A Dose of Desire

"It's as though the government is worried women will be turned into nymphomaniacs," she says. "Look, the FDA blocked the morning-after pill for ages. Why? Either they're worried we'll be bad girls, or they don't understand women's sexuality."

A number of drug companies say they can clear the FDA's bar, no matter how high. In January, 100 clinical trials began across the country for LibiGel, a testosterone gel made by BioSante. Women rub a dab of LibiGel into their upper arms once a day. (It builds up testosterone levels over the course of months.) There's also a German company, Boehringer Ingelheim, that discovered that a drug it developed for depression didn't lift anyone's mood but boosted desire in women. It hopes to win FDA approval for the drug in 2009.

The sooner the better, say many physicians in the field of sex medicine. They describe FSD as a kind of silent epidemic, particularly among post-menopausal women. Surveys on this issue, like just about every issue related to sex, vary widely in their results, depending on how you phrase the question. A recent paper in the journal American Family Physician combed through a bunch of surveys and decided that anywhere between 10 percent and 46 percent of women suffer from "hypoactive sexual desire disorder," a term often used for FSD.

Other studies have found that most women who are distressed by their sex lives are too embarrassed to discuss it with their doctors. Those who do speak up are often told they need a shrink.

"When I started this field in the '70s, 90 percent of the treatment was psychological," says Irwin Goldstein. "It was just assumed that every couple needed therapy."

The success of Viagra changed that. For decades, a guy who couldn't get aroused was thought to be "impotent," which carried the connotation that he needed to talk it over, on a couch, with a therapist. Viagra redefined impotence as "erectile dysfunction" and revealed that a lot of men didn't need to plumb their psyches at all; they needed greater vasodilation of the corpus cavernosum. In other words, they needed a pill.

After the launch of Viagra, Goldstein started organizing annual conferences to share research and ideas about FSD, then a relatively unknown diagnosis. About 500 clinicians, doctors and reps from the pharmaceutical industry showed up for the first Boston Forum, as it was called, in 1999. The media turned out, too. It was the moment FSD began to go mainstream.

It was also the moment that turned Leonore Tiefer into an activist. What bothered her, she says, was the idea "that women would be overtreated and given stuff they don't need that won't help." That a number of drug companies were underwriting the conference added to her sense that Big Pharma was simply cooking up a new malady, ravenously eyeing a new market. It was a criticism that would eventually gain some traction in parts of academia. An article in the Journal of British Medicine in 2003 called FSD "the freshest, clearest example we have" of "the corporate-sponsored creation of a disease."

But in 1999, the opposition consisted entirely of Tiefer and a dozen or so fellow travelers, who flew to Boston and strategized in a pre-conference meeting about how to voice their dissent.

"Someone suggested guerrilla theater, but I'm an academic, not a guerrilla theater person," Tiefer says.

Her debut, while not strictly speaking "theater," still grabbed everyone's attention. Here's how Goldstein remembers it: "She stood in the middle of the room and shouted."

The Paradox

One recent afternoon, Tiefer is sitting in a leather chair in the midtown Manhattan office where she sees patients, mostly men and women with sexual problems. She looks younger than her 63 years and has a trace of the Bronx in her voice, which somehow adds to the sense that she is on the verge of putting you in a headlock. But headlocks aren't her style. Dry wit is.