A pink Viagra for female sexual dysfunction?

Last year, a pharmaceutical company was on the verge of a major new breakthrough – a Viagra-type drug for women – that’s meant to boost female sexual drive. The US Food and Drug Administration (FDA) however, having been criticized at that time for taking the risks of some drugs too lightly, ruled that the testosterone patch required longer-term testing for possible serious side effects before it can win approval. The rejection meant that the possible release of the patch, which supporters hoped would have been the first approved treatment for female sexual problems, will now most likely be delayed for a few years.

This early though, controversies already exist on whether women really need a female Viagra. For one, feminists are muttering that the drug companies are sexist for taking so long to find a cure for female sexual dysfunction (FSD) while the fix for its male counterpart, erectile dysfunction (ED), has already been available for more than five years. On the other hand, there are others, like sex expert Shere Hite, who are denouncing the drug companies for "cynical money grabbing," that is, creating a disease in order to market a pill or a patch. So, has FSD actually been accepted as a new disease category just as ED was a decade earlier? And do women really need a pink Viagra for FSD?

Do We Have An Accepted Definition?

The implied parallel between FSD and ED is deceptive. A woman’s sexual responsiveness is not the same as a man’s. And ignoring its complexity can make "difference" look like "dysfunction." In medical parlance, dysfunction means anything that doesn’t work the way it should. The problem is there is no acknowledged norm of female sexual dysfunction. That norm has never been established.

Unlike penile erection, which is a quantifiable physical event, a woman’s sexual response is qualitative. It embodies desire, arousal, and gratification – and it can’t be measured objectively. Without an empirical standard by which to assess female sexual function, it would seem difficult, if not impossible, to come up with criteria for female sexual dysfunction.

That hasn’t stopped experts from trying. For example, the US National Institutes of Health formed a panel on FSD, and in its report, which was published in the March 2000 issue of the Journal of Urology, proposed a working definition of sexual dysfunction in women that includes both physiological and psychological symptoms (please refer to table). Experiencing any one of them warrants an FSD diagnosis, but it must be a source of distress for the woman to qualify as a sign of FSD.

An Epidemic Of FSD?

Viagra alone didn’t spark this interest in female sexual dysfunction. It can also be attributed to the publication of a 1999 study indicating that 43 percent of American women experienced sexual dysfunction (Journal of the American Medical Association, Feb. 10, 1999).

That simple number, which has become the mantra of FSD advocates, belies the complexity of the issue. The 43 percent figure emerged from an analysis of responses by 1,749 women and 1,410 men to a similar set of questions. Women who reported any of the following – lack of sexual desire, difficulty in becoming aroused, inability to achieve orgasm, anxiety about sexual performance, reaching orgasm too rapidly, pain during intercourse, or failure to derive pleasure from sex – were considered to have sexual dysfunction. Women were more likely to suffer from sexual dysfunction if they were single, had less education, had physical or mental health setbacks, or were dissatisfied with their relationship with a sexual partner.

In the years since the report’s publication, researchers have revisited it and challenged its conclusions. Several critics have pointed out that the women were not asked whether their problems were severe enough to cause personal distress. Some have also noted that the duration of problems in the survey – two months – may have represented only a temporary response to illness or other stress.

In 2000, critics garnered additional support from a preliminary report by the Kinsey Institute, the organization that published a benchmark study on female sexual behavior in 1953. The most recent Kinsey data indicate that emotional health and personal relationship factors were more important for women’s sexual satisfaction than achieving orgasm. In that survey, general well-being ranked at the top as a requirement, followed by emotional reactions during lovemaking, the attractiveness of one’s partner, physical response to lovemaking, frequency of sexual activity with one’s partner, the partner’s sensitivity, one’s own state of health, and the partner’s state of health.

Women And Men Are Different

In an article published in the October 2002 issue of the Archives of Sexual Behavior, Dr. John Bancroft, director of the Kinsey Institute, suggested several reasons why women and men have evolved to experience their sexuality differently. First, although testosterone stimulates libido in both sexes, it’s a far stronger determinant of sexual interest in men. Second, male orgasm (ejaculation) is essential for reproduction, while female orgasm is – in strictly reproductive terms – irrelevant.

Bancroft also speculated that women’s greater tendency toward sexual inhibition could be a response to cultural influences. Most societies have restricted women’s sexual expression more tightly than men’s.

FSD In The Post-Viagra World

There’s little doubt that Viagra’s influence has spilled over into the arena of women’s health. By kindling a search for a comparable elixir to treat women’s sexual problems, Viagra has made women’s sexuality a high-profile research target. And by enabling older men to recover erectile function, it has stimulated new research into later-life sex and drawn welcome attention to the sexual vitality of postmenopausal women.

But the resulting focus on pharmaceutical rather than emotional solutions has serious limitations. This way of framing the problems threatens to make women’s sexual experience, no less than men’s, a performance issue. Also, without downplaying the significance of any women’s pain or distress, there can be real danger in defining "difference" as "dysfunction."

Improving Female Sexual Responsiveness

Although the incidence of sexual dysfunction may have been exaggerated, the problem is real for thousands of women. It’s rarely a simple issue, because sexual pleasure – and sexual distress – involves a complex web of physical and emotional factors. If you’re disappointed with your sex life, you may want to try any or all of the following:

• Have an honest discussion with your partner. Sexual pleasure is the result of mind/body collaboration – usually involving two minds and two bodies. As surveys attest, the most satisfying sexual activity is the product of a caring, secure personal relationship. When one partner is dysfunctional, the other is affected as well. For example, a woman may interpret her husband’s inability to have an erection as a sign that he no longer finds her attractive. A talk with one’s partner can help to determine whether the problem is primarily physical or emotional.

• Seek medical treatment. If sexual problems are new – especially if you’re postmenopausal, have undergone surgery, have developed a chronic medical condition, or are taking a new medication – you should discuss the circumstances with your doctor. A variety of physical changes can be responsible for discomfort or reduced pleasure during sex, and many can be reversed with appropriate therapy.

• Consider psychotherapy. Although current research, which is heavily financed by pharmaceutical companies, emphasizes the physical causes of sexual dissatisfaction, the reality is that our sexual responsiveness is strongly related to our emotional well-being. So deep-seated issues of control and trust, as well as identity and body image, can’t help but influence our sexual responsiveness. If you sense that such issues are interfering with your sex life, you might consider psychotherapy. After all, there is truth to the old adage that the most important sex organ is the brain!