The debate surrounding the female libido pill is back and more controversial than ever.
Sprout Pharmaceuticals announced Tuesday it would be resubmitting its application for approval to the Food and Drug Administration for its female libido-enhancing drug flibanserin. The push follows a "recent lobbying blitz by politicians, women's groups and consumer advocates aimed at pushing it onto the market," reports CBS News. If passed, flibanserin would be the first FDA-approved drug to approach the needs of women who reportedly lack sexual desire, though there are already 24 on the market to improve male sexual dysfunction.
The proposed female libido pill is making a splash because it works on neurotransmitters in the brain. According to NPR, flibanserin increases desire chemicals like dopamine and norepinephrine, while decreasing serotonin, which hinders sex drive for some.
Though early trials of flibanserin yielded an 18% improvement in sexual desire from participants, female libido pills have a long-established history of being rejected by the FDA on efficacy and safety claims. And flibanserin has already been rejected by the agency twice. Yet with every whisper of a nearing FDA approval for a female libido pill come women lining up desperate to try it.
But what many women may not realize is that a lot of the issues associated with a lack of female sexual desire stem from problems a pill cannot address — and they're ones women shouldn't feel bad about. Before you or a friend get in line for a clinical trial for the "female Viagra," this is what you should know.
The female libido pill is not women's Viagra.
We can't solve female desire disorders with a women's Viagra because, well, women don't get erections. Viagra works by increasing blood flow to the penis to facilitate an erection. As Refinery29 notes, "Viagra presupposes men's desire to have sex and merely gives them the equipment to do so."
Female libido pills, on the other hand, frequently work to change either the hormonal or neurochemical makeup of a woman's brain (culture doesn't just assume women want sex). While other once-proposed female libido pills altered testosterone and estrogen levels, flibanserin works to change the executive functions of the brain by acting on neurotransmitters like dopamine, norepinephrine and serotonin.
The focus on the brain is key here, as desire starts in the brain. As Daniel Bergner wrote for the New York Times, "If women, generally speaking, learn other lessons, that sexual desire and expression are not necessarily positive, and if therefore they don't think as much about sex, then their neural networks will be less stimulated and comparatively weak."
A lack of an orgasm isn't necessarily a medical problem.
While the pill focuses on sex drive generally, the female orgasm is crucially tied to women's perception of their own sexual function. An estimated 15% of women cannot achieve orgasm, according to ABC News, a statistic that's related to a number of highly complicated factors — many of which aren't necessarily medical issues.
Yes, there are women whose issues with sex may be best addressed with a pill. But as discovered in Liz Canner's 2009 documentary Orgasm Inc., the frequently cited statistic that 43% of women are sexually dysfunctional is based on bad data and poor questioning. Canner suggests that the rise of female lust-enhancing pills might have more to do with the pharmaceutical industry wanting to medicalize female sexual dysfunction than an extreme pervasiveness of it.
That's because women's sexual problems don't necessarily even have to be physical. Data from the 2014 National Survey of Sexual Attitudes and Lifestyles found that women's sexual problems may be related to factors including relationship dissatisfaction, communication issues, sexual victimization or an STI diagnosis.
The problem with "getting there" might not even be inherently sexual always. According to the Mayo Clinic, common causes for a woman's lack of orgasm include diseases like diabetes, multiple sclerosis, gynecological issues like hysterectomies, vaginal pain, antidepressants, blood pressure medications, alcohol, drugs, aging, stress, cultural beliefs and "mental health" issues. And that doesn't include common causes for low sex drive, which could be as simple as boredom in a relationship. The most commonly recommended treatments for such issues include couples counseling, an increase in sexual stimulation, sexual education, sex therapy and finally, estrogen and testosterone therapies.
If any of these causes are behind a lack of sex drive or orgasm, a female libido pill can't totally tackle the issue at hand.
The orgasm gap is real.
What's the orgasm gap? It's the fact that women, on average, experience orgasm during sex only about 80% as often as men. That percentage falls down to 50% during casual hookups.
