Women’s Fliberation

Big pharma claims to hold the chemical key to a vigorous female libido. It’s called Flibanserin and you pop it to get randy. Inkling writer Tania Rabesandratana investigates to find out whether it’s indeed that simple.

Serendipitous drug development makes for a good story. It makes science sound surprising while making the pharmaceutical industry look spontaneous and candid. Remember how Pfizer was originally looking for a compound against hypertension, and ended up marketing Viagra?

In the (not-yet-so-naughty) noughties, global pharmaceutical firm Boehringer-Ingelheim tested Flibanserin as an anti-depressant. The drug didn’t work against depression, but to everyone’s surprise it boosted the ever-mysterious female libido. Cyrine Ben Amor, a psychiatrist and medical projects leader at the pharmaceutical company’s offices in Paris, recalls: “This came as a surprise, since other anti-depressants can cause negative sexual side-effects.” So development shifted towards libido-boosting, and Ben Amor now insists that Flibanserin is “not an anti-depressant.”

Last November, Boehringer-Ingelheim presented results of self-funded, phase-III clinical trials at a major medical get-together. The pooled studies involved a total of 5,000 pre-menopausal women in long-term relationships. The women on the drug reported, on average, 0.7 more “Satisfying Sexual Events” per month vs. those on placebo. Significant, but not mind-blowing.

Defining Dysfunction?

To come up (on purpose) with a libido drug, one must understand how desire works in the first place. But desire is often elusive and always entwined in cultural, social, hormonal, and psychological factors. “There are so many reasons for not wanting sex,” explains Dr. Petra, London-based psychologist extraordinaire and infamous sex-advice guru. “You’re not getting on well with your partner, you’re tired or ill, you just had a baby, life’s getting in the way…”

Boehringer-Ingelheim claims Hypoactive Sexual Desire Disorder (HSDD) is a real, frequent, serious condition that causes great distress in women. Others, such as the grassroots organization New View Campaign believe that the HSDD-hype is simply disease-mongering, orchestrated by the pharmaceutical industry to make us ladies feel inadequate and buy more drugs.

“In order to name a dysfunction, you need to define function. But there is no such thing as normal sexual function,” notes Liz Canner, director of Orgasm Inc., a documentary film about the over-medicalization of sex.

We don’t know how Flibanserin works, exactly, only that it modulates several neurotransmitters—mostly serotonin, and to a lesser extent dopamine and norepinephrine. Ben Amor says the medication “lowers inhibitory factors and increases stimulatory factors.” But as the British neuroscientist and blogger Neuroskeptic pointed out, it is also a sedative.

Doesn’t that sound like what a glass of wine does? “That would be an environmental factor,” replies Ben Amor, whilst Flibanserin is meant to act on internal factors on a durable basis.

Dr. Petra would like to see Flibanserin pitted against precisely such “environmental factors.” “Why not test the drug not only vs. placebo, but also vs. using a sex toy or lubricant, communicating better with your partner, having a glass of wine, or going to sex education sessions?” she suggests.

Long-Term Romance

Unlike Viagra, Flibanserin is effective only after several weeks of daily pill-popping. Again, filmmaker Liz Canner is critical: “Pharmaceutical companies want drugs you take every single day, because they mean a higher profit.”

Sylvain Mimoun, head of the Psychosomatic Gynaecology and Human Sexuality Unit at the Robert Debré Hospital in Paris, thinks this suits women just fine, because “they want to feel better generally, without having to schedule sex.” Does that mean patients would have to be on the medication forever?! Mimoun doesn’t think so. “If a patient sprained her ankle… I’d say to her: ‘I can help you walk again,’ and for this I’d need a crutch,” he explains.  That crutch could be Flibanserin, which might help break a vicious circle or reduce irritability and low self-esteem.

Ben Amor agrees, but when I ask about what happens when the drug is withdrawn, she contradicts herself. “Patients who had benefited from an increase in sexual desire after 24 weeks on Flibanserin had no withdrawal symptoms during another 24 weeks on placebo,“ she tells me. That’s good. But then she admits that “after 48 weeks in total, the effects on sexual function decreased too.” That’s not too good: some women could feel they can’t be turned on without their “chemical crutch.”

Besides increased desire, the drug can produce dizziness, somnolence, or nausea. These side effects affected a significant but reasonably low percentage of patients, and went away after a few weeks of treatment. At Boehringer-Ingelheim, Ben Amor says she was “pleasantly surprised” to see that “the product is exceptionally safe.” But we don’t really know the long-term outlook.

The Big Picture Behind the Little Pink Pill

At the end of the day, no data set can tell us if Flibanserin is good news or not. Mimoun and Ben Amor believe any pharmaceutical tool that can help women overcome an upsetting situation is positive. The industry congratulates itself for shedding light on an overlooked topic—a taboo, even!

But Dr Petra warns: “Lots of women are made to believe that they should want it all the time,” and this generates a potentially huge market to tap into. “I would like the drug to not be the first port of call, and not to distract from other potential approaches,” she continues.

Boehringer-Ingelheim is awaiting the decisions of the FDA and the European Medicines Agency (EMEA), which will determine if Flibanserin can be launched on the prescription market. Meanwhile, the corporate communications guns are out already. Flibanserin’s press pack comes in pretty lilac tones with matching websites about “The Science of Desire,” walking a fine line between providing “much-needed training” for doctors or patients, and fabricating a problem in the same breath that it offers the magic fix.

There’s no doubt that a storm of Flibanserin hype is on the horizon. When it hits, remember: whether they’re helped along by pills or pillow talk, in the final analysis our sex lives are deeply personal—not pharmaceutical.