women report losing their desire for sex, some temporarily,
some permanently. Is this a relationship problem, a normal
aspect of life changes or, as the pharmaceutical industry
maintains, an "unmet medical need"? That was the
question under consideration for two days of meetings
recently, during which the Food and Drug Administration heard
from sexual medicine experts and women with sexual complaints.
It was a
rowdy meeting by sedate, scientific standards, and months of
public relations campaigning had preceded it. The
International Society for the Study of Women’s Sexual
Health, which is largely funded by the pharmaceutical
industry, had joined with Sprout Pharmaceuticals and other
companies with skin in the game to develop two slick
campaigns, "eventhescore.org" and "womendeserve.org,"
which argued that the FDA’s failure to approve a drug to
treat women’s sexual problems was "sexist." After
all, men have Viagra and its various relatives.
patients told stories of their frustrations and distress, but
they appeared to have been coached to demand drug solutions.
They acknowledged that their travel expenses to the meeting
had been paid. Wearing matching green scarves and buttons
proclaiming "#WomenDeserve," the women described the
mixed results and side effects of their various off-label
treatments, including implanted testosterone pellets,
testosterone gels and antidepressants. They insisted they had
no nonmedical problems. Their desire had simply "turned
off like a light switch," as one woman said, sometimes as
much as 30 years earlier, and they wanted it back, routine and
professional sexologists and advocates of women’s sexual
rights, we were horrified by the campaigns’ use and abuse of
the language of equality to pressure the FDA to approve a
potential billion-dollar blockbuster "pink Viagra."
The only two drugs for women’s sexual dysfunctions that have
come to the FDA in the 16 years since Viagra was approved were
rejected. One was Sprout’s drug, flibanserin, then owned by
a German company. The drugs for women didn’t work and were
unsafe. That’s not sexism, that’s proper regulation.
campaigns to "even the score" are deceptive for
they repeat the statistic that 43% of American women have a
sexual dysfunction. That number is from a 1994 survey that
asked women whether they had any kind of sexual problem (yes
or no) without asking whether the problem bothered them. The
senior author of the study has said for years that this
statistic is being misused. Independent research has found
that about 10% of women have distressing sexual concerns, most
notably pain or a low desire for sex. Furthermore, many of
these concerns can be remedied without drugs or medical
procedures. But the 43% figure creates a sense of urgency for
a supposed condition that deserves to be treated by a pill.
the campaigns claim that the FDA has approved 26 drugs for
male sexual dysfunction and zero for women. This is nonsense.
The 26 include different versions of similar drugs, and mostly
feature testosterone, which an FDA advisory committee recently
warned is wildly oversold to men for age-related normal
changes, has serious risks and has not been approved for
sexual dysfunction. Yet you will see "26-0" repeated
in the media.
there is absolutely no evidence for womendeserve.org’s claim
that "a biological lack of desire to have sex negatively
impacts 1 in 10 American women." No diagnostic test has
identified any biological cause — brain, hormone, genital
blood flow — for most women’s sexual problems. On the
contrary, abundant evidence shows that low sexual desire in
women typically reflects a difference in desire between two
partners. It is unethical and unscientific to attribute a
couple’s discrepancy in desire to the woman’s biological
deficit. In study after study, women’s response to both test
medications and placebo drugs is high. These repeated findings
do not support the "unmet medical need" theory.
the scientific community regards most sexual problems in
healthy people as related to what is going on in the bedroom,
the relationship, the partners’ individual lives and shifts
in cultural norms. The incentives for sex — or for avoiding
sex — are far more important in understanding a couple’s
issues than one partner’s biology.
pharmaceutical industry were truly concerned with women’s
sexual well-being, companies would market drugs that are
effective for women whose sexual problems are caused by
physical problems or disease, such as diabetes, multiple
sclerosis and spinal cord injuries. Yet efforts to test drugs
for narrow markets have been curtailed on several occasions as
the industry pursued its blockbuster dreams.
partnership between sexologists and drug companies is full of
conflicts of interest and has sullied our field. Fortunately,
judging by their comments at the recent meeting, we are
hopeful that the FDA experts are not being taken in by
ill-advised initiatives. We hope that the public won’t be,
article appeared as an opinion piece in the L.A. Times. Ellen
Laan is an associate professor of sexology at the University
of Amsterdam, the Netherlands, and a Kinsey Institute research
fellow. Leonore Tiefer is a clinical associate professor of
psychiatry at NYU School of Medicine and founder of the New
View Campaign, newviewcampaign.org.)