Blue is for boys – and Viagra has been giving men a lift since 1998. Now there’s a pink tablet for girls: flibanserin, or “pink Viagra”.
Those whose job it is to market a new drug often find it helpful to invent either a new condition, or at least a new and impressive-sounding name for an old problem. And so it is with the "discovery" of HSDD (Hypoactive Sexual Desire Disorder) in women. I have my reservations about this “new” condition as I’m sure that losing their interest in sex for whatever reason is actually a relatively common situation in women.
A clumsy and selfish partner?
The availability of a pretty pink pill must not distract us from the need to assess sexually “hypoactive” women carefully, to identify the cause and extent of their problem. Some such disorders may indeed be helped by medication, but loss of libido can be due to a wide range of physical medical problems, such as anaemia, which need to be recognised and cleared up. Low libido can also be a side-effect of a number of other drugs, including antidepressants, which affect the levels of serotonin in the brain.
All such problems are however not physical, and a clumsy and a selfish partner, for instance, may also affect a woman’s sex drive. Often it is the partner who needs to learn how to get her “in the mood”, instead of artificially trying get her more excited than the situation deserves. HSDD could be used by either sex as an excuse for a suboptimal sex life, rather than tackling the real issues.
Someone who is juggling a job, house chores and raising children may also be just too exhausted to be interested in recreational sex, and alleviating her burden may be far more helpful than any pharmacological solution. It is important that the availability of a profitable pill doesn’t discourage attention to stumbling blocks in relationships. Medicalising a problem whose causes and cures may lie elsewhere might not, in the long run, benefit women.
Two previous attempts to get the drug registered with the FDA failed because the evidence suggested only moderate effectiveness, coupled with unromantic side-effects like sleepiness, nausea, and dizziness. In 2010, the panel considered it no more useful than a placebo (and an independent panel of experts unanimously advised that it should not be approved), and in 2013 the FDA asked for more safety data.
Have women been left high and dry?
In a smart marketing move, the manufacturers then enlisted the support of some women’s groups, complaining of sexism in the FDA, “which has approved 25 drugs for male impotence since Viagra, but none for women”.
They started an online petition “Even the Score”, with a slogan “Women have waited long enough”, which gathered an unremarkable 40,000 signatures. Of course it would be far more dangerously sexist to rush to approve a drug for women, irrespective of whether it is truly effective and safe, but that was apparently not what was foremost on their minds. We must, of course, not lose sight of the fact that a “female Viagra” would be a goldmine for any pharmaceutical company, and that they’d be very tempted to “push” it, regardless of any reservations.
These campaigns are full of clever exaggerations, and, in fact, the active ingredient of Viagra (phosphodiesterase-5 [PDE-5] inhibitors) does not affect sexual desire in men. Viagra is not a treatment for low desire; it merely improves the blood flow to the penis, and hence a man’s ability to have an erection. The flibanserin campaign is run by a PR company, and the sources of its funding have not been disclosed.
There have been previous failed attempts at producing sex-enhancing drugs for women. Pfizer, who introduced Viagra, tried it in women back in 2004, but without any success. Other companies tried a testosterone skin patch and gel, again without success. It’s also interesting that the American Psychiatric Association doesn’t list hypoactive sexual desire in its manual of significant disorders, viewing it, rather, in combination with low arousal – indicating once again that the problem with low sex drive in women may have more to do with lack of appropriate stimulation than anything medical.
How safe is flibanserin?
There are reasons for concern about potential interactions between Flibanserin and alcohol, which may lead to low blood pressure and fainting.
In August, the FDA approved the marketing and use of the drug, available under the odd name Addyi, and it has recently gone on sale in America. One hopes that the safety concerns that have been raised won’t turn out to be serious, as this is one of the first cases where a drug has been approved due in significant part to a powerfully funded PR campaign.
HSDD in women is a complicated issue. The basic problem is that sexual desire has been lost, impacting on the relationship. Diagnosing HSDD can be severely distressing, but untreated, it may continue for years. And if the cause of HSDD is physical, it is easy for both partners to mistake the biological loss of libido for a loss of love itself.
Precisely how flibanserin works is not clear. What I do know, though, is that, unlike Viagra, it works on neurotransmitters in the brain. It decreases serotonin activity, indirectly increasing available dopamine and noradrenaline, thereby reducing inhibition of libido, as well as stimulating it by other means. It shows its effects gradually over a period of up to 8 weeks.
We must hope that no unexpected harmful effects emerge. The main side-effects, as mentioned have been nausea, sedation and dizziness, and these are reduced by taking the daily dose at bedtime. Most of those experiencing benefits are able to remain on the drug as needed.
As the companies profiting from its sale gained approval by a sly PR campaign, we can expect an extensive ad campaign to sell HSDD, and to persuade women worried about libido issues to go to their doctor and discuss the matter. Already a primitive screening questionnaire on sexual desire is being promoted, though I have doubts about its accuracy and validity, as it seems likely to over-encourage the making of the diagnosis.
Although the results reported may be primarily placebo effect, patients may be satisfied and even happy with the effects. It seems likely to be effective in about half of the women taking it, so some who start may later choose to stop.
If this product is successful, it may encourage further research into understanding problems relating to female libido and better ways of treating them. Maybe they can adopt the song from the Audrey Hepburn movie, Funny Face: “Think Pink!”