Are pills for the bedroom a good idea?
The question has divided the sex therapy community since Viagra was approved 17 years ago in 1998. And it's coming up again now. Sprout Pharmaceuticals announced this week that it was submitting its newest application to the FDA for flibanserin (or "Pink Viagra," as it's been inaccurately but charmingly called) for low sexual desire in women.
A few months ago I wrote a piece called "The FDA Wants to Hear More About Women and Sex" that we're nearing a crucial stage in the years-long debate over whether 'Pink Viagra' is potentially a good thing or not.
The article prompted an interesting comment:
"The problem is culture," one reader wrote. "Women are NOT monogamous! We get bored fast... Anytime I am tempted with a new lover it's like a whole new sexual awakening. You are simply looking for a monogamy cure!"
The author of this comment isn't completely wrong, of course. Monogamy has many benefits, but outside some traditional religious circles, few people claim it's an automatic ticket to erotic bliss.
We clearly do have instincts for pair bonding. But that's different from strict sexual exclusivity, which most people agree is not natural for us.
There's some evidence that our hunter-gatherer ancestors were at least somewhat promiscuous. Without bedrooms, bedroom doors or locks, sex on the plains of Africa must have been a pretty free-wheeling public affair.
That probably all changed when agriculture was invented and people started settling down to work the land. Hunter-gatherers have plenty of time for sex. But farming life revolves around work, which is not the greatest aphrodisiac in the world (as most of us can attest).
Most importantly, as my colleague Chris Ryan has noted, agriculture would have led naturally to stronger notions of individual ownership. MY land. MY tools. And eventually, MY spouse.
Strict sexual monogamy has always had more to do with property rights than with erotic pleasure. It's served us pretty well for thousands of years. But it's not exactly natural.
At every stage in human cultural evolution, we've strayed farther and farther from our natural habitat. For our ancestors, going north out of Africa in search of big game required the invention of shoes and warm clothing. Now, millennia later, we've got Ritalin to enable some of us to stay focused at our desks.
The concept is the same: more and more technology to help us tolerate ways of life farther and farther from the one we were first designed for. Whether it's shoes, air conditioning or sitting on toilets rather than squatting on the ground, there's not much in our lives that's natural anymore.
As I wrote in "Sex for Pleasure, for Profit, or Both?" There are plenty of people who would have us draw the line at medications for sex.
But we're not going back to promiscuous mating in small bands of hunter-gatherers. Most of us aren't going to open our marriages and take new lovers. We don't know to what extent our desire concerns are the product of the un-natural lives we lead. But if a pill were to enable some of us to accommodate a little better to long-term monogamy, then why not?
In their 2014 editorial in the Los Angeles Times, anti-medication activists Ellen Laan and Leonore Tiefer discussed a recent FDA meeting on loss of sexual desire. Describing some women who testified at the meeting, Laan and Tiefer wrote, "Their desire had simply 'turned off like a light switch,' as one woman said, sometimes as much as 30 years earlier, and they wanted it back, routine and predictable."
I found Laan and Tiefer's last phrase, "routine and predictable" a bit snarky. It seems to me that someone who hasn't felt sexual in 30 years might be grateful for it to return at all.
As Tiefer and others have pointed out, sometimes a woman's lack of sexual desire can be a rational response to relationship problems or other issues in her life. But that's not always the case. There are many women in otherwise happy, loving relationships who are troubled by lack of desire. Many have been through counseling and sex therapy and still report feeling that something is missing.
Not even a new lover, that most potent of drugs, can guarantee great sex every time. But many women who participated in the 'Pink Viagra' trials felt the medication made an important difference in their lives.
I can understand a concern that medications for the bedroom might over-simplify sex or make people even more out-of-touch with their real emotions than is already the case. Sex is a special thing, or at least should be. I can understand wanting to keep it unpredictable and somewhat wild and untamed.
Except human mating hasn't been wild and untamed for a long time. When it comes to sex, our species is a long way from home. Don't talk to me about natural. We left natural behind a long time ago.
I'll be interested to see what the FDA decides this time around.
© Stephen Snyder MD, 2014
www.sexualityresource.com
New York City
The author affirms that he has no financial stake in or professional relationship with Sprout Pharmaceuticals, and that he has not received financial compensation from any entity mentioned in this article or in any of the embedded links.