Female Viagra: Discrimination or Medicalization or Something Else?

Earlier this year, the flibanserin pill, aka “female Viagra,” was introduced to the market, generating tons of headlines. After many years in which the plain old (male) Viagra was the sole sexual stimulator in the market, flibanserin was finally approved last August, following an 18-6 vote by the FDA advisory committee.

Before approval, flibanserin was rejected twice, and reports say that even members on the advisory board who voted in favor still had misgivings despite their final decision. Their concerns were driven by doubts regarding flibanserin’s effectiveness to treat low sexual drives. Trials showed that women who took the pill ‘earned’ only 0.7 “sexually satisfying events” in a month, whereas the drop-out rate due to negative side effects was relatively high – 14%. The side effects associated with flibanserin are low blood pressure, dizziness and such.

So what made this low cost-benefit ratio get the advisory committee’s approval the third time around? Some credit mass political campaigns promoted by women’s organizations claiming to advocate women’s interests. One position advocated by the organizations presented the pill as a treatment for a legit medical problem called HSDD (hypoactive sexual desire disorder), and it was said to be a step towards realization of women’s sexuality. The other side of the debate pushed back against what they perceive as medicalizing another realm of women’s sexuality and subjecting it (again) to the gaze of the male expert.

The drug’s opponents say HSDD is not a real disease but rather another case of medicalizing behaviors within the realm of human diversity, pressuring women for ‘better performance’ in bed while reinforcing sexual normalcy, discouraging alternative styles of sexual fulfillments, etc.[1] The group initiated a campaign called “Campaign for a New View of Women’s Sexual Problems” which calls to critically observe attempts to label women’s sexual behavior as pathological. It performs “watchdog activism” on pharmaceutical companies and promotes the use of a social constructivism perspective to push back against medicalization.

The drug promoters on the other hand, advocate for the exact opposite. They actually blame FDA for discriminating against women in failing to approve the drug more quickly. The two main organizations “Even the Score” and “Women Deserve,” backed by a massive coalition, initiated a campaign called “26-0,” referring to how many male sexually stimulating drugs were approved (26) as opposed to (0) drugs approved for women. They signed a petition calling on the FDA to approve flibanserin, and were said to show up at the advisory committee’s meeting room with mass supporters and new data that tipped the point for approving the drug. Instead of repeating their claims, I encourage you to watch this great parody illustrating their core argument: when it comes to sexual functioning, women need help too.

With respect to my modest feminist engagement, I think that claiming discrimination in FDA’s failure to approve flibanserin more quickly is one of the most cynical uses of sex equality terminology I have ever come across. And yet, I’m not buying into the wrongful medicalization argument either. In fact, I think it’s counter-productive to argue that a pill meant to help people have better sex (or sex at all) is great for men (because men obviously want to have sex), but bad for women (because women, well…).

Yet, with respect to what I’ve learned on the topic so far, and despite the cynical use of equality terminology, I still don’t think the FDA approval was necessarily wrong. It seems to me that the target crowd for the pill is women in later stages of their sexual life with firmly established agency. Also, the potential harms aren’t severe; low blood pressure and dizziness seem to be manageable, especially as this is a prescription drug given by a doctor. So generally, I don’t have a problem with a consenting informed adult, who thinks she could benefit from an extra 0.7 satisfying events per month on average.

I do think, however, that she deserves better, that women deserve better, a better medication to address their special needs than what was finally approved. If getting a better medication was what motivated the “Women Deserve” coalition, shouldn’t they have  utilized their political influence to encourage pharmaceutical companies to develop a product that fulfills this aspiration? Proving there’s a financial potential here would have probably been enough. Instead, they campaigned to get the FDA approval on (what seems to be) a frail drug, which may also discourage incentives to develop a better one in the future. Maybe, women’s purchasing power will make the argument that organizations didn’t.

[1] Leonore Tiefer, Beyond the medical model of women’s sexual problems: a campaign to resist the promotion of ‘female sexual dysfunction’, Sexual and Relationship Therapy, Vol. 17, No. 2, (2002).