestigious groups of feminist scholars, researchers and academicians who are watching what the pharmaceutical companies are marketing to women. Many of you may be aware of the campaign against the ‘female Viagra” that was waged to prevent the FDA from passing the drug – which twice-failed to get their nod of approval when it was packaged as an antidepressant. The New View Campaign was formed in 2000 as a grassroots network to challenge the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs. They simply ask “Sex for our pleasure or their profit?” And that is what women need to be asking themselves about any drug that is being marketed to “enhance” anything – especially our sex drive.
When this article came through the list-serv, I immediately asked for permission to re-post it. I love feminist writing – and most of you dear readers, have not even been exposed to this type of perception or style of thinking. And yes, this is the very point of view that is missing in history books, and literature. If we were all versed in feminism and knew about the contributions feminist writers and authors have made over the years, our libraries would be filled with books and our reality would be based on concepts and theories that are relevant to our nature – or being – our sense of reality. We would struggle less – and know so much more. A New View is a great feminist book to start changing your perceptions.
Why does “female Viagra” target women’s minds when men’s treatments for sexual dysfunction target their physical performance?
By ALYSON K. SPURGAS
Reprinted with permission from the author.
SINCE the unprecedented success of Viagra in the late 1990’s, pharmaceutical companies have sought to expand the market for sexual dysfunction drugs to women. Several methods were dreamed up and tested in clinical trials, including a testosterone patch, a testosterone patch, a testosterone gel, a hormonal nasal spray, and oral ingestible tablets, but none secured FDA approval until flibanserin, which comes in the form of a pill marketed under the brand name Addyi. The little pink pill was approved in August 2015 to treat “acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women.”
The history of Addyi suggests how profitable pharmaceutical companies expect such a drug could be. In the early 2000s, Boehringer Ingelheim, a German company, owned the patent to flibanserin but sold it to the U.S.-based Sprout Pharmaceuticals for for $20 million. This was after flibanserin was twice denied FDA approval, in 2010 and 2013, both times because its side effects outweighed its benefits. After new clinical trials showed slightly lower side effects, flibanserin was approved, and a much larger Canadian firm, Valeant, bought Sprout Pharmaceuticals in a $1 billion deal. Patients with health insurance will reportedly pay between $30 and $75 a month for flibanserin treatment.
Though Addyi is sometimes called the “pink” or “female” Viagra, how similar are the two drugs really? It turns out that the approaches the two drugs take to sexual dysfunction are entirely different, drawing on very different sets of assumptions about men’s and women’s sexuality. Administering these drugs to patients also means administering a particular theory of sexuality and sexual difference, which has deep roots extending back to the earliest sexology texts of the Victorian era. As much as medicine and science have changed since then, many characterizations of masculinity and femininity have remained the same; this has undoubtedly had an impact on women’s experiences of our sexual self-determination, agency, desire, and pleasure.
From sexology to psychoanalysis to our current biopsychiatric and neuroscience-based explanations and treatments, gender differences have been assumed and discursively reproduced. In early medical textbooks, women were depicted as sexually deviant—the vagina was thought to be an “inverted” penis, and women were framed as constitutionally asexual or, at the very least, as innately lower in sexual desire than men. Female sexuality has also consistently been characterized as complex, complicated, wayward, and peculiar—nothing like the straightforward, potent, goal-oriented, and virile sexuality of men.
Within contemporary sexual medicine and studies of pathology, men are perceived as disproportionately likely to suffer from physiological ailments such as erectile disorder, whereas women are understood as more likely to suffer from psychological blocks to optimal sexual enjoyment. These perceived differences translate into drastically different framings and treatments of sexual dysfunction for men and for women, with broad consequences for both “dysfunctional” and “healthy” populations.
For example, for the first time in the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — the clinical psychologist’s “bible” — diagnoses of sexual hypoactivity are gender-differentiated. The diagnosis of Female Sexual Interest/Arousal Disorder (FSIAD) did away with the older, gender-neutral Hypoactive Sexual Desire Disorder, which has been transmuted into Male Hypoactive Sexual Desire Disorder. FSIAD, which is estimated to affect anywhere from around 10% to more than 25% of premenopausal women, includes “lack of receptivity” to a partner as a criterion; the male counterpart does not. Thus, a woman’s desire to respond to her partner’s sexual advances becomes textually embedded in notions of what is considered “healthy” or “functional” female sexuality.
The FSIAD diagnostic framework itself reflects the purportedly complicated nature of female sexuality. It derives from the “alternative sexual response model” for women first developed as a “woman-centric” “corrective” to the Human Sexual Response Cycle, which is considered the classic model of human sexuality, and was originally posited in 1966 by Masters and Johnson. The Human Sexual Response Cycle offered a linear model of sexual response: in sexually healthy or “normal” individuals, sexual stimulation ought to lead to orgasm. As a response, in the 1990’s, some psychologists began to challenge this model, arguing that it did not accurately fit “the female experience of sex.” Rather than question how well the linear Human Sexual Response Cycle describes sexual experience for everyone, these psychologists designed an alternative model of sexual response for women only, based on a categorically feminine framing of sexual health and pathology. It draws on and perpetuates the notions that women are:
(1) less driven than men by spontaneous or internal sexual needs
(2) more likely than men to engage in cost-benefit analyses of sex, as they consider possible nonsexual rewards or incentives
(3) more likely than men to feel desire only or primarily when “triggered” by an initiating—and tacitly male—partner.
