Can Medicine Boost Female Sex Drive?

that is, erection -- is the goal of treatment for men. For women,
researchers hope that ease of arousal will translate to increased sexual
desire.

Technically, arousal and desire are not the same thing. Arousal is the
physical and psychological state of being primed for sex. The penis becomes
erect, the vagina lubricates, heart rate increases, and blood vessels dilate.
Whereas arousal can be easily seen, sexual desire is vague. It has to do with
wanting to become aroused, but there are a lot of questions about what that
really means.

Not everyone thinks that sexual desire is a medical issue. Lenore Tiefer,
PhD, a psychologist at the New York University School of Medicine, is an
outspoken critic of what she sees as a trend toward unnecessary medical
intervention in sex. She is a founding member of a group promoting "A New
View of Women's Sexual Problems," and editor of a book by that title.

The idea that desire is a thing women have or lack, apart from any object of
desire, is mistaken, she says. But it is convenient for the purpose of selling
pharmaceuticals.

"I don't think people desire sex, or rather, let's put it this way:
They're learning to desire sex," she tells WebMD. "It used to be I
thought that people desired people: 'I desire Fred' or 'I desire Louise.' Then
there was masturbation, which was a kind of tension-relieving thing where you
felt like having an orgasm, but it wasn't sexual desire. It wasn't anything
like that. Sexual desire was this longing that you felt in your body or in your
heart to be with that person over there."

Tiefer contends that there are too many other reasons why desire for sex
might wane to pin it on a biological cause. Fred is emotionally distant and
snappish. Louise feels bad about how her body looks. Early in her life she
learned that sex is dangerous and yucky. At the end of the day, after the kids
are tucked in and dinner dishes are washed and put away, she has only enough
time to catch a few minutes of American Idol before lights out.

Another prominent sex researcher, Rosemary Basson, MD, of the University of
British Columbia, Canada, agrees that the medical focus on desire is misplaced.
Women and men "have multiple motivations to be sexual, and 'desire' -- as
in urging 'lust,' 'horniness,' or 'drive' -- is only one of these reasons,"
she tells WebMD. Desire for sex can also be the desire to feel emotional
closeness with someone, to please that person, or to feel attractive.B

She points out that the definition of this "mental disorder" assumes
that all women have a constant amount of sexual desire that is normal, like the
pilot light of a stove. Just turn up the gas, and you're cooking. But there's
no definition for what a normal level of desire is, so no one can say what's
"low," Basson says.

Sometimes when the motive to have sex is something other than a physical
drive, some women just can't get into it. "Even if she is trying to focus
on any pleasurable feelings, her body is simply not responding and neither does
her mind," Basson says. "It stands to reason that her motivation will
sooner or later also drop." That's where she thinks medicine can help. It
also happens to be the approach of researchers studying the drug
bremelanotide.

Michael A. Perelman, PhD, is a consultant involved in the clinical trials on
bremelanotide and co-director of the Human Sexuality Program at Presbyterian
Hospital and Weil-Cornell Medical School in New York City. He explains how the
drug might work in terms of setting the "tipping point" for sexual
arousal lower. He thinks the drug should be used together with counseling to
help with emotional problems that inhibit desire.

"I'm interested in helping people respond more to the right kind of
stimulation from the right person when that's just not happening naturally for
them, in the way that they would like, or that it used to," he says.

The Market for Desire

If one of these drugs eventually wins approval, the drugmaker probably spend
millions to advertise it. it's hard to imagine that it would be discretely
recommended by licensed sex therapists as part of a comprehensive approach to
women's sexual problems. Instead, ads will urge women to "ask your doctor
if it's right for you."

Millions may go ahead and do that.

"I think it's impossible that it won't sell a lot," Tiefer says.
"I don't see any way around it."

The size of the potential market for these drugs is debatable because
estimates of how many women could be diagnosed with the disorder vary widely.
Would you believe up to 43% of women have low sexual desire? That figure comes
from a survey published in the January/February 2005 issue of the
International Journal of Impotence Research. It got a lot of play in the
early publicity for Intrinsa, and it is still cited often. Those offering it as
evidence of a vast epidemic have been sharply criticized, however. The survey
from which it came asked women if they ever lacked interest in sex but not
whether it caused them any distress. The survey also found that lack of
interest in sex was linked to age and depression.

Other research has come up with different numbers. Survey results published
in 2003 in the British Medical Journal show that about 10% of English
women reported "lack of interest in sex" lasting at least six months in
the past year.

A survey by John Bancroft, PhD, former director of the Kinsey Institute,
published in the Archives of Sexual Behavior in 2003, asked women not
only if they lacked interest in sex, but also if it caused them distress
personally or if it caused distress in their relationship. About 7% of the
women reported having "no sexual thoughts" in the past month, but less
than 3% said they didn't think about sex and felt distress because of it.

On the one hand, it's probably not true that nearly half of all women have
sexual dysfunction. But on the other hand, sexual problems are not wholly
invented by the pharmaceutical industry.

"It's really important to recognize that people really do suffer,"
says Lisa Schwartz, MD, a professor at Dartmouth Medical School in Hanover,
N.H., who researches harms vs. benefits in medical treatment. "It's just a
question about what the solution to that suffering is, how to acknowledge that
suffering in a way that's helpful -- and it's not necessarily by putting it in
the medical care system."

Peer Pressure

It's not farfetched to suppose that if Fred wants it more often than Louise
does, he might pester her to ask her doctor about that drug in the ad on TV
until she finally caves in.B

If a drug for female sex drive were successful, women might feel pressure to
conform to a new cultural norm. "People do now expect things that they
didn't used to," Tiefer says. Take orgasms, for instance. Orgasms are
divine and everyone is entitled to be as orgasmic as possible. But the ideal of
being able to have routine or multiple orgasms sets up some women to feel
defective if they don't. Men, too, are expected to be able to get erections no
matter what. Today it would strike many people as plain weird that a man might
choose to live with erectile dysfunction. Ten years ago it wouldn't have.

Louanne Cole Weston, PhD, WebMD's Sex MattersB. columnist, says she thinks
there has been too much hand-wringing over these kinds of questions. "I
don't want to belittle women by saying, 'We're not going to give you this drug'
or 'we're not going to look into this drug because we don't think you're
capable of standing up to the pressures of the people in your life,'" she
says.

If libido drugs don't do anything for women, despite marketing efforts, they
won't take them, she argues. But she hopes that someday something that works
will make it to the market and help a lot of people.

When and what that is will ultimately come own to what the studies on
flibanserin and bremelanotide show and how the FDA evaluates the science.
"It all depends on how scientifically rigorous they're going to be,"
Tiefer says.

By Martin Downs
Reviewed by Louise Chang
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