Female Viagra: still a tough pill to swallow? We asked experts

At last, sisters! “female Viagra” is upon us! Thanks to flibanserin (also known by its brand name, Addyi) and its revolutionary female-libido-enhancing properties, we are free. Free to pop lady-boners at the time and place of our choosing! Free to discuss the precise nature and frequency and satisfactoriness of our sexual encounters with doctors! Free to … well, reportedly, free to have about one more sexual encounter per month, assuming we are among the 9% to 15% of womenfor whom Addyi actually works.

We are also free to take this pill every day – because, unlike Viagra, Addyi is a central nervous system drug, much like an anti-depressant. We are free to experience side effects, including dangerously low blood pressure and fainting, especially when combined with alcohol. And we are free to live with a female ailment – “hypoactive sexual desire disorder” according to Dr Anita Clayton of the University of Virginia, who conducted some flibanserin trials — that some expertsdoubt even exists.

“The real problem that I have with this is that this is framed in terms of dysfunction,” says Rachel Hills, author of The Sex Myth. “For a drug to be passed, it needs to be treating an illness. So for a drug to be passed to treat women’s lack of desire, that has to be a [medical] problem.”

Hills’ concern is grounded in history. Western medicine, for all its wonders, has a distinct habit of pathologizing women’s sex lives. Aside from the fact that same-sex attraction was once considered a mental illness, and that “gender dysphoria” (or being transgender) is still listed in the DSM, you could look to Freud’s insistence that clitoral orgasms were a form of neurosis, or to “hysteria”, an illness that supposedly accounted for both masturbation and frigidity. At the height of the “hysteria” fad, one doctor estimated that 75% of women were affected. In 2015, of course, 0% of women have hysteria, because the disease doesn’t exist.

But we do have a drug that women can take if they don’t want sex often enough – although “enough” is, of course, a highly subjective term, and in a culture where women are pressured to be sexually accommodating to male partners at all times, a difficult one to measure.

Hills points out that, in reporting her book, she found that most women had an idea of how much sex should be “enough” for them, whether they actually wanted it or not.

“The women I interviewed, more so than the men even, internalized the idea that sex needed to be done at a certain frequency,” Hills says. “Which was universally two to three times a week, because that’s what they’d read in women’s magazines.”

Feeling bad about yourself because you don’t want sex as often as a magazine tells you to is less a problem with you than it is with the magazine. There’s also the fact that loss of interest in sex, to the extent that it is felt to be a problem by the woman in question, can be caused by any number of situational factors.

“The illusion that low sexual desire is a physical disease in need of a cure [is] obscuring other reasons for low desire and other, less dangerous ways of dealing with these issues,” says Dr Laurie Mintz, psychology professor at the University of Florida and author of A Tired Woman’s Guide to Passionate Sex.

In her own work, Mintz has found that “most women have such a decrease as they age and as their relationship ages”. She also lists a plethora of other reasons that sex might move down on a woman’s priority list. Number one, she says, is simple stress and exhaustion. If a woman tells you she’s tired tonight, she probably means it.

“There is ample evidence that stress affects women’s sex drives more than men’s,” Mintz says. “Other reasons include relationship issues (anger, too much closeness, not enough closeness), unsatisfactory sex and/or painful intercourse.”

Dr Clayton told me that a diagnosis of hypoactive sexual desire disorder, or a flibanserin prescription, was not intended to supplant psychotherapy. She says that HSDD (which she argues affects 10% of women) describes a loss of sexual desire that is distressing to the woman in question, and is not caused by situational factors.

“Our desire might be impacted because we don’t have any privacy, it might be impacted because we’re angry at our partner,” Dr Clayton says. “Normal desire rebounds. If we go on vacation and we have opportunities and release of stress, sexual desire bounces back. But for about 10% of women that’s not the case. They used to have what they would consider normal sexual desire … they experience a decline, or in some cases even a complete absence.”

To prove that flibanserin should be treated as a real medical problem, Clayton tells me, a questionnaire was designed – the Decreased Sexual Desire Screener – for women to take with their doctors. It’s five questions long, and asks, simply, (a) whether you used to have a “satisfying” level of sexual interest, (b) whether that’s changed, and (c) whether you see that change as a problem, and would like to fix it. Women are also given an opportunity to check off potential contributing factors, including “stress or fatigue,” relationship problems, or other medical conditions. It’s when there are no potential contributing factors, Clayton says, that HSDD might be diagnosed and treated.

Still. The price tag on flibanserin – Sprout, the makers of Addyi, were just purchased for $1bn– seems to show that there’s substantial interest in commodifying women’s lack of desire, or simply their desire to desire more than they do.

For women genuinely distressed by their lack of sexual desire – and these women do exist, and their pain is not inconsiderable – flibanserin might represent a ray of hope. But for critics, it represents both a new “hysteria” and a new “restless leg syndrome” – a disease created because there is a profit in curing it, and another way for experts to tell women their sexuality isn’t OK.

“When it comes to sex, there is no ‘normal,’” says Therese Schecter, director of How To Lose Your Virginity (for which, full disclosure, I was interviewed). “There’s no right way to have sex for the first time, no timetable for sexual experiences, no perfect amount of sex to have, and no requirement to even have sex at all. Saying ‘normal’ exists, and ‘normal’ is a moving target depending on who you ask, means there’s something wrong with anyone who doesn’t conform. Meaning, all of us.”