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Sex, Drugs, and Whose Business Is It Anyway?

Illustration by J.D. King

Maybe it's presumptuous of me to try to write about women's emotions, but here goes.

What started me on this was my reading that the venerable German drug company, one of the top 20 in the world, Boehringer Ingelheim, is preparing a drug to make women want to have sex more often. I know quite well this idea floats through our culture. We had a hugely popular television show like Sex in the City, where grown women acted like fraternity boys; music videos and stars who look and act like the streetwalkers; magazines like Cosmo and Glamour that advise young women about better sex. Many movies have desperate gymnastic sex scenes; many movie stars, men and women, have sculpted their bodies with whole days in the gym, assisted by regimens of steroids. No one who lives a normal life, no man or woman, could possibly measure up. Now we have this notion of a drug that can make life imitate art. The difference between the movies and music and this is that the former are all entertainment. A drug to alter what a human being wants is more serious — it's real.

The drug, called Flibanserin, would be something of a coup for the company because drug regulators, mainly the Federal Drug Administration, have been reluctant to approve final trials for other libido-enhancing drugs for women because the benefits seem to be too meager for the risks and side-effects. But the safety trials for this drug are well under way.

Ever since the drug industry's bonanza from Viagra and its knockoffs, Cialis and Levitra, the treatments for male impotence, the pharmaceutical labs have been working hard to cook up something similar for women of the world. On the men's side of the equation, Pfizer's Viagra, Lilly's Cialis, and Bayer's Levitra sell a combined total of about $4 billion. The drug companies need new sales in the next few years, as patent protection for many of the most popular antidepressants will end.

Flibanserin even shares some of Viagra's heritage. It came out of the lab as a compound that affects the serotonin and dopamine levels in the brain, meaning that it was a potential antidepressant, like Viagra. Its aphrodisiac properties were discovered accidentally during the trials as a depression treatment, which it failed. The series of tests as an aphrodisiac are currently under way. Of course, that's not exactly the way the company and the authorities look at such issues. Before a legal pharmaceutical can be sold, it has to be certified as a treatment for a medical condition.

And it's the American Psychiatric Association to the rescue. The association maintains the Diagnostic and Statistical Manual of Mental Disorders. If your problem is not in this book, you don't have a mental problem. In general, if there is no condition for your drug to treat, it's not a legal drug. It's not enough for a drug to make you feel good. It has to match something in the DSM manual. The fifth edition of the manual is in the works, but the fourth edition has been around for 10 years, and it has the target for Flibanserin: Hypoactive Sexual Desire Disorder. The new edition will combine the Hypoactive disorder with Female Sexual Arousal Disorder into one disorder: Sexual Interest/Arousal Disorder in Women. It's worth a look at what this is. In menu form, to have this disorder, you need to suffer four of these six conditions for at least six months:

Then:

Finally:

Aside from the bizarre record-keeping qualifications, this definition appears to play fast and loose with the notion of being sick. Notice that most of the requirements use the qualifier "reduced" and the big second diagnostic step uses "significant". These are entirely subjective. Who's to say how much desire an individual, man or woman, wants or needs?

This question doesn't trouble Boehringer. Boehringer financed a study of some 65,000 European women and 1 in 10 of them say they experienced "low sexual desire with associated distress." From that point, they checked the nature and severity of the distress and whether or not there was an alternative explanation, roughly using the criteria in the DSM. They even gave the study a cute name: DESIRE — Desire and Its Effects of female Sexuality Including Relationships.

From there, the drug company hired, with unrestricted grants, the New England Research Institutes to conduct a further, long-term study of these women. They call it a registry and will use it to study the long-term consequences of this low-libido syndrome. This sure sounds like a marketing study, and it was greeted with some mixed reviews by experts in academia who study dysfunction. One quoted in the company press release, Sheryl Kingsberg of Case Western Reserve University, said that afflicted women suffer a high degree of guilt and confusion. She said, the study "provides an in-depth look at this under-recognized but distressing condition." On the other side, Petra Boynton of London University complained that it wasn't clear how the questions were asked and that they appeared to be too vague for the yes and no answers indicated. She was troubled by the marketing tone of the study, and even its name, DESIRE. "What we are seeing is a shift towards setting up a lack of desire as a widespread, distressing, clinical condition that requires drug treatment as a first port of call," she said. "Now many women do report dissatisfaction with sex, but that does not mean they are dysfunctional."

An item in Bitch Magazine by Holly Grigg-Spall talked about the cultural backdrop to the news of this developing drug: "I have to admit, after reading some Glamours and Cosmopolitans, I began to feel quite distressed about my apparent abnormal level of sexual desire. It looks to me like if I don't want to do it in the office bathroom on my lunch break, I'm all wrong."

You might remember all the fuss about women's orgasms during the sexual revolution of the 60s. The idea was that traditional male-dominated society demanded that women be sexually passive as part of the overall domination of women. Consequently, they had to seize sexual pleasure as a way to fight back. Jump ahead a couple of decades and you have the business of the G-spot, a locus of sexual pleasure. Women proceeded to look for it, and many failed to find such a thing, feeling somehow deficient because of that. The Glamours and Cosmopolitans were full of articles going on about the G-spot, real or myth. Somehow, the issue is still alive today, in academic publications for sexual medicine. In back to back articles in recent issues of the Journal of Sexual Medicine, researchers cast considerable doubt on the existence of the G-spot. One study focused on female twins and found no evidence for a genetic basis. The other failed to find convincing evidence of a physical manifestation of the legendary spot. They even made ultrasound images of a volunteer couple having sex.

Nonetheless, I think the authors of spam emails have tapped into the same cultural theme. Of course, they are trying to sell black-market Viagra, Cialis and Levitra to men, and they base their pitch on the sexual powers of porn stars. Only slightly less sleazy are the music videos, television shows, ads and movie scenes that grind away in a pretty good imitation of pornography. If the culture conveys an insatiable sexual appetite as the ideal, or worse, the normal, many men and women are going to think they need help. That is what the drug company is betting on.

But maybe the saddest thing about this whole affair is spelled out in the results of the initial trial of Flibanserin by Boehringer. As in all drug studies, the subjects are divided into two groups, one given the drug being tested and the other, a placebo. The test was broken into six 4-week periods. The first was the baseline for comparison's sake.

The Flibanserin group reported an average of 2.8 "sexually satisfying events" in the first 4-week spell. By the end of the test, they achieved 4.5 of the same — more than a 50% increase.

But the placebo group reported an initial average of 2.7 sexually satisfying events over four weeks at the outset of the test, and 3.7 of these by the last period. That's not much less that the real-drug group.

What do we make of the difference? In statistics, the difference is "significant" — highly unlikely to be due strictly to chance. The difference in "events" is less spectacular: about three-quarters of an event. The difference between real live people, then, is simply this: sometimes one extra satisfying event a month — whatever the individual means by that, and sometimes not.

Posted 2 March 2010

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© 2010 Barry Schiffman