Female Sexual Dysfunction: “Pink Viagra,” A Dysfunctional Approach to Treatment

You may have noticed the recent hype surrounding the “little pink pill” or “pink Viagra,” a pill used to treat female sexual dysfunction, or FSD, a condition affecting nearly 50 million women nationwide. The FDA’s latest rejection of the drug flibanserin has caught the attention of a number of media outlets and women’s groups, including the National Organization for Women (NOW), who are questioning the motives behind this decision. Why does the FDA refuse to approve any drugs for women with sexual dysfunction, while men have five to choose from, plus another nineteen generic brands of these drugs? After reading many articles indicating that FSD was, in fact, an epidemic affecting millions of women (possibly myself included) and that the FDA was being outright sexist in their reluctance to approve drugs to treat it, I decided to do a little research. Instead of finding answers though, I seem to be left with questions. One in particular is: what are we treating here anyways?

So what is FSD exactly? I mean, if we are so actively seeking a treatment, we should pin down a proper diagnosis. The major statistic thrown around in the news stating that 43% of women in the US have FSD came from a study published in 1999 in the Journal of the American Medical Association. [1] In this study, sexual dysfunction was determined based on the presence of one or more of the following: lacking sexual desire, arousal difficulties (i.e. lubrication difficulties), inability to achieve climax, anxiety about sexual performance, climaxing too quickly, physical pain during intercourse, or not finding sex pleasurable. The broad range of this diagnosis is rather disconcerting. I think most women would agree that one or more of these descriptions may apply to them at one point or another during their lifetime.

Critics have challenged the 43% figure since the study first appeared. They call for more specific, quantifiable measurements in determining FSD, but it appears these appeals have been in vain. The newest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V) reflects a similar diagnostic set. The three types of female sexual dysfunctions are sexual interest/arousal disorder, genitopelvic pain/penetration disorder, and female orgasmic disorder. Again, I would not be surprised if a large number of women reported having problems with their sex life in at least one of these areas. I mean, who doesn’t want to increase arousal or sexual interest? So if nearly half of all women convey feeling sexually dissatisfied in some way or another, does that call for a mass treatment option? Does it call for an urgent response by pharmaceutical companies to discover a drug to curb this epidemic? Or, does it call for a shift of focus in the way we are diagnosing women’s sexual dysfunction in the first place?

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It seems to me that FSD may be a case of disease mongering– the broadening of diagnostic criteria in order to fuel the medical market, or by Lynn Payer’s definition “trying to convince essentially well people that they are sick, or slightly sick people that they are very ill.” [2] The major push for the “pink pill” came soon after the approval of Viagra for men in March 1998. Pharmaceuticals hit the jackpot with the medicalization of sexual dysfunction in men, so naturally, companies were eager to “treat” the other half of the population, women. The term “female sexual dysfunction” was used as early as 1997 by urologists, but diagnoses regarding inadequate sex drive in women began long before then. In the early versions of the DSM, sexual dysfunction in women was labeled ‘frigidity.’ This term has been used since the 15^th century to describe a woman’s inhibitions towards sexual excitement, but it gained particular momentum after Freudian theory regarding the vaginal orgasm emerged in the early 1900s. This theory, proposed by psychoanalyst Sigmund Freud, suggested that as young girls become women, the way in which orgasm is achieved changes from clitoral to vaginal. This false concept that a mature woman’s orgasm should be achieved through penetration is still rampant today, and one has to wonder the effects this myth has had on the diagnosis of FSD, especially female orgasmic disorder. We need to be aware of the heteronormativity of this thinking as well. If we are primarily treating sexual dysfunction in terms of penetrative sex, where does that leave non-heterosexual women?

The female orgasm is just one example of the ways social influences may be misconstrued into biologically treatable disorders. One might also draw a connection between interest/arousal disorder and the fact that we live in a sex-negative culture. Growing up, I was taught that abstinence was the morally right choice, something that’s probably familiar to many people my age. It’s no surprise that when I first started having sex, my interests and arousal were affected by this. I was questioning the morality of my actions. The concept that sex can be and should be a natural, healthy part of life is simply not taught in our society, especially to young girls. This is not taken into account, though, when diagnosing and treating FSD using a medicalized approach. There is no drug that accounts for the ethical complications we’ve given sex.

Before we jump on board the “FDA is sexist” train, let’s keep in mind broader issues that continue to negatively affect women. Disease mongering and the medicalization of women’s bodies perhaps currently constitute a more pertinent epidemic we are facing. Calling for a cure-all pill ignores the larger complexities that influence our sexual behavior and threatens to bypass viable solutions such as therapy and open communication.

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[1] E.O. Laumann, A. Paik, & R.C. Rosen, “Sexual Dysfunction in the United States.” Journal of the American Medical Association, 281 (February 10, 1999), 6.

[2] L. Payer, Disease-mongers: How Doctors, Drug Companies, and Insurers are Making You Feel Sick. New York: J. Wiley, 1992.

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Nicole Foti

At the time of publication, Nicole Foti was a post-baccalaureate student at the University of Oregon in Women’s and Gender Studies with a bachelor’s in Biology from Oregon State University. She hoped to study medicine in the future.

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