Debate erupts (again) over women’s libido drugs


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A meta-analysis prompted calls for researchers to disentangle horniness from hype. But understanding desire isn’t easy.

In the fall of 2016, sex therapist and researcher Leonore Tiefer shuttered the New View Campaign, an organization she had founded to combat what she refers to as “the medicalization of sex” — essentially, the pharmaceutical industry’s efforts to define variations in sexuality and sexual problems as medical issues requiring a drug fix.

For 16 years, the group had fought against industry’s involvement in sex research, including its push for a drug to boost women’s sex drives. New View hosted conferences and its members penned papers and testified before the United States Food and Drug Administration. The campaign was prominently featured in an 80-minute documentary called Orgasm Inc, and promoted a clever (if off-pitch) video advising women to “throw that pink pill away,” a reference to the female-libido drug flibanserin (Addyi), which was seeking FDA approval at the time.

New View counted some successes: The FDA didn’t approve an allegedly libido-boosting testosterone patch for women, on the grounds that the patch’s slim benefits didn’t outweigh its risks, and the FDA twice rejected flibanserin for the same reason. But in August 2015, the agency reversed itself and approved the so-called pink Viagra. “I felt we’d said everything we had to say,” said Tiefer of ending the campaign. Advocates predicted FDA approval would be sought for additional women’s libido drugs, but the group felt there was nothing they could do to stop it. “However many more drugs were going to come down the pike,” said Tiefer, “it was just going to be more of the same.”

Indeed, four years later all was quiet when the FDA approved bremelanotide (Vyleesi), a libido drug that women inject into their abdomen or thigh at least 45 minutes before sex. The study results had been decidedly unimpressive: Participants who received the drug didn’t report more satisfying sexual events than those getting a placebo shot, and they scored only slightly better on measures of desire. Further, four out of 10 women taking the drug reported that it made them nauseous.

“There really was no opposition in 2019,” said Tiefer, speaking for herself and others that had spoken out against flibanserin’s approval. “We all had pink Viagra fatigue of one sort or another.”

In March, the Journal of Sex Research published an analysis casting doubt on the methodology behind the two pivotal studies of bremelanotide. The study’s author, Glen Spielmans, a psychology professor at Metropolitan State University in Minnesota, accused industry-sponsored researchers of cherry-picking favorable findings. Reinvigorated by this new paper, Tiefer reached out to a few like-minded colleagues to “make a little noise.”

Everyone I talked to agrees that losing the spark that once kindled enjoyable sex is a real and distressing problem.

In explaining the rationale for approving female-libido drugs, the FDA often cites the “unmet medical need.” Yet researchers are fiercely divided over the question of just how many women lack libido and how best to help them. If you believe advertising for Vyleesi, American women suffer from an epidemic of insufficient horniness. More than 6 million premenopausal women — one in 10 — have low sexual desire, the website claims.

Research doesn’t support the notion that millions of women are sexually deficient, said Tiefer, whose long career includes more than three decades as an associate clinical professor of psychiatry at the New York University School of Medicine. “There is no standard of what is ‘normal sexual desire,’” she said, noting that desire varies widely and depends heavily on a woman’s personal situation and culture. After all, she points out, in the 19th and early 20th centuries some doctors diagnosed nymphomania in women deemed to enjoy sex too much.

Everyone I talked to agrees that losing the spark that once kindled enjoyable sex is a real and distressing problem. Some doctors told me that they were glad to have drug options that might help enflame a woman’s lost desire. But Tiefer said in all 40 years as a sex therapist, she has never had a patient complaining of low libido who did not also have physical, emotional, or relationship issues. “If you want to have a better sex life, read some books, and ask some questions, and talk to knowledgeable people,” she said. Just don’t think that a pill or shot will fix it.

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