Flibanserin, a drug that revs up women’s sex drives, has been battling for five years to get the FDA’s stamp of approval. Some feminists say flibanserin is a victory for women’s rights, but scientists question whether the drug really works.
Alice Mongkongllite / BuzzFeed News
At 45, Amanda Parrish had been divorced for nine years, and spent most of her free time in her hometown of Nashville, Tennessee, running after her four kids. She was, in her words, "your typical Southern Baptist soccer mom who didn't really talk about sex." Then she met Ben.
Ben was a lawyer, also divorced, with two kids from his previous marriage. Their shared experiences in failed marriages made it easy to connect, and they soon were married. Parrish describes the sex during their first few years together as "consistent, active, and awesome."
Then, out of nowhere, came an increasing sexual malaise. "I was one of those ladies who would try to figure out how to go to sleep early," Parrish told BuzzFeed News. "I started to do anything to avoid having sex — and when we did, it felt obligatory."
The issue wasn't physical attraction: Ben was as good looking as ever, and in great shape. And the problem didn't extend to Parrish's enjoyment of sex, since she could still climax. "The issue was getting me started," she said. She felt off, like she'd lost an integral piece of her femininity.
Despite having an otherwise communicative relationship, she avoided talking to Ben about her plummeting sex drive. She didn't even know how to think about it — was there something wrong with her body, or was it all in her head? And was there even a difference?
Afraid of what their waning intimacy might do to an otherwise healthy marriage, Parrish began desperately searching for solutions. She ordered bottles of libido enhancers online, but threw them away after getting "too freaked out" about where they came from. She asked her doctor to write an off-label prescription for testosterone, which has been shown to rev up female sex drives. The hormone shots made her feel physically energized in a way she hadn't felt in years. But her libido remained flat. "It ended up working out better for me in the weight room than the bedroom," Parrish laughed.
Her doctor asked about the obvious culprits: her full-time job, her six kids, the predictable dimming of the post-honeymoon period. But Parrish swore it was something deeper.
Less than a year later, she found herself enrolled in a clinical trial for a new drug called flibanserin, the so-called "female Viagra." That was 2009. In the years since, flibanserin has sparked a national debate over the nature of female sexuality.
Last week, the drug was given its final shot at being approved by the Food and Drug Administration (FDA), after being rejected twice before. If approved, it will be the first drug authorized by the agency to treat sexual dysfunction in women, compared with nine prescription drugs available for men. Its manufacturers have been battling with regulators over whether female sexual desire should be treated with drugs. Can something as elusive as desire boil down to biology?
Low libido is the most common sexual complaint among women — and it's not just Parrish's middle-aged cohort feeling the squeeze.
About 10% of pre-menopausal women in the U.S. are diagnosed with "hypoactive sexual desire disorder" (HSDD), first defined in medical literature roughly 30 years ago.
People with HSDD are uninterested in sex regardless of mood or occasion, capped off with a heavy dose of distress and anxiety over doing the deed. Most importantly, their problem exists in the absence of any other notable culprits — psychiatric problems, for example, or drug side effects, or an inattentive partner.
The biological contributions to female desire are no better understood than the social ones, but they have the advantage of potentially being tweaked with drugs. While a testosterone patch for women was tested in 2004, it never made it to the U.S. market. A handful of other hormonal and non-hormonal drugs owned by small companies are now at various stages of clinical testing.
The drug farthest along in this category, by far, is flibanserin. The drug was originally tested, in 2006, as an antidepressant. It didn't work well as a mood-lifter, but researchers noticed it had an intriguing side effect: Unlike most antidepressants, which squash libido, flibanserin seemed to do the opposite.
So in 2007, the drug's manufacturer, a large German company named Boehringer Ingelheim, remarketed it as a sex-enhancing drug. The company ran two clinical trials in the U.S. and Europe testing the drug on 5,000 premenopausal women, and in 2010, submitted flibanserin's application to the FDA.
If approved, the company knew, this drug could be big. Viagra, after all, had been a blockbuster drug for a decade, prescribed to more than 30 million men across 120 countries and raking in roughly $1.6 billion a year. Viagra works by increasing blood flow to the penis so men can have and maintain hard-ons during sex. Viagra's manufacturer, Pfizer, also tested the drug in women with HSDD to see if — like in men — the female sex impulse could boil down to sheer hydraulics. And though Viagra did increase blood flow and circulation down south, it didn't do anything to actually turn women on.
Although flibanserin is often referred to as the "female Viagra," the drug doesn't work at all like Viagra does. Instead, it has a much more elusive target: the brain. Specifically, flibanserin alters serotonin and dopamine levels to affect the brain circuitry that somehow drives pleasure and desire.
Advocates of flibanserin say that for too long, women's sexual desires have been reduced to social and psychological factors. It's time to stop ignoring female biology, they argue.
"Sex is complex," Cindy Whitehead, CEO of Sprout Pharmaceuticals, the North Carolina company that now owns the drug, told BuzzFeed News. "We bring our religion, how we were raised, and what's going in our lives into the bedroom. But men and women alike bring biology into the bedroom."
But that leads to a sticky scientific question: How do you measure a drug's effects on something so elusive as sexual desire?
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