Sprout Pharmaceuticals has framed the FDA approval of Flibanserin as a feminist victory. But this book actually is one.
  • Simon & Schuster
  • Sprout Pharmaceuticals has framed the FDA approval of Flibanserin as a feminist victory. But this book actually is one.

If you’ve been on the internet at all today, you’ve likely heard about the recent FDA approval of Flibanserin, the drug intended as a Viagra for ladies that promises a whopping 0.8 more “satisfying sexual events” per month, if you feel like risking nausea, dizziness, sleepiness, low blood pressure, and fainting. A lot of this coverage has been deeply rosy, touting the drug’s approval as a win for gender equality in pharmaceuticals, as if that is a thing given that we live in a country where something as basic as birth control is not nearly as accessible as it should be.

Anyway, in all matters of science and sexual health, I defer to Emily Nagoski, who has a Ph.D in this stuff, and came to Powell’s back in March to promote her new book, Come As You Are. It’s one of the only author readings I’ve been to where audience members teared up multiple times and actually asked great, necessary questions. Nagoski’s been an outspoken critic of Flibanserin, and its parent company, Sprout Pharmaceuticals, and for good reason. To put it mildly, there are plenty of red flags w/r/t Flibanserin. But the biggest is the drug’s ties to a wacky campaign called Even the Score, whose messaging frames FDA approval of Flibanserin as an issue of gender equality, because Viagra was approved by the FDA, and now it’s our turn, ladies! Or something. The NY Times has some wonderful coverage on the messaging groups and big pharma companies that worked on that campaign. Meanwhile, feminist rhetoric is off crying in a corner about this, feeling so misunderstood right now, and Nagoski’s made some really useful points about what’s actually going on. Here, she tackles Even the Score’s claim that “there are 6 FDA approved drugs to treat various sexual dysfunctions for men (41 if you count generics!), but still not a single one for women.”

I find it pretty easy to disagree “that gender equality should be the standard when it comes to access to treatments for sexual dysfunction.” I think it’s pretty inarguable that safety and efficacy should be the standards when it comes to access, approval, and every other aspect of pharmaceutical treatment. Gender equality is in the mix, for sure, but I’d rather have no drugs than an unsafe and/or ineffective drug.

Nor do I agree “that the approval of safe and effective treatments for women’s sexual dysfunction should be a priority for action by the FDA.” The reason I don’t agree with that is because “Even the Score” ignores the fact that there are NONPHARMA interventions THAT WORK – which is more than any drug can claim.

I’ve said before sex doesn’t have to be THE SAME in order to be FAIR. Similarly, a health intervention doesn’t have to be the same, it just has to WORK – and if what works for one group is different from what works for another group, so be it.

So let’s talk about “the score.”

First of all, I don’t know where the “26:0″ score comes from. I emailed the Even the Score folks, asking for a list of the 26 drugs, but have not received a response yet. I’ll let you know if I do. However, according to a 2013 report from the European Association of Urolology, there are three (PDF, p. 20), and a meta-analysis comparing different drugs compared 5: sildenafil, udenafil, tadalafil, vardenafil, and avanafil. So there might be 26 individual formulations, brands, combined drugs, and slightly-altered-so-as-to-keep-copyright drugs, but really there’s three… or five… and they’re all PDE5 inhibitors. And some of them don’t work very well…

So. I don’t know what” the score” actually is, I don’t even know how we would go about calculating it. But if we count “interventions that work,” rather than only counting “interventions with potential profit for pharmaceutical companies,” the score is way, way closer.

This—ignoring non-pharmaceutical treatments—seems like a pretty big omission. To this I’d add only that if you look at the list of sponsoring organizations on Even the Score’s website, some key reproductive health orgs are absent: The American Congress of Obstetricians and Gynecologists, for example, are often a group to look for when it comes to advocacy for reproductive health. If ACOG signs off on something, it’s usually a sign of legitimacy. But while a group evidently called the Blue Thong Society is listed as a supporter, ACOG is notably absent, as is Planned Parenthood.

Another interesting finding from Nagoski refers to patients who testified as to their need for the drug, who have what Nagoski calls “responsive” rather than “spontaneous” desire—a characteristic that isn’t so much a medical problem as a very normal way of experiencing desire:

ASHA, ARPH, and even the FDA itself have not recognized what the American Psychiatric Association has: that responsive desire is a normal, healthy variation on the experience of desire, and that spontaneous desire – fun as it is – is not necessary for normal, healthy sexual functioning. They are, it seems, tied to an understanding of sexual functioning that puts desire, “wanting,” at the center, when the science and social justice would, I believe, put PLEASURE at the center of sexual wellbeing.

Those of you who’ve been reading the blog for a long time have been hearing about responsive desire from the very beginning. Quick summary: responsive desire begins in response to arousal, as contrasted with spontaneous desire, which begins in anticipation of arousal. (That’s not a technical description – technically all desire is responsive, it just feels spontaneous for some people, sometimes.)

Many of the women participating in the trials describe their pre-drug sexual desire as responsive – which is a normal, healthy way of experiencing desire – except they hated their responsive desire. They believed that their lack of spontaneous desire meant they were broken. They felt profoundly inadequate, and their partners agree with that assessment.

That piece right there speaks volumes, I think, as to why this drug isn’t a feminist victory of any kind. Wouldn’t it be more empowering to offer women an effective, scientifically proven, side effect-free way of approaching their own sex lives? I’m glad you asked! If you’re interested in learning more about responsive desire—and the many non-pharmaceutical approaches to maximizing yours if you, like many women, experience it—I can’t recommend Nagoski’s book highly enough. Go get it, really. The price for Flibanserin hasn’t been released yet, but I highly suspect that Come As You Are is cheaper—and more effective. In other words:

Me too, Emily. Me too.