The FSIAD diagnosis builds on the idea that because women are “naturally” less sexual than men, a lack of spontaneous desire in women on its own should not lead to a low-desire diagnosis. Instead, women may be diagnosed with FSIAD because they can’t generate a rational, incentive-based “interest” in sex. A healthy, sexually functional, or normal woman is understood to be rationally receptive and responsive to her partner’s overtures, eventually priming herself to engage in sex with him, bringing her innately low-desiring mind in line with her lubricated and vasocongested body. And the “disordered” women who are unable to respond? Well, now they have Addyi.
Addyi is not only the first sex drug marketed to women; it is the first drug ever to target desire or libido in humans. Whereas Viagra affects physiology—increasing blood flow to the genital region—Addyi affects neurocircuitry. It goes right to the source of the so-called problem: the female brain. Initially formulated as an antidepressant, Addyi works by allowing for more uptake of norepinephrine and dopamine, while decreasing levels of serotonin in the brain. (It is in a different drug class but similar to another antidepressant, Wellbutrin, which is sometimes prescribed to offset the symptoms of low sexual desire and anorgasmia that can result from taking SSRIs like Prozac and Zoloft.)
According to studies conducted prior to FDA approval in 2015, the average number of times a woman taking Addyi experienced “satisfying sexual events” rose from 2.8 to 4.5 times per month. (Women receiving a placebo also experienced an increase in “satisfying sexual events,” from 2.7 to 3.7 times per month.) Many women who took Addyi in the study experienced side effects, including dizziness, nausea, fatigue, sleepiness, insomnia, and dangerously low blood pressure, particularly when combined with alcohol consumption (even just two glasses of wine).
Despite these side effects, many clinicians and practitioners have offered support for the drug, stating that the potential benefits may outweigh the potential harms. But harms to whom? In a New York Times article, Dr. Irwin Goldstein, a sexual specialist based in San Diego, stated that “some women might find the risk of side effects acceptable if their relationships are in jeopardy because of a lack of desire.” According to Dr. Bat Sheva Marcus of the Medical Center for Female Sexuality in New York City, “Drug trials have shown those women who take the drug are more receptive to sexual stimulation and have more satisfying sexual activities.” Such comments suggest this drug is less for a woman suffering from her own lack of desire than for her purportedly more virile and desiring partner, who is also presumably male in this context. Here, these doctors are prescribing the very cost-benefit analyses that women are thought to “biologically” engage in when it comes to sex. But why is it assumed that what women should desire most is to make their partners happy? Why is women’s own sexual desire so sorely lacking from this representation?
More troublingly, financial stakeholders have tried to advance these questionable treatments on the grounds that they are “feminist.” For instance, a “patient advocacy” campaign funded by Sprout called Even the Score sought to pressure the FDA to approve a sexual dysfunction drug for women, arguing that its prior reticence to do so constituted blatant sexism. The campaign, which includes groups such as the National Organization for Women (NOW) and a variety of so-called “women’s health” groups who received grants and other funding incentives from Sprout, released a short “thank you” video after Addyi was approved, expressing gratitude to the FDA for finally moving beyond its “sexist” ways. In this short clip, a man quips that Addyi might give “new meaning to his four-hour erection.” His blonde female partner responds, “I know what to do with it!”
The video ends with an image of a “Treatment Score Board,” with the text “Men = 26, Women = 1.” This disparity is meant to convey the pervasive lack of concern for women’s sexual problems (and a small supposed “win” for some variant of gender equality in regards to pharmacological treatments for these problems). But that’s a false equivalence. Of the 26 treatments for men (really three primary drugs and 23 slight variations on them) none affect neurochemistry or attempt to influence sexual desire. They simply target men’s ability to maintain an erection. They are taken on an as-needed basis, when this very visible symbol of sexual readiness is absent. Addyi, by contrast, targets women’s brain chemistry. But are chemical imbalances the real reason behind any given woman’s low desire? Desire—for all sexes and genders—is more complicated than something as easily detectable as an erection. What if desire is actually so subjective and relational that it is impossible to isolate in the neurotransmitters of a single individual?
How we assess sexual problems and treatments — and how we know whether a treatment is working — depends on what kind of sex is regarded as optimal. This is a sociological question, and such researchers as Carol Vance, Deborah Tolman, Michelle Fine, and Meika Loe have examined the psychosocial, cultural, and political factors that affect desire and pleasure—and which produce gender differences in these experiences—for some time. But the pharmaceutical companies and even the psychologists running these companies’ drug trials tend to neglect this work and operate under unexamined, heteronormative assumptions about what sorts of sex women and men should engage in.
This essay was adapted from this previous published post. Sexual desire is not divorced from the domain of the political: how we have sex, with whom, and with what technologies (including drugs and other treatments) are all political choices. Even more than women’s desire, it seems that women’s pleasure has been almost forcibly shut out of the clinic and the bedroom in too many times and places, or negated in lieu of someone’s else pleasure. If we really cared about women, we’d focus more on their pleasure and try to dismantle some of the barriers to pleasure that women experience so regularly in our world—including gendered harassment and violence, low pay, and antiquated divisions of labor, including the disproportionate burdens of carework and emotional tending that women are expected to provide. Maybe we’d stop thinking about how to make women more receptive and reassuring to men and more about how to put women’s desires and pleasures front and center. There are many trajectories to that place of pleasure — if “sexual” pleasure is what we choose to pursue. If taking a drug will make women feel the desire that they desire to have, then, by all means, we should have it! But let’s not pretend we’ve come a long way, just because we now have a little pink pill to match his little blue pill.