Was Sexism Really Responsible for the FDA's Hesitancy to Sign Off on Flibanserin?

An early look at a Pacific Standard story that's currently only available to subscribers.
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(Photo: Oppenheim Bernhard/Ocean/Corbis)

(Photo: Oppenheim Bernhard/Ocean/Corbis)

The Food and Drug Administration’s approval of pharmaceutical treatment for low sexual desire in women has launched a heated debate over the dangers and benefits of medicalizing sex. Maya Dusenbery examines whether flibanserin either represents a long-overdue feminist victory for equality in sexual health or is a product of a clever faux-feminist con carefully orchestrated by Big Pharma.

Dusenbery's Pacific Standard essay is currently available to subscribers and will be posted online on Tuesday, January 05. Until then, an excerpt:

For nearly as long as the industry has been hunting for a “female Viagra,” feminist critics have been resisting the search. In 2000, Leonore Tiefer, a researcher and associate professor of psychiatry at New York University School of Medicine, convened a group of feminist social scientists and clinicians “to challenge the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs,” as the organization’s website explains. Dubbing themselves the New View Campaign, the group released an influential manifesto proposing an alternative model for understanding women’s sexual problems that emphasizes socio-cultural, political, psychological, and interpersonal factors. In a 2006 article exploring the pharmaceutical industry’s outsized influence on—not to mention financial interest in—defining female sexual dysfunction, Tiefer called the process “a textbook case of disease-mongering by the pharmaceutical industry and by other agents of medicalization.”

Trying to determine what is sexually abnormal is inherently fraught. Much feminist scholarship has explored how ever-shifting cultural norms dictate what is labeled as a disorder in the Diagnostic and Statistical Manual of Mental Disorders and in the medical community more broadly. “It wasn’t until very recently—just over 40 years ago—that female sexuality really was acknowledged as normal and important and not just about reproduction,” explains Thea Cacchioni, sociologist at the University of Victoria and author of the book Big Pharma, Women, and the Labour of Love. “I think any attempt by experts to define nymphomania, or frigidity, and now ‘female sexual dysfunction,’ really betrays a lot of social constructions.”

Without an objective way to measure something as subjective as desire, there’s no guarantee that what one person means when they say “desire” is the same as what another person does. In fact, HSDD actually doesn’t technically “exist” anymore. Once listed as an official disorder in the DSM, it was merged in the 2013 edition into a new problem called female sexual interest/arousal disorder. The change was pushed by some researchers who believe that desire and arousal are better understood as two sides of the same coin, and that for many people—perhaps especially women—desire sometimes kicks in after, not before, arousal. “They now say you have to have an arousal problem and a desire problem,” Cacchioni says. “Because even the very medicalized American Psychiatric Association recognized that desire is just more abstract and difficult to quantify. How would you quantify normal desire?”

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