Viewpoint: Drugs to Boost Female Sex Drive: That’s a Good Thing, Right?

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In the past, women who lacked sexual desire were stigmatized as “frigid” — today, psychiatry’s diagnostic manual labels them with hypoactive-sexual-desire disorder. Big Pharma is betting that many such women will want to take a drug to rev up their sex lives, but is that a good idea?

Ethicists and feminists are concerned that the emergence a drug that can amp up female sexual longings may have lasting effects on the very nature of female desire. Male-sexual-enhancement drugs, you see, are about shoring up the plumbing — improving blood flow to the penis — while research so far suggests that most women need more than mere physical arousal to get in the mood. To stoke female desire with pharmacology, then, you need to get into the brain. And that, understandably, makes some people nervous. While I share some of those worries, I believe we’ll nonetheless soon be faced with a variety of such drugs — and need to address the way we view and regulate them rather than trying to turn back the tide.

In this week’s New York Times Magazine, author Daniel Bergner chronicles the lives of some participants in clinical trials of two new drugs aimed at relighting women’s fires. He writes:

The promise of Lybrido and of a similar medication called Lybridos … or of whatever chemical finally wins the race for F.D.A. [Food and Drug Administration] approval, is that it will be possible to take a next step, to give women the power to switch on lust, to free desire from the obstacles that get in its way. “Female Viagra” is the way drugs like Lybrido and Lybridos tend to be discussed. But this is a misconception. Viagra meddles with the arteries; it causes physical shifts that allow the penis to rise. A female-desire drug would be something else. It would adjust the primal and executive regions of the brain. It would reach into the psyche.

In fact, Lybrido is actually a combination of Viagra (sildenafil) and testosterone. Just as they do in men, Viagra sends blood to the organs of arousal and testosterone can increase lust. The second drug, Lybridos, combines testosterone with buspirone, an antianxiety drug that lowers serotonin levels briefly. That may help because elevated serotonin can interfere with sex drive, which is why SSRI antidepressants like Prozac can kill desire.

With millions of American women taking antidepressants — and with dampened sexual desire a common experience in aging and in long-term relationships — pharmaceutical companies see room for blockbusters. I certainly wouldn’t mind having the option, if I needed such a pill.

But some feminists anticipate that the marketing of these drugs will pathologize normal losses of desire and make women feel as though we need a pill to please our partners when in fact, low desire may result from stress or relationship problems that should be addressed in other ways. Men have already felt such pressures, thanks to Viagra and similar drugs that imply anything but a constant ability to turn on arousal is worthy of medical treatment. The same pathologization of normalcy appears in a completely different environment — intensely competitive academic programs — where some students feel they must take stimulants just to keep up.

Leonore Tiefer, associate professor of psychiatry at New York University, is so concerned about the potential misuse of female-sexual-desire drugs that she founded an organization, the New View Campaign, back in 2000, to address calls for a “female Viagra” that arose after the drug was first approved for men in 1998.

In an essay for the scientific journal PLoS Medicine, she called the selling of drugs for female sexual dysfunction “a textbook case” of “disease mongering,” or creating and selling a disorder simply to market a medication for it. Just as pharma rebranded impotence as “erectile dysfunction” to sell Viagra, Tiefer fears it will label a large chunk of normal female sexual experience as a disease to be medicated away for profit.

However, if pharma wants to develop and sell a drug, it needs a disease for the drug to treat. Because in the U.S., it’s increasingly difficult, and in many cases illegal, to sell them otherwise. With a few exceptions like alcohol, caffeine and cigarettes, Western societies have decided that using drugs to change your mind or mood is only acceptable if you agree to be labeled — as some sort of patient. And in the absence of alternatives, many see this medicalization as a fair bargain.

(MORE: The Dangers Lurking in Male-Sexual Supplements)

But this leads to massive overdiagnosis of conditions like ADHD as people seek to use stimulants to enhance performance. And the failure to regulate “lifestyle drugs” has also created the crazed market in so-called legal highs, where analogues of the active ingredients in drugs like marijuana and methamphetamine are sold before authorities can make them illegal. This cat-and-mouse game makes consumers who want to get high but stay (at least technically) on the right side of the law into human guinea pigs, taking ever-newer drugs, some of which have never been tested first in animals.

Moreover, as I recently reported, so-called natural health supplements sold for male-sexual enhancement, which are far less regulated than pharmaceutical products, frequently turn out to contain counterfeit versions of drugs like Viagra or even analogues of such drugs — again, often without prior testing for safety and efficacy. The deaths and psychoses associated with these unsafe supplements and with legal highs like “bath salts” are unlikely to end any time soon — in fact, they are likely to escalate.

All that said, our increased understanding of neuroscience, our massively globalized markets and the anonymity of the Internet make the eventual availability of female-desire drugs almost inevitable. The question is, Will we make them legal and safe — and require the marketing and labeling of low desire as a disease — or will we recognize that we need a new system of regulation to address nonmedical drugs?

(MORE: Outlawing ‘Legal Highs:’ Can Emergency Bans Hinder Drug Development?)

The current system of turning normal behavior into diseases and allowing pharma to market them — while relegating everyone else to an illegal market — is not sustainable. When pharma discovers a drug that, say, turns off nonmonogamous desires, will we make adultery into a disease — or will we make the drug illegal? Will we make normal IQ a disorder if we discover a drug to raise it — or clamp down on people who are trying to make themselves smarter and send them to prison? The questions raised by drugs that change what we want to want or alter our intelligence make their regulation an extremely difficult challenge — but one we can no longer afford to ignore.