THE BLOG

The FDA, Sexual Dysfunction and Gender Inequality

02/07/2014 10:17 pm ET | Updated Apr 09, 2014
  • Anita H. Clayton, MD Interim Chair, Department of Psychiatry & Neurobehavioral Sciences; David C. Wilson Professor of Psychiatry; Professor of Clinical Obstetrics and Gynecology, University of Virginia School of Medicine

Throughout our society, gender inequality is evident -- in politics, employment, pay, attitudes and drug approvals, specifically medications for female sexual dysfunction (FSD). While sexual dysfunction is more common in women than in men (43 percent vs. 31 percent), the FDA has approved 24 treatments for sexual dysfunction in men* and ZERO for hypoactive sexual desire disorder (HSDD) or low sexual desire that causes marked distress, the most common form of FSD.

Our culture continues to manifest gender bias. Some of it is about power (if someone else gets something, it means I am giving up something). Some of it is about paternalism (we know better and need to protect women from poor decisions). And some of it is about fear (who knows what women might do if they wanted to have sex and could do so without repercussions).

But in reality, the gender disparity isn't because most people want to keep women from being all they can be. It is far more insidious than that. It is being able to see and valuing an erection (the most common sexual dysfunction in men is erectile dysfunction or ED) because it is necessary for sexual activity in men. But sexual desire is not valued because it is not necessary for a woman to have desire in order to participate in partnered sexual activity. And if sex can occur without desire, the thought that follows is that lack of desire must not be a serious problem.

While male and female sexuality are more similar than different, they are not the same and cannot be measured in the same way. The requirements for FSD drug approval were based on male sexuality, rather than acknowledging the process of female sexuality and establishing the measurements from that perspective. Viewed from this male-centered focus, the FDA has acknowledged by its approval of so many drugs for male sexual dysfunction that men are able to make informed medical decisions to take drugs that can lead to prolonged, painful, damaging erections or even death. But the FDA has set a very high bar to measure the risks and benefits of a medical treatment for FSD, as if women do not have the capacity to make informed medical decisions. This is patently ridiculous since women actually make most of their family's medical decisions.

The double standard is striking. A recent public opinion poll commissioned by the International Society for the Study of Women's Sexual Health (ISSWSH) showed that American women of all political parties see that disparity clearly. Almost 60 percent believe that society places more emphasis on men's sexual satisfaction than on women's. Nearly half surveyed believe medical treatment options for conditions that uniquely affect women often lag decades behind those for men. Almost two-thirds believe the disparity in federal approval of treatments for sexual dysfunction in men vs. women is inappropriate, and 54 percent believe that drug treatments for women should not be held to stricter standards for approval than drugs for men's sexual health. Finally, three-quarters of respondents believe that women can discuss with their health care provider, the risks and benefits of medical treatments as easily as men.

Sexual functioning cannot occur without functioning biology -- for women as well as men. Of course, pharmacologic treatment is not for all women with HSDD, and no drug will work for every woman who needs a medical intervention. But women should have a medical treatment option for this condition.

Until that happens, women with HSDD will intensely feel the loss of their desire, remain distressed and be concerned about the impact on their intimate relationship. They will continue to turn to what IS available out there -- psychotherapy, supplements and drugs for men -- to no avail.

For the millions of women with HSDD, the FDA must overcome the problem of institutionalized sexism -- unconscious and perhaps unintended, but damaging nonetheless. Right now, there is an opportunity to change the situation. Women need and DESERVE a medical treatment option for hypoactive sexual desire disorder. The FDA must do the right thing and consider the scientific data on efficacy and safety fairly, without genderbias.

*References: There are 24 FDA-approved treatments for either erectile dysfunction (ED) or low testosterone: low testosterone treatments, PDE5 inhibitors, Peyronie's disease and alprostadil treatments