A Dose of Desire

By David Segal
Washington Post Staff Writer
Wednesday, March 12, 2008

Viagra turns 10 this month, and didn't time just fly? It seems like only yesterday we started guffawing at the Symbolism for Dummies ads on TV for the little blue pill and its "erectile dysfunction" rivals -- footballs tossed through tires, faucets erupting. The spots ended with a list of potential side effects that sounded like a satire of potential side effects. "More than four hours ?" we winced. "Ouch."

However discomfiting the commercials, the Food and Drug Administration's approval of Viagra -- on March 27, 1998 -- is a landmark day in the history of sex. It seemed at the time like a biomedical revolution was upon us all, and about five minutes after word of the magical med went global, the question first was asked: Where is the women's version of Viagra?

The short answer: They're still working on it. A bunch of companies have tried and failed to create "pink Viagra," as it's often called. Other companies have drugs in late stages of clinical testing, including a gel that recently began a make-or-break nationwide study with several thousand women. Give us five years, maybe less, say the most optimistic researchers and doctors. Though it's unclear exactly how many women would ask for a prescription, no one doubts that the first company that gets to market a remedy for female sexual dysfunction, as it's formally known, will earn a fortune.

But as this race reaches what could be its final lap, not all of the spectators are cheering. Some, in fact, are booing as loudly as they can.

A modest-size but fervent group of psychologists, academics and public health advocates contend that FSD isn't an authentic medical condition, or at least not the sort of problem that should be treated with drugs. These aren't the obtuse male physicians who for decades have been telling women distressed by their lack of libido that "it's all in your head." The anti-FSD crowd is mostly women, many of them self-described feminists. The most prominent is Leonore Tiefer, a psychotherapist and clinical associate professor at New York University, who has long decried what she calls "the medicalization of women's sexuality."

"Drug companies want to say to women, 'You don't need to know anything; you can have the satisfying sex life that you seek -- people dancing on TV, the whole bit -- without knowing anything. Just ask your doctor,' " she says. "I resent that, because there are specific harms that come from being ignorant and dependent in the world we live in. There may be lots of people who aren't interested in sex, but is there a medical reason for that, and do we diagnose that?"

Tiefer's critique centers, in part, on the way that pink Viagra is sure to be marketed -- with ads day and night, suggesting that women who aren't feeling frisky have a medical problem. She and her allies -- organized as the New View Campaign -- are also galled that so much money and media attention are heaped on the lust drug, even before it exists, when for many women the solution to their libido problems isn't that exotic. Maybe they have a partner who hasn't a clue about technique.Maybe they're stressed out. Maybe they can't possibly get in the mood because they're so busy raising children. Therapy, counseling, even free day care, says the New View Campaign, might do more for women's sex lives than any drug company ever could.

"People walk out of their doctors' offices with a prescription in hand 85 percent of the time," says Meika Loe, the author of "The Rise of Viagra" and a New View endorser. "But health insurers won't pay if you want to talk to a counselor or if you need advice about how to communicate your sexual desires. We've got a health-care system that is almost entirely focused on medical solutions."

On the other side of the FSD divide, allied with the pharmaceutical companies, is a group of physicians who are prescribing off-label treatments for women vexed by their sex lives. (Off-label means the drug hasn't been approved by the FDA for that specific treatment.) The highest-profile of the bunch is Irwin Goldstein, the director of sexual medicine at San Diego's Alvarado Hospital. He and Tiefer have debated the topic of FSD for a decade, but as far as he's concerned, there's really nothing to discuss. He's been using hormones to treat women, and he'll happily put you in touch with patients who will rhapsodize about the results.

Women like Virginia, a 60-year-old native of Britain and an artist who, for privacy reasons, asked that her last name be omitted. She'd spent years asking doctors for medical help to boost her sex drive, which had once been voracious. All of them, she says, "rolled their eyes and harrumphed and tried to change the subject."

"But when I was younger, a really strong libido was just part of who I was," she goes on. "Losing that was like losing a good friend."

Three years ago, she heard Goldstein interviewed on National Public Radio. Within weeks she flew to Boston, the site of his practice at the time, and she soon was taking several hormones. There was tinkering with the combination and the dosage, but a few weeks later she suddenly felt "perky" -- more confident about herself as a sexual being and more attractive. She also started having better sex.

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