A new female desire drug?

Imagine a drug that can increase female sexual desire. Many of you have already tried to imagine it. So have the pharmaceutical companies. Since about 30% of women report their sexual desire is too low, the income potential for such a drug has many businesses hoping to cash in.

Testosterone patches are just one of the medications proposed for increasing sexual desire in women. The latest attempt has been called by some the “female Viagra”. The nickname is misleading since Viagra is an arousal drug not a desire drug, but potentially accurate in the impact it could have on society. At this point, however, Filbanserin (proposed trade name is Girosa) has been rejected by the FDA.

Filbanserin is a serotonin receptor agonist administered as a pill taken daily. It was originally developed to treat depression. While clinical trials showed failure as an antidepressant, there was some reported increase in sex drive during the trial. This prompted the manufacturer to explore the drug’s potential for increasing sexual desire. As of June 22, 2010, the advisory committee for the FDA has recommended against approving Flibanserin for Hypoactive Sexual Desire Disorder (HSDD).

Part of the problem with approving Filbanserin was that it failed to show enough increase in sexual desire to justify the risks and side effects in taking the medication. About 15% of the trial subjects taking the drug discontinued the trial due to dizziness, nausea, anxiety, insomnia, fatigue and somnolence – none of which makes one feel very sexy or increase sexual desire. Additionally, it didn’t play well with alcohol, birth control or other anti-depressants – all common for many women.

Interesting to me, however, is that although the trials failed to show Filbanserin was the “miracle drug” for increasing female sexual desire, it did support some of what I have been teaching for years.

The primary way sexual desire was assessed was through the use of an electronic diary where subjects indicated “your most intense level of sexual desire” on a daily basis (0=no desire, 1=low desire, 2=moderate desire, 3=strong desire). Consistent with results from previous such studies (i.e., Wellbutrin), what the researchers found was that sexual desire significantly increased for both the placebo and treatment group. In one study those taking the drug found a 71% increase in reported desire level over the course of the study but the placebo effect was 67%. Clearly the intervention with the greatest impact was keeping the electronic diary, not taking the drug.

Another way researchers evaluated the effectiveness of Filbanserin was by asking participants to record their sexually satisfying events. Again, participants recorded daily if they had experienced a sexually satisfying event (defined as: intercourse, oral sex, masturbation or genital stimulation by a partner). While the way the data was analyzed makes it difficult to know, it appears both the placebo group and those taking Filbanserin had 1-2 additional sexual encounters per month than they did before the trial began. Although those taking the medication showed an increase over the placebo group of a little less than one event per month, this increase did not offset the problems the drug caused. But note again that the major effect came as the study participants monitored their activity.

For a variety of reasons, men are prompted to think about sex far more regularly than most women. Men typically report thinking about sex (and evaluating the possibility of such) multiple times a day. It’s normal for women to think about sex far less often (maybe 1-2 times a week at the high end). This means she isn’t evaluating the possibility very often. Asking her to track her desire and activity daily causes her to evaluate it far more often than normal. Telling her the goal is to “treat her low desire” clearly states something is wrong with her current level of desire (a presupposition I would generally reject). Thus, she assumes that what is normal for her is not ok. Asking her to evaluate it daily means she is judging whether her desire and activity is “ok” or not. The clear pressure is for it to increase. And it works.

After learning about the studies, one of my students joked about developing a computer program that prompts wives to record their sexual desire and activity on a daily basis. While various studies like the above lead me to believe this would increase the level of desire and amount of sexual activity, my questions would be “to what end?” and “at what cost?”

If the goal is simply to make women more like men, I believe the end is dishonoring to women and flat out wrong. Similarly, the cost will be the potential loss of some of the beauty and mystery of her femininity. Clinically, many women report that increasing the number of times they “think about sex” means increasing the pressure and self-condemnation they feel. Sex becomes even more of a chore and less of a joy and delight.

Female sexuality is significantly different from male sexuality. Research shows women want sex slightly less often than men (though in 20% of couples, the wife is the high desire spouse). When they do want sex, however, it is rarely because they are “horny” or hungry for sex. Women are generally looking for the closeness and contact that comes through the sexual act. Men tend to be prompted more often by a sexual hunger that triggers them to initiate sex. All the medical interventions I have seen appear to deny women the beauty of their sexuality in attempts to make them more masculine in their desire and response. While at one level this seems appealing, the long term consequences for women, marriages, intimacy and our society are scary.

Even though sexual desire is profoundly complex, I won’t be surprised if some day a drug company develops a drug that makes women experience a more masculine type of sexual desire. I fear what that will mean in how we treat women in our society.

So, while you might continue to hope for a “female Viagra”, I’m glad we don’t have to deal with the consequences of it yet.