Let's begin with the story of Viagra. It started off as a drug to treat male sexual dysfunction but over time, and with millions of dollars spent on marketing, it's become the lifestyle drug. This turn of events brought forth unexpected complaints from many wives. Used to their formally sexually docile husbands, the drug upset the whole apple cart.
Given Viagra's commercial success, scientists from around the globe have been busy trying to concoct an equivalent sex drug for women. But as they tinkered with creams, nasal sprays, pills, and patches, they encountered a small, irritating problem. While the effect of Viagra is essentially physical -- to make the penis hard and keep it that way -- boosting desire in women has proved trickier. Desire for many women stems from our brain: how we feel, our mood, the context. Enter pink Viagra: shorthand for the entire controversial enterprise -- the women who don't feel like having sex anymore, or never did, the teams of brilliant international researchers, and the pharmaceutical companies footing the bill.
Lucille, age 39, lives in Sydney and is married with two children. Of her sex drive she said, "It's very rare that I ever think about doing it and usually if I do it's after a sexy dream." With an ironic laugh, she adds: "I'm more interested in sex when I'm asleep than when I'm awake."
Research shows that lack of desire is women's number one sexual concern and once in an established relationship, women's sex drive tends to drop. A German study found that four years into a relationship, less than half of 30-year-old women desired regular sex. After 20 years the rate dropped to 20 per cent.
Fierce debate exists about whether waning desire is natural and part of the rich life cycle of a relationship or whether it's a disorder, requiring treatment. Adding to the complication, many, if not most, of the top international researchers working in the area have financial links to pharmaceutical companies. Putting aside the issue of "low libido" being pathologized, what is pink Viagra and can you get some?
There are a number of sex drugs for women but most aren't on sale at a pharmacy near you. Many are being trialed -- for the second or third time -- while most have been rejected by the FDA because they haven't been considered safe or effective enough for public consumption. Yet it's only a matter of time before one of them, or a close relative, will come out on top, and get us on top.
Drugs that target female desire are grouped by whether they affect blood flow, the hormonal system or the central nervous system. Looking at the blood flow drugs, we have Viagra and its groupies, Cialis and Levitra. Classed as phosphodiesterase 5 (PDE5) inhibitors, they increase blood flow to the genitals by raising the levels of nitric oxide, encouraging relaxation and dilation of the blood vessels. Limited research shows that women who take Viagra experience increased blood flow to their vagina and clitoris. Some research has shown that PDE5s can counter the negative sexual side effects associated with taking SSRI antidepressants and may be helpful to women with arousal disorders. But as for women in the mainstream population, studies have been disappointing. Viagra may turn women on physically (getting us wet), but it doesn't turn us on mentally. Other sex drugs targeting blood flow include NMI-870, Femprox and ArginMax.
There are also a number of promising sex drugs that work by engaging the hormonal system. Testosterone has been given to men for many years. Researchers are currently looking at how it might benefit women. The concept of female "androgen deficiency" is controversial, with some researchers believing it can cause lethargy and lack of desire. It is agreed that total circulating and available testosterone in women in their 40s is about half that of women in their 20s. (1) (Testosterone declines over time, not a sudden drop like oestrogen). That said, it's difficult to measure and there is no definitive testosterone level that correlates to low libido. Nevertheless, an increasing body of research shows testosterone therapy causes improvement in desire and pleasure for women. Safety concerns include masculization, risk of exposure to children, pets and a possible link to breast cancer.
Intrinsa (the testosterone patch), was rejected by regulators in the U.S., Canada, Australia and Asia, before gaining approval in Europe in 2006. But not for everyone. It's only available for women with diagnosed sexual problems or women who have premature menopause as a result of surgery. It was rejected in America not because it wasn't shown to work -- the panel voted 14 to 3 that the trials showed a meaningful improvement in desire and pleasure -- but because data on safety was inadequate.
As no testosterone product has been government-approved to treat low libido in women in the U.S., Asia or South-America, it has led to the off-label use of testosterone products commonly used for men, but in lower doses. (Off-label refers to using a legally available drug for an unapproved purpose, without knowing its true effectiveness or long-term health effects. Discussing this practice, Australian expert Dr. Susan Davis and her colleague Esme Nijland suggest that an uncontrolled trial of the safety of testosterone is already happening in the community.
At present, different testosterone sprays are being tested, such as Tefina, a nasal testosterone spray taken hours before sexual activity and Libigel, a testosterone gel applied to the arm. Drugs based on DHEA (dehydroepiandrosterone), a precursor to testosterone and oestrogen, can be bought in U.S. and Canada.
Hormone replacement therapy (HRT) has been around for a long time and its purported benefits include a reduction of vaginal dryness and benefiting overall sexual function. Tibolone, for instance, a synthetic hormone with estrogenic and testosterone effects, is mainly used for HRT in postmenopausal women. It is available in the U.K., other parts of Europe and Australia, but not the U.S.
Although HRT usually comprises synthetic one-size-fits-all drug combinations, American women are increasingly opting for bioidentical hormone replacement therapy. And they're not just using it as a drug to treat menopausal symptoms but as a way to increase sex drive, vitality and beauty. With celebrities such as Oprah Winfrey, Suzanne Somers and Robin McGraw (the wife Dr. Phil) fronting the trend, it has become an it drug. Blood tests are taken to determine a woman's hormonal levels, resulting in an individualised prescription of bioidentical oestrogens, progesterone, pregnenalone, testosterone and/or DHEA, followed by regular hormone monitoring. The risk with bioidenticals is that we do not know the risks: no studies exist on their long-term effects. Also, when drugs are compounded at a pharmacy, quality-control standards are brought into question.
Finally, there are the drugs that affect the central nervous system. After much media hype the pill Flibanserin was recently rejected because it wasn't considered effective or safe. And then there is Bupropion, originally an antidepressant and smoking cessation aid, which is currently used off-label for women with chronic low libido. Several studies have shown it improves women's desire, although its side effects include skin reactions and in some cases psychiatric disturbances. Known formally as the "Barbie drug" (a sunless tanning drug), Bremelanotide is impending phase 2 trial discussions in the U.S. Studies have shown that when given to female rats, they expressed more interest in males. As for human females, some small studies have garnered positive effects for genital arousal and desire.
What can we make from all this? Will our increasing cultural reliance on pills and external solutions to our problems render us Sexual Stepford wives, drugged up to provide services on command? Although most women I interviewed had no interest in taking a sex drug, a small few would do anything to feel desire again.
Spiritual and religious use of drugs has been occurring since the dawn of our species. Some religions are even based on the use of drugs. Perhaps, one day, sex drugs for women will provide a similar pathway to transcendence. The difference is we'll have to pay for it -- and it'll be some pharmaceutical company thanking the gods.
1. S. Davis and H.G. Burger (1999) 'Androgen replacement in women', in AW Meikle (ed.), Hormone Replacement Therapy, Humana Press, New Jersey, pp. 401-18.