Is ‘Female Viagra’ Feminist?

A new drug divides the women’s health movement

Molly M. Ginty

Female Viagra: a tough pill for some to swallow. (Photo via Shutterstock)

It’s been called the first Via­gra for women” and hailed as a health break­through. But Addyi (gener­ic name flibanserin) is spark­ing ire just as it claims to spark desire. Is this drug a boon for fem­i­nism because it final­ly gives women what men have enjoyed since 1998: pre­scrip­tion med­ica­tion that can effec­tive­ly boost sag­ging libidos? Or are the drug’s plus­es (an aver­age increase of 0.5 to 1 sex­u­al­ly sat­is­fy­ing events per month”) not real­ly worth its poten­tial side effects of nau­sea, dizzi­ness and fainting?

Since the FDA approved Addyi in August 2015, feminist debate on these questions has raged.

Since the FDA approved Addyi in August 2015, fem­i­nist debate on these ques­tions has raged. Height­en­ing the con­tro­ver­sy is the fact that fem­i­nist orga­ni­za­tions, with fund­ing from the drug’s mak­er, Sprout Phar­ma­ceu­ti­cals, played an active role in get­ting the drug approved. Four­teen groups, includ­ing NOW, the Nation­al Asso­ci­a­tion of Clin­i­cal Nurse Spe­cial­ists, and the Amer­i­can Sex­u­al Health Asso­ci­a­tion, formed a coali­tion called Even the Score” that lob­bied the FDA as part of a larg­er goal of level[ing] the play­ing field when it comes to the treat­ment of women’s sex­u­al dysfunction.”

Does Addyi work? And is it a wor­thy fem­i­nist cause? Seek­ing answers, In These Times spoke with Sal­ly Green­berg, exec­u­tive direc­tor of the Nation­al Con­sumers League and a mem­ber of the Even the Score Coali­tion, and Diana Zuck­er­man, pres­i­dent of the Nation­al Cen­ter for Health Research and a crit­ic of both Addyi and Even the Score. Join­ing the con­ver­sa­tion were two women’s health experts who have not tak­en pub­lic sides in the con­tro­ver­sy: Mon­i­ca Raye Simp­son, exec­u­tive direc­tor of Sis­ter­Song Women of Col­or Repro­duc­tive Health Col­lec­tive, and Susan F. Wood, direc­tor of George Wash­ing­ton University’s Jacobs Insti­tute of Women’s Health and the FDA’s for­mer assis­tant com­mis­sion­er for women’s health.

Sal­ly, can you tell us why you’re a fan of this drug?

SAL­LY: We can argue whether there are four or 26 treat­ments for male sex­u­al dys­func­tion. But the fact is that there are real­ly zero phar­ma­co­log­i­cal options for women with sex­u­al dys­func­tion. A num­ber of orga­ni­za­tions believe a treat­ment like this is long over­due. The new treat­ment is approved for a very spe­cif­ic con­di­tion: Hypoac­tive Sex­u­al Desire Dis­or­der (HSDD), which has been rec­og­nized in med­ical lit­er­a­ture since 1977 and is char­ac­ter­ized by the total dis­ap­pear­ance or sig­nif­i­cant reduc­tion of sex dri­ve and dis­tress about the con­di­tion. This is the most com­mon cat­e­go­ry of women’s sex­u­al dys­func­tion, an issue that made the FDA’s list of the top 20 unmet health needs. We think flibanserin is a break­through treat­ment and hope this opens the door so women can have the same treat­ment options as men.

What do oth­ers think about HSDD and how to treat it?

MON­I­CA: HSDD is impact­ing the lives of many women. Forty per­cent of women have sex­u­al prob­lems, includ­ing a lack of sex­u­al desire, inabil­i­ty to orgasm, and pain or dis­com­fort. We want to cre­ate oppor­tu­ni­ties for women to engage in con­ver­sa­tion with their health­care providers about things that might make their sex­u­al lives bet­ter. Maybe that’s not a drug. Maybe it’s what’s hap­pen­ing in women’s lives. We’re liv­ing in a very stress­ful envi­ron­ment — espe­cial­ly in com­mu­ni­ties of col­or — and that def­i­nite­ly impacts women’s sex­u­al dri­ve. Peo­ple are not exer­cis­ing. We do not have ade­quate access to health­care. When think­ing about this dis­or­der, we should ask, How do we cre­ate bet­ter envi­ron­ments that will also help peo­ple con­nect with each other?”

DIANA: Men have drugs for one type of sex­u­al prob­lem, and that is erec­tile dys­func­tion. That’s a phys­i­o­log­i­cal prob­lem that’s quite spe­cif­ic. Women also have treat­ments for a phys­i­o­log­i­cal prob­lem relat­ed to sex­u­al enjoy­ment: vagi­nal dry­ness. There is no drug for men or women for loss of libido, which can be an emo­tion­al and psy­cho­log­i­cal issue as well as a phys­i­o­log­i­cal problem.

How well has flibanserin been shown to work, and what are the risks?