What can account for that gap? A cultural premium on male orgasm foremost but also misconceptions about how fast women can actually achieve climax. Sandra Lindholm, a clinical psychologist and sex therapist from Walnut Creek, California, told Mic that women usually require 20 to 40 minutes of arousal and touching before experiencing an orgasm. "Women tend to be more like Crock-Pots. We have to be more slowly aroused," she said, "whereas men tend to be like microwaves: They can be turned on fast and the goal is orgasm."
The orgasm gap contributes to many women feeling like something must be wrong with their sex drive ("Why does my boyfriend always orgasm and I never do?"), when in fact, both biological and social factors might be causing the partner-to-partner orgasm discrepancy.
The lack of orgasm doesn't always mean the lack of desire.
The myth that an orgasm during intercourse is somehow the "right" orgasm or the "correct" way to end sex is all too pervasive. For some women, it's far out of reach. According to data collected by the Kinsey Institute, only 29% of women always have orgasms with their partners. That means over 70% of women aren't having earth-shattering, headboard-slamming sex around the clock.
Other studies indicate as little as 8% of women experience orgasms from vaginal penetration. Looking at female sexual dysfunction also requires a re-evaluation of what sex is — because most women are getting off with the help of mouths, hands and toys too. Sex doesn't always have to be penis-oriented, and it certainly doesn't need to include an orgasm to be enjoyable.
There's no correct amount of sex drive someone should have.
Medical professionals define hypo-active sexual disorder (HSDD) as a point at which a lack of sex drive causes clinical emotional distress, according to Bergner in the same New York Times article. If you haven't concluded it already: That's a very arbitrary, subjective definition.
A large part of thinking about female sexual desire is what has been socially programmed. Since we don't quite understand what makes female desire tick just yet, female libido pills are servicing a problem that, though real for many, we can't quite name, measure or trace to one origin. As Hayley MacMillen wrote for Refinery29, "We don't actually know that female sexual dysfunction can exist in a vacuum, independent of such other factors — which is why, if the drug is approved, women struggling with low libidos will do well to explore other options before resorting to pharmaceuticals."
How we talk about women's pleasure is shaped by our culture.
Our belief that women must always (and easily) orgasm during sexual intercourse is one that's supported by the film, television and magazines we surround ourselves with, right down to the ridiculous popularity of the Hollywood female "orgasm face."
Erica Marchand, a psychologist and sex therapist, told Mic that media portrayals of female orgasms can influence how women relate to their own pleasure. Marchand refers to the "spectatoring effect," in which women can become so consumed over anxieties about their bodies, voices or appearance during sex that they forget to actually enjoy it.
"If you're not in your body feeling what is happening, because you don't know what you're 'supposed' to like and what you're not 'supposed' to like, and if you're not there emotionally and intellectually, you're never gonna make it to orgasm," sex therapist Michael DeMarco told Mic.
Letting go of culturally propelled stereotypes about sex, including notions of female sex drive and orgasm, is the first step to releasing women from unattainable expectations.
Tackling female sexual dysfunction starts with education.
A lot of men (and women!) don't know basic facts about female anatomy and pleasure. Just take a look at what happened when Mic asked colleagues to draw vaginas.
Recognizing the desperate need for education is the first step in honestly addressing female desire disorders. Only 19 states in America require comprehensive sexual education that is medically accurate. Adolescents, both boys and girls, might never be introduced to information and anatomy that are essential to providing female pleasure like clitorises, multiple orgasms, lubrication, masturbation and safe sex. According to Psychology Today, 70% of women need direct clitoral stimulation to climax, and yet that's rarely a typical PowerPoint slide in high school sex ed.
It's important to start introducing information about female pleasure to teens and young adults as openly and frankly as society speaks about male sexual pleasure. After all, studies show that pre-menopause, age is not a contributing factor to orgasmic difficulties in women. The female libido impacts all women.
If anxieties, fears and misconceptions about female sexual dysfunctional starts at a ridiculously early age, the conversation about female sexual pleasure should start even sooner.