The Need for a Pink Viagra?

An academic paper

In the wake of the successful profitable commercialization of Viagra® to solve men’s erectile dysfunction (E.D.), pharmaceutical companies in the U.S. have since attempted to produce and promote a ‘pink Viagra’ as a cure for women’s sexual dysfunctions (Tiefer 2003/2005, Fishman 2004, Bancroft 2002, M2 2003).

This paper will briefly argue how, disguised as a boon for women’s sexuality, the medicalization of women’s sexual difficulties is a process which has reduced the complex causes of sexual problems to sheer medical ones, mainly to testosterone imbalance, and has put women’s health at risk by making them feel sexually defective and in need of pharmacological treatment. Some of the bias and threats associated with the promotion of testosterone will be explored and some suggestions will be offered on how to prevent women’s sexual rights from being violated by these pharmaceutical industry manoeuvres.

Although no definition can be found of what constitutes a sexually functional woman, the term ‘dysfunction’ is still widely used in medicine, in spite of its meaning having changed through ages and social contexts. In fact, whereas in the 19th Century Western women were labelled nymphomaniacs if they exhibited too much sexual desire, they are now labelled dysfunctional when showing low desire for sexual intercourse or having inadequate ‘performances’ (Groneman 1994).
With the aim of achieving consensus on the definition of Female Sexual Dysfunctions (FSD) in order to facilitate the development of drugs to eventually cure them, a conference sponsored by eight pharmaceutical companies was held in Boston in 1999. Acknowledging the complexities and interrelations of the dysfunctions, the conference did not achieve general consensus on a single definition or cause underlying all five disorders, which are defined by the DSM-IV as:

* Hypoactive Sexual Desire Disorder (HSDD)

* Anorgasmia

* Sexual arousal disorder

* Sexual aversion disorder

* Sexual pain disorders (vaginismus/dyspareunia)
(Basson 2000)

This classification remained unchallenged despite the many limitations of labelling women’s sexual difficulties only on the basis of quantitative methods and despite the evident coital and male perspectives these dysfunctions are considered from (Tiefer 2004).

For instance, anorgasmia refers only to lack of vaginal, but not clitoral, orgasm and some of those disorders, such as vaginismus and sexual aversion disorder, may stem from sexual trauma and could be considered protective mechanisms rather than dysfunctions.

Reports of women admitting having these sexual problems revealed an epidemic proportion of women (43%) who were deemed dysfunctional and ‘suffering’ from low sexual libido in particular. Despite being quoted in many studies as almost an undisputable fact, the “43%” figure, gathered by a controversial 1999 study, has in fact never been properly established and is recognized as misleading (Lauman 1999 criticized by Tiefer 2004, Bancroft 2002).

In 2001, a new conference again sponsored by pharmaceutical companies was held in the U.S. with the purpose of defining a new disorder named ‘Female Androgen Insufficiency’ (Bachmann 2002).

The conference established the existence of this new syndrome and highlighted the need to further research the links between low testosterone and women’s low libido, thus justifying the drug industry intervention in the sector. Non-medical causes of FSD were again marginalized despite much evidence proving that it is rather the presence of rigid sex roles, double standards, negative social/ economical/interpersonal circumstances and poor sexual education or sexual abuse which contribute to creating the shame, fear, ignorance and anxiety which mediate to the development of women’s sexual problems (Bancroft 2002, Usher 1993, Tevlin 1983).

In the years following the 2001 conference, many clinical trials sponsored by pharmaceutical companies (Berman 2003, Bersheva 2005 etc.) have since tried to develop testosterone formulations and tried to scientifically prove that testosterone deficiency is linked to women’s low libido. Results have been controversial: although testosterone seems to increase physical aspects of sexual arousal, it seems unjustified to link testosterone with increase in satisfaction and in sexual desire (Apperloo 2003).

