Flibanserin Defeated; What Is Accomplished?

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The big news in the world of sex is that Flibanserin, the drug that’s supposed to increase desire in some pre-menopausal women, has been rejected by the federal Food & Drug Administration (FDA).

A group of activists is taking credit for pointing out the drug’s side effects, limited efficacy, and big-ticket marketing campaign. They also criticize the medicalization of female sexuality, accusing drug maker Boehringer-Ingelheim (B-I) of creating a disease where none exists.

Despite clear evidence that the lobbying had no serious impact on the FDA process, these activists are now celebrating, having made the world safe for, um, low desire.

But what’s really been accomplished?

* The further public confusion of desire and arousal. People everywhere are referring to “pink Viagra,” which is a fundamental error.

Viagra addresses arousal, not desire. Flibanserin addresses desire (albeit imperfectly), not arousal.

* Reinforcing the myth that women’s sexuality, especially desire, is more complicated than men’s.

No, no, no. Eroticism in adults is complicated, and it insults both genders to suggest that only women have emotions around sexuality. Professionals don’t understand why men don’t desire women they love any more than we understand why women don’t desire men they love.

Most men are not heartless machines eager to screw anything with a heartbeat, any more than most women are frigid creatures who only acquiesce to sex out of duty.

* Denigrating the idea that some women (and their relationships) really do suffer from low sexual desire even when the emotional and relational conditions are supportive.

It’s accurate, of course, to say that there isn’t a single level of desire that’s “normal.” But women who experience dramatic drops in their desire know there’s something wrong. And isn’t it obvious that one definition of “healthy adult” is the experience of sexual desire when the conditions are right?

* Knocking down the straw man that “women’s sexuality is so simple it can be fixed with a pill.”

C’mon, no one—certainly not the drug company—has suggested this. Flibanserin is proposed for women whose reduced desire can’t be explained by a dozen other factors, including well-known desire killers such as ambivalence about the relationship, sexual trauma, and husbands who don’t bathe.

* * *

While continually repeating that women’s desire is complex (yes, we all received that memo, thanks), the solution proposed by anti-flibanserin activists is both limited and very tired.

1. More conversation among professionals, and between professionals, policy-makers, and the public;
2. A “comprehensive approach” to (female) sexual distress.

Well, more public conversation about sex is good, especially if it’s about the right things (as opposed to, say, deliberate lies about abortion making you sterile or premarital sex making you depressed). But you don’t have to be against flibanserin to favor “more conversation.” Every competent sexologist has been encouraging, and participating in, such conversations for years.

The suggestion of a “comprehensive approach” as if it’s some wonderful and effective new technology is troubling. Western psychologists have known for a century that sexuality is a complex and subtle combination of biological, psychological, and social components. And so all competent therapists use a “comprehensive approach” to sexual issues. And we encourage other therapists to use it as well.

But here’s the unfortunate truth of American psychotherapy, marriage counseling, and clinical sexology: this “comprehensive approach” isn’t nearly as effective as we or our patients would like. In fact, inhibited desire in both men and women is the sexual issue with which therapists have the least success.

Now I come here not to praise Flibanserin—I know its limitations better than most people. But let’s be honest about what’s left after its rejection—the same old “comprehensive approach” that doesn’t work very well.

Besides, there’s something unseemly about activists—self-described feminists, sexual health advocates, whatever—working so hard to prevent a drug from coming to market because its creators might manipulate and confuse possible consumers.

I didn’t hear much about this when Viagra was cooking (actually, I wrote one of the few cautionary articles about this back in 1998). I still don’t hear much about how Viagra exploits people’s over-emphasis on erection as a prerequisite to enjoyable sex. Is that sexism?

And I don’t like the idea that we have to protect women from being told by a drug company that their sexuality is problematic. Women—people—are told every day that their sexuality is problematic, by beer commercials, Cosmo magazine, Dr. Phil, and priests.

Millions of women (and their partners) know their lack of sexual desire causes suffering. Whether taking a drug is the best treatment for any woman isn’t the point. Dismissing B-I’s drug and its marketing as “disease mongering” is terribly disrespectful to the many women who struggle with low desire.

The vociferous righteousness about this drug is terribly reminiscent of the hysteria over other sex-related drugs such as Plan B, RU486, and gardasil. Historically, conservatives have always attacked any technology designed or used to support sexual expression. But getting this resistance from progressives who care about women is new.

So with Flibanserin’s defeat, I don’t want to hear about the “patriarchal drug companies” who are “willing to develop a drug to help men, but cruelly withhold one from women.”

And complaints that the drug would create unrealistic expectations in consumers—doesn’t sex therapy do that, too? Most people don’t realize we do so poorly enhancing our customers’ sexual desire. A typical outcome is that people acquire better communication skills—not more reliable desire.

Fortunately for sex therapists (and the public), no one’s trying to prevent the public from getting access to us. Or demanding data on the effectiveness of our treatments. If people saw our numbers, I don’t think the public would ever trust us again.

And we cost more than a pill—sometimes with side effects that are just as complicated.

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