An advisory committee to the Food and Drug Administration is recommending today the approval for a drug to treat low sexual desire in women. Since Viagra hit the market in 1998, some two dozen drugs to treat impotence in men have been approved, but this "lady Viagra," called Flibanserin, would be the first such drug on the market for women—if the FDA heeds the committee's advice.
Viagra, which appeared doomed to become nothing more than a failed remedy for chest pain in the early '90s, found new life as a treatment for erectile dysfunction, Gina Kolata reported for the New York Times in 1998. "Not only did Viagra work for impotency but it was so effective that the F.D.A. approved it in only six months and without consulting an advisory committee of outside experts," Kolata wrote. "There was no need to consult a committee, the agency said. There were no troubling questions, no significant side effects." (One month later, Kolata reported on six deaths in men taking Viagra, and the dangers of mixing the drug with other chest pain medications.)
The side effects of Viagra are generally minor—headaches; indigestion; a temporary, bluish tinge to vision—as are those associated with Flibanserin, such as nausea, dizziness, and drowsiness. Still, the FDA has rejected the drug twice already, citing safety concerns.
"Companies worried about the prospect the F.D.A. would reject an application out of concern that a chemical would lead to female excesses, crazed binges of infidelity, societal splintering."
Many, including Sprout Pharmaceuticals, the company that makes Flibanserin, have accused the FDA of sexism. The FDA has denied such claims (and to be fair, the disparity in available treatments between the sexes can be explained, in part, by the fact that low sexual desire in women has proven harder to understand and treat). But there is reason to believe that some gender bias, subconscious or otherwise, may be at play.
In 2013, New York Times reporter Daniel Bergner wrote about Flibanserin and several other drugs used to boost female libidos in clinical trials, citing concerns within the drug development industry that their products might actually be too effective to ever hit the market. "More than one adviser to the industry told me that companies worried about the prospect that their study results would be too strong, that the F.D.A. would reject an application out of concern that a chemical would lead to female excesses, crazed binges of infidelity, societal splintering," Bergner wrote.
Discomfort with female promiscuity runs deep in our society, and explanations abound. Our own Tom Jacobs reported on a study in 2014 that linked our potent anti-promiscuity morality with issues of paternity and economic dependence. "In other words," Jacobs wrote, "these feelings are a remnant of some of the oldest impulses in our evolutionary history: A man’s fear of getting stuck with the tab for raising another man’s child, and a woman’s fear of losing her man’s financial support because he suspects her child isn’t his."
Whatever the cause, this discomfort has long-running roots. In 1994, Carol Groneman, an emeritus professor of history at John Jay College of Criminal Justice, explored the construction of female sexuality with a fun (read: horrifying) look back at the history of nymphomania as a medical disease. Here are some highlights:
- Opinions about "uncontrolled sexuality" in women are as old as medical theories themselves. Hippocrates prescribed marriage to cure young girls of the "melancholy madness" that pining for men could induce. Centuries later, the Greek physician Galen described a "uterine fury" that could result when widows lost their husbands—and their sexual fulfillment with them.
- Nymphomania became a medicalized disease in the 19th century, and the diagnosis was liberally applied. There was malarial nymphomania, platonic nymphomania, and opium induced nymphomania. Medical reports from the era assigned nymphomania to women who desired gynecological exams, or one who could orgasm at "the mere sight of a man." In the 19th and early-20th centuries, women could be diagnosed with nymphomania for flirting, committing adultery, having a higher sex drive than their husbands, attempting to attract men’s attention with perfume, or talking about marriage.
- Treatments were equally arbitrary. In the 1850s, Horatio Storer, gynecologist and once president of the American Medical Association, treated a case of nymphomania with recommendations to reduce consumption of meat, brandy, and all stimulants, sleep on a bed made from hair, rather than feathers, to "limit the sensual quality of her sleep," and to swab her vagina with borax—a cleaning solution—to "cool her passions." The lady in question had been having "lascivious dreams" and, the doctor wrote, "If she continued in her present habits of indulgence, it would probably become necessary to send her to an asylum."
Some people may still fear that the drug could create an epidemic of lady nymphomaniacs, but in reality, hypoactive sexual desire disorder (a.k.a. low libido) is already a problem, affecting nearly five million premenopausal women in the United States. And this drug may be the best shot they have at the sexual relationships they desire.