Some of the limitations of privately sponsored clinical trials are their narrow selection criteria and their tendency to focus on medical, quantitative elements and to treat sexuality as a performance happening out of context. Besides, a high placebo effect has been highlighted in many of these trials (Bancroft 2002), which suggests the importance of subjective elements in increasing a woman’s libido and the positive impact of receiving sexual information during trials.

Worried about potential long term side-effects and alerted by committee of academics and feminists expressing their concerns regarding the medicalization of women’s sexuality, the American Food and Drug Administration (FDA) has not as yet approved any testosterone replacement as a valid, safe cure for HSDD (Allina 2005).

Public studies such as one recently conducted in Australia (Davis 2005) have concluded that the measurement of testosterone levels is not useful for the diagnosis of female insufficiency syndrome. Although scientifically and academically the ‘testosterone theory’ is not found to have enough validity and support, it has also been argued that testosterone use validates women’s right not to be discriminated, by having what men had with Viagra and that it enhances their right to attain the highest standard of sexual health.

In fact, although a tiny percentage of women (menopausal, with hysterectomy etc.) may indeed marginally benefit from receiving testosterone (Bancroft 2002), it is likely that in order to pursue their long-denied right to a satisfying, pleasurable sexual life and deceived by marketing that equates testosterone use with an increase in ‘intimacy’, many healthy women may disregard its proven side-effects and resort to its use nevertheless. A further bleak threat is its potential of misuse: considering that Viagra is one of the most counterfeited drugs worldwide, especially in developing countries such as Thailand (Inbaraj 2004), it is legitimate to suspect that a ‘pink Viagra’ may follow a similar trend with negative consequences for women, especially in the sex industry.

Overcoming negative clinical evidences, the FDA rejection and academics’ concerns, pharmaceutical companies such as Procter&Gamble or Pfizer have nonetheless begun successful marketing campaigns to make testosterone products appealing to the general public. Testosterone use is being advertised through many books, websites or media appearances by doctors who are increasingly prescribing it off-label and recommending it.

Considering that some popular doctors, such as Goldstein or the Berman sisters, directly receive money from the drug-companies by participating in their sponsored clinical trials or by advertising their drugs in books or websites and have participated in both 2001/2002 conferences, their public promotion and prescriptions of testosterone raises serious concerns about the respect of women’s right to receive unbiased information regarding sexuality (Berman in www.newshe.com, Meika 2000, Tiefer 2005).

In view of these real and potential violations of women’s sexual rights, the medicalization of female sexual problems should be seriously addressed. It is important for clinical trials on sexuality to be publicly funded and for drug companies’ campaigns and studies to be monitored and their inclusion criteria and placebo effects carefully evaluated (Tiefer 2004, Bancroft 2002, Irvine 1995).

Most importantly, definitions of women’s sexual difficulties should be seen from female perspectives and include all their non-medical causes. One new suggested comprehensive classification, known as New View Nomenclature (Hicks 2004) urges practitioners to diagnose a woman’s sexual problems inside personal, social, psychological, familiar and medical contexts. Furthermore, whether or not testosterone is believed to improve aspects of women’sexuality, women’s full enjoyment of their sexual rights cannot happen without more sexual education and efforts to eliminate sexual/physical violence and sexual stereotypes. The message that testosterone deficiency is the key to women’s sexual problems has to be challenged, ‘dysfunctions’ should be redefined as sexual ‘difficulties’ and the term ‘sexual health’ should remove its medical component and be renamed ‘sexual well-being’.

In conclusion, the pharmaceutical industry is medicalizing low sexual desire in women by overemphasizing the role of testosterone imbalances while downplaying the overwhelming impact of social and contextual factors and by portraying an almost unachievable standard of what a sexually ‘functional’ woman should be. The risks are of serious side-effects caused by the sale of an unapproved and yet prescribed ‘quick-fix’ drug and the exploitation of women’s right to be sexual, which now seems to have been turned into a sexual imperative.

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