Op-Ed: The real problem with ‘pink Viagra’

The drug has many names: flibanserin, Addyi, Ectris, Girosa or, colloquially, “pink Viagra.” Whatever you want to call the long-in-the-making libido pill for women, it recently gained FDA approval despite “serious, serious safety concerns” and benefits that are “modest, maybe less than modest.” But as a science-driven sex educator, I am less troubled by the risk of low blood pressure and fainting than I am by the drug maker’s reinforcement of an outdated, scientifically invalid model of sexual desire.

The supposed problem that flibanserin helps women solve is an absence of spontaneous, out-of-nowhere desire. Here’s how one participant in the flibanserin drug trials described her difficulty: “Once I started, it wasn’t an issue. It was getting me started.”

“I hate having to ‘wind myself up’ to do it,” said another participant, “It makes me feel broken.”

Like many women, the two flibanserin Guinea pigs were taught to believe that if they don’t experience a “craving” sensation, there must be something wrong with them. But that’s simply not true.

Research over the last 20 years has found that there is another totally legitimate way to experience desire. It is called responsive desire, because it emerges in response to pleasure, whereas spontaneous desire emerges in anticipation of pleasure.

Sex therapist Christine Hyde teaches her clients about responsive desire with this analogy:

Suppose you accept a friend’s invitation to a party, and then as the party approaches you think, “We have to find a babysitter, there will be so much traffic,” and you don’t want to go. But because you promised your friend, you go anyway. And you have a great time at the party! If you’re having fun at the party, you’re doing it right, Hyde says.

Spontaneous desire is not an essential component of sexual well-being. Pleasure is an essential component — having fun at the party — and what the research tells us is that responsive desire is not associated with arousal difficulties, problems with orgasm or any other dysfunction.

Most people experience both spontaneous and responsive desire at different times in their lives, though researchers don’t have universally accepted numbers of how many people experience either. Responsive desire isn’t worse than spontaneous desire, it’s just different.

Yet Sprout, the company that owned flibanserin at the time of its approval, appears, shockingly, not to realize that a little “winding up” is perfectly normal, and that it’s — therefore — been treating healthy women.

During an FDA hearing, one panelist asked why women in the study were having, on average, two or three “sexually satisfying events” per month before the trial began. If they lacked desire, asked the panelist, why were they having any sex? A Sprout presenter answered, “Once they engage in activity, it’s pleasurable.”

Which is a tidy definition of responsive desire.

The FDA’s analysis of the data showed that only about 10% of the research participants taking flibanserin experienced “at least minimal improvement,” while the remaining 90% experienced nothing at all.

This is a drug with such potentially serious side effects that the FDA is requiring special training and certification before providers can prescribe it.

And the “disorder” it treats (or, 90% of the time, fails to treat) isn’t a disorder at all but a normal, healthy variation in human sexual response.

The pharmaceutical industry has millions — billions? — of dollars riding on all of us, including our doctors, ignoring 21st century science and reverting to a model of sexual desire that made really good sense in 1977. I think women deserve better.

Emily Nagoski has a doctorate in health behavior with a doctoral concentration in human sexuality from Indiana University. She is the author of “Come As You Are: The Surprising New Science That Will Transform Your Sex Life.”

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