Why Don't We Have a Female Version of Viagra Yet?

Photo via Flickr user Arbyreed

According to a National Center for Health Statistics report, women are two and a half times as likely as men to be prescribed an antidepressant. I am one such woman, so my doctor gave me SSRIs, which unfortunately caused an array of sexual side effects, the most annoying of which was that I had a tough time reaching orgasm.

So, as they say on TV, I talked to my doctor about Viagra. Instead, he prescribed me Cialis, warning me never to take the drug with poppers because amyl nitrites and boner pills mix poorly. At first, the medication sounded like a dream solution to my problems. Cialis lasts in your bloodstream longer than competitors like Viagra, which, in theory, means if you take it Friday night, you’ll still be good to go by the time you want to have morning sex on Saturday. But the Cialis hit me the wrong way: I spent the weekend with a migraine and flu-like symptoms on my bathroom floor throwing up.

After the drug had worked its way out of my body and I was able to resume normal sexual activity, I wondered why as a woman I had to try a penis pill in the first place. There are plenty of erectile-dysfunction medications on the market, but zero that treat sexual dysfunction in women. What's the deal with that?

A company called Sprout Pharmaceuticals has been developing a pill, Flibanserin, to fight what's called Hypoactive Sexual Desire Disorder (HSDD), for years now, but its facing several roadblocks. For one thing, HSDD is no longer listed in the DSM-5, which means it doesn't technically exist according to the medical establishment. (Flibanserin fans believe it could possibly treat what's called Female Sexual Interest/Arousal Disorder as well—as that condition's name suggests, that's when women don't want sex or don't like sex when they have it.)

The other difficulty facing Flibanserin is that the FDA has declined to approve the drug, a decision that Sprout President and COO Cindy Whitehead has implied is because of sexism.

“One in ten women suffer from HSDD, and to this day they don’t have a single medical treatment,” she told me. “Sexual dysfunction is actually more common in women than it is in men and it can take a variety of different forms. It can be arousal, it can be orgasm, or it can be pain disorders. By far the most common sexual dysfunction in women is low sexual desire and that affects about a third of women.”

According to Sprout, the German company Boehringer Ingelheim discovered the drug 12 years ago. It was originally studied as an antidepressant until the drug’s potential as a sexual stimulant was discovered—just as researchers once thought of Viagra as a potential cardiovascular medicine until someone noticed it had the odd side effect of giving subjects rock-hard erections. Unlike erectile dysfunction medications, which send blood directly to the sex organ, Flibanserin works on the brain, Whitehead told me. Many antidepressants can decrease your libido by changing how the brain absorbs the neurotransmitter serotonin; Flibanserin essentially reverses that effect.

The medication has been tested on over 11,000 women and produced relatively minor side effects like dizziness, nausea, and fatigue. But the FDA declined to approve Flibanserin—a decision Sprout formally disputed in December.

At that time, Whitehead said, “the FDA approved what was the 24th drug now marketed for sexual dysfunction [in men], and it was significant because it was the first of its kind and it was studied on only 832 patients and it has serious side effects including penile rupture. Many started to think, Do we have a different risk tolerance for women?”

Whitehead sees the difficulty Flibanserin has had making it to market as an expression of latent societal sexism. “When [Boehringer Ingelheim] hit a roadblock with the FDA, they sort of threw their hands in the air and were going to walk away from all that development,” she said. “I think that was a reaction not only to difficulty in the process but also this societal reaction that is reticent to accept the biology of sex in women.”

Dr. Suzanne Gilberg-Lenz, an obstetrician and gynecologist who has been following Flibanserin’s progress for years, agrees: “It’s completely sexist. Women are sexual, and not just sexual objects, but sexual in their own right. It scares many people.”

For now, women who have problems with their sex drives will have to turn to medication intended for men, which, as I found out, can have mixed results. Gilberg-Lenz considered the research a sign of progress, but finds the FDA’s denial of Flibanserin frustrating. “There’s like no major side effects that I’m seeing,” she said. “So what is the issue? I don’t get it.”

But some women’s health organizations doubt sexism motivated the FDA’s decision, citing Flibanserin's lack of effectiveness and possible side effects.

“We like our feminist sisters who think the FDA is just being sexists and know that we have to watch for that; however, we’re also FDA watchdogs,” said Cindy Pearson, the Executive Director of the National Women’s Health Network. “Our opinion is that this time [Sprout] just hasn’t finished answering the question about what the side effects and risks are so women can make a full, informed decision.”

While the debate surrounding the FDA’s motives continues, the agency has made it clear it's paying attention to the lack of treatments for female sexual dysfunction (FSD)—it's holding a public workshop on the subject on October 27 and 28.

Until the FDA approves a drug to combat the problem directly, aside from off-label uses of erectile dysfunction meds, testosterone will remain a common treatment for women. Various herbal remedies also exist, and some doctors tell women to try therapy. (Some doctors may feel uncomfortable discussing sex, but foreplay and sex toys, like vibrators, can also help increase blood flow to the pelvic region and increase desire and orgasms.) While we consider men’s limp dicks a physical problem and therefore dismiss possible psychological factors, women’s sexual woes have often been dismissed as psychological issues until recently, when doctors started analyzing biological causes of FSD.

“The FDA is committed to supporting the development of therapies for medical conditions related to female sexual dysfunction,” said Jeff Ventura, a spokesman for the FDA. “Additionally, the FDA has also identified female sexual dysfunction as one of 20 disease areas of high priority and focused attention.” Regarding the Flibanserin decision, he said the FDA can’t comment on any drugs that haven’t been approved.

In five to ten years, Pearson predicts the FDA will approve a product to solve FSD. “There’s a market there and that’s going to drive investment,” she said. “I think we’ll celebrate.”

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