February 2017

The Medicine

by Karen Hitchcock

Sex and pharmaceuticals

It was championed by women’s groups, but Addyi is not the “female Viagra”

Towards the end of 2015, in a third-time-lucky bid by Sprout Pharmaceuticals, the US Food and Drug Administration gave its tick of approval to a new drug called flibanserin. It was the first drug approved to treat “female sexual interest/arousal disorder”. The following day, Valeant, a major pharmaceutical company, acquired Sprout for $1 billion. Flibanserin – colloquially known as “the female Viagra” and marketed under the trade name Addyi – had been twice rejected by the FDA, due to its dangerous side effects and minimal efficacy. The drug was a failed antidepressant shown in trials to increase the number of “sexually satisfying events” by about half an “event” per month, when taken daily. Fainting and sedation are common, and complete abstinence from alcohol is necessary while on the medication. Upon the drug’s FDA approval, Dr Irwin Goldstein, a sexual medicine expert and paid consultant for Sprout, said, “If you have a broken leg, a broken toe, or a broken libido, you can now go to a doctor and get help.”

Studies show that about 40% of women report some sort of sexual problem, and that about half those women are distressed about it. The numbers aren’t dissimilar for males. When a man goes to a doctor with a troubling sexual problem it’s usually because he can’t get or maintain an erection, or because he prematurely ejaculates (officially defined as “less than one minute of penetration”). The most common distressing symptoms reported by female patients are painful sex or a lack of interest or pleasure in sex. Male patients want to, but can’t. Female patients don’t want to, but want to want to.

The story behind the final FDA approval of Addyi is noteworthy. Sprout spun the issue of the FDA rejection from one that rested upon efficacy and safety into one focused on gender inequality. It provided funding for the “Even the Score” campaign, which signed up large feminist organisations and politicians to support the claim that the FDA had turned the drug down due to underlying sexism. Even the Score paid for the travel costs of patients and activists to attend FDA meetings, where they gave positive testimonials. It was perhaps the first drug trial where the final outcome was determined by a highly manipulated and terrifically ignorant public.

Addyi is no “female Viagra”. Addyi is a modern-day would-be aphrodisiac, although it is interesting that none of the marketing so much as whispers the word. Viagra and the other drugs like it aren’t aphrodisiacs. They act to dilate the blood vessels of the penis and keep them full of blood, so that – when aroused – a man can get and maintain an erection. When Viagra was launched in the US market, half a million scripts were written in the first month. When Addyi was launched in October 2015, it was only prescribed to a little over 200 patients in the first month. Given it had arguably been cleared for market on the strength of a gender equality campaign, the pills were priced accordingly: the same as Viagra. (Despite the fact that, unlike Viagra, which you take 30 minutes before you need it, Addyi needs to be taken every day.) Turns out there’s not that many women who are willing to completely abstain from alcohol, tolerate myriad side effects and spend $800 a month for the chance of six extra orgasms a year.

Drugs (particularly the licit ones) are rarely successful at increasing or decreasing desire for anything – be it for food, other drugs, sex, change, leaving the house or hard work. And an understanding of human desire is not really part of the modern medical paradigm. The only reliably aphrodisiac drug is methamphetamine, which besides being illegal and addictive has its own host of side effects. So other than prescribing a pretty-pink, ineffective, risky and expensive drug, how might a doctor help her patient who wants to want to? Most medical guidelines suggest sex and couples therapy (which has a 65% success rate), new partners, erotic literature or vibrators as the most successful way to increase a female’s interest and pleasure in sex. The start of 2013 saw the biggest UK baby boom in 40 years. The most convincing reason sociologists have come up with to explain this boom is the huge sales spike in copies of Fifty Shades of Grey in May 2012. And the book costs less than a single dose of Addyi.

Late last year, five girlfriends and I went to Sexpo with tickets we pilfered from the ABC. Dozens of complimentary tickets had been distributed to the ABC staff, most of them theatrically abandoned on tearoom counters or pitched off like rattlesnakes. That sort of sealed it for me. And all the friends I asked accepted with glee. It was like a huge indoor market where the stallholders only sold things to do with sex: vibrators and other prostheses, cheap lingerie, instruments of torture, and multi-flavoured, coloured or glow-in-the-dark lube. It was mostly hetero-norm in its focus, and mostly crowded with heterosexual couples in their 30s to 50s.

There were (very sad) live peepshows that still haunt me, and two main-stage performances. The first was a dance routine performed by two women, who by the end were completely naked, covered in wet silver paint and simulating what seemed to be sensationally satisfying lesbian sex. The second was a group of six muscle men, dressed as tradies, who never laid so much as a finger on each other, and for the grand finale revealed only their arses. Talk about gender discrimination.

And, look, I could give a scathing feminist critique of Sexpo. But in the end I was happy for everyone in the festive crowd negotiating their way up and down the aisles, unashamedly looking for ways to increase their pleasure. The women were far more likely to find their get-off there than in anything dispensed to them by a pharmacist.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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