SAL­LY: For women in the clin­i­cal tri­als, the num­ber of sex­u­al­ly sat­is­fy­ing events per month went from 2.5 to 5 per month. [Edi­tors’ note: The aver­age increase of 0.5 to 1 cit­ed by the FDA includ­ed place­bo con­trols]. That meant flibanserin met the mea­sures set by the FDA, which cre­at­ed an advi­so­ry com­mit­tee that vot­ed 18 to 6 to approve flibanserin.

DIANA: There were two ways that the sex­u­al ben­e­fit was mea­sured in the stud­ies. The first was a dai­ly diary, the oth­er was a month­ly esti­mate. As a researcher, I think it’s ridicu­lous to ask women to mea­sure their sex­u­al­ly sat­is­fy­ing expe­ri­ences based on their mem­o­ry of the past month. I can remem­ber my dai­ly expe­ri­ences over the last week, but couldn’t accu­rate­ly remem­ber them over the exact time­frame of one month. The dai­ly diary found no sig­nif­i­cant improve­ment com­pared to place­bo, but the month­ly mea­sure found a small improve­ment: an aver­age of less than one addi­tion­al sat­is­fy­ing sex­u­al expe­ri­ence per month. That small ben­e­fit might be worth­while for a drug with­out risks, but that is not true of Addyi.

SAL­LY: I think there may have been some uncon­scious gen­der bias when the FDA reject­ed the drug the first two times. Drugs that treat male sex­u­al dys­func­tion have far more dire side effects — stroke, heart attack, fourhour erec­tion, etc. — and we allow men to decide with their health­care prac­ti­tion­ers about whether they’re going to take on those risks. Mil­lions of men have access to those drugs, and women should have the same rights to decide to take on the risks. There has been a lot of inac­cu­rate infor­ma­tion about this drug, includ­ing that it has life-threat­en­ing side effects. Its risks are nau­sea, dizzi­ness and fatigue. It has a black-box warn­ing not to be tak­en with alco­hol. Eleven thou­sand women were involved in clin­i­cal tri­als, and 58 per­cent of them said they were social drinkers and had no prob­lem using alco­hol in small quan­ti­ties with this drug.

DIANA: You don’t die of nau­sea, but who wants to live with it? Oth­er risks include pass­ing out and dif­fi­cul­ty sleep­ing — which could result in women nod­ding off while driving.

The day after the FDA approved the drug, its par­ent com­pa­ny, Sprout Phar­ma­ceu­ti­cals, sold for $1 bil­lion. Was this drug rushed through because prof­it was at stake?

SUSAN: I don’t think the FDA rushed it through that way. Indi­vid­ual review­ers object­ed quite defin­i­tive­ly to the approval, but the more senior-lev­el review­ers made the deci­sion to approve it, in part because of patient demand. I think that the pub­lic rela­tions advo­ca­cy cam­paign, which was financed by Sprout, had an effect on both the advi­so­ry com­mit­tee and the senior review­ers at the FDA.

DIANA: That’s what mon­ey will buy. You have a room full of patient advo­cates who were brought there — whether their way was paid or they were encour­aged by this very high­ly pub­li­cized cam­paign. The advi­so­ry com­mit­tee mem­bers are human; they’re very heav­i­ly influ­enced by peo­ple in the room, who were cheer­ing and boo­ing. So they com­pro­mised on the sci­ence, I believe, in order to please the patients, some of whom were not even eli­gi­ble to take this drug, since it is approved only for women who are pre-menopausal, not drink­ing alco­hol at all, and so on.

What does the way all of this has gone down mean for feminism?

SUSAN: Fem­i­nism is a big tent, and we all work togeth­er on some things and dis­agree on oth­ers, and that’s not nec­es­sar­i­ly unhealthy. The unhealthy aspects includ­ed the company’s strat­e­gy of divide and conquer.”

MON­I­CA: This is where fem­i­nism real­ly shows its dis­con­nect from the most mar­gin­al­ized com­mu­ni­ties. For men, Via­gra was huge. For women, I don’t know if this is. I just think there are so many questions.

DIANA: To me, the focus on this debate is very unfor­tu­nate giv­en all the very real health issues fac­ing women. For exam­ple, there are a hun­dred con­tra­cep­tives on the mar­ket in the Unit­ed States, and some are much safer than oth­ers. Women are dying unnec­es­sar­i­ly as a result of the ones that aren’t as safe. We are hav­ing a hell of a time try­ing to get any­body to pay atten­tion. It is just not a sexy issue, and cer­tain com­pa­nies have a vest­ed inter­est in mak­ing sure no one is talk­ing about it.

SAL­LY: I view this drug as a break­through for women. Men have had many treat­ment options for sex­u­al health for decades —women have had few, if any. The FDA lis­tened to women suf­fer­ing from a con­di­tion, HSDD, that under­mines their rela­tion­ships, their health and their self-esteem, and approved a treatment.

Mol­ly M. Gin­ty is a jour­nal­ist who writes for Ms., Wom­en’s eNews, On the Issues, the Utne Read­er, The Nation and oth­er pro­gres­sive publications.
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