When Difference of Desire is Sold As a Deficiency

Why can’t a woman be more like a man? Henry Higgins posed the question in My Fair Lady and ever since Viagra began earning Pfizer more than $US1 billion ($1.2 billion) per year, the big pharmaceutical companies have been asking it, too. Why can’t women’s sexual problems be cured as simply and profitably as men’s?

Now, Boehringer Ingelheim says it can. It claims that a new drug for which it is seeking approval from the US Food and Drug Administration, Flibanserin, improves hypoactive sexual desire disorder, or low libido. The company says the condition affects one in 10 women.

Flibanserin began life as an antidepressant but wasn’t much chop. But during its trials some women reported sexual benefits. Boehringer looked further. It now claims that 50 per cent of women with low desire who take the pill for at least six months say their condition improved.

This outcome compares favourably with results reported for Europe, where trials failed to show any statistically significant benefit for women taking Flibanserin compared with a placebo.

So does the drug work? Who knows? All we’ve got so far is Boehringer’s claims, which has only presented the contradictory findings of its studies – ones it has funded and conducted itself – in the highly abbreviated form of conference abstracts. No independent evaluations of either the drug’s safety or efficacy have been undertaken and no reports of the trials have appeared in journals. But the bigger problem with Flibanserin is that independent experts are unsure that the condition it claims to treat – hypoactive sexual desire disorder – actually exists.

Men want sex often and intensely. Barring erectile problems, their desire leads to arousal and then to orgasm in a nice, linear fashion. Women’s sexual response – and I’m sure I’m not telling you anything here you don’t already know – is more complex.

For women, arousal may be necessary for desire but not sufficient. Sometimes, women won’t want sex until they’ve started having it and many enjoy sex without orgasming. Being desired exclusively seems to be key to female libido, which may explain why relationships initially arouse women but cease to do so as time goes on. Indeed, while men tend to find their partners more desirable over time, women often need a new partner to rekindle desire.

All this raises the obvious question about whether low libido in women is pathological or just evidence that female sexuality is different to men’s? Indeed, even if we accept that marital disharmony resulting from mismatched desires for sex is a problem in need of address, is a pill really the answer? And if it is, why medicate women? Why not give men a drug to settle them down?

The reason seems to be that low libido, as well as other sexual deficiencies, could be big business. If women can be convinced that a pill will solve their problems by restoring what they have lost – the successful paradigm behind the marketing of the change as an estrogen deficiency syndrome for which HRT was required – there is serious money to be made.

Sex, Lies and Pharmaceuticals, a book by Ray Moynihan and Barbara Mintzes due in September, says pharmaceutical companies have a lot to answer for.

“The claim that one in 10 women have a chemical deficit in their brain that causes low desire is an absurd and shameful lie,” Moynihan told me. “The truth is that marketing is the foundation for these disorders. They use marketing to shore them up and make them appear more sold than they are.”

Publication history

When difference of desire is sold as a deficiency  The Sydney Morning Herald