A Dose of Desire

She didn't shout at that 1999 meeting, she says.

"I didn't need to shout, because I had a very good point to make: That the meeting was window dressing for the pharmaceutical industry."

Tiefer led the quiet life of a Manhattan psychologist until 1998. She's been a feminist since the early '70s, she says, but when she got involved with a cause, she was always in the audience, not on the podium. Soon after FSD turned up, it dawned on her that she was as qualified as anyone to lead an attack. So she put together the New View Campaign, which now has a Web site, dozens of endorsers (such as the American College of Women's Health Physicians) and a manifesto.

Tiefer's argument can sound a little paradoxical -- it's clearly intended to help women, but at the same time, it tells women they can't have a medication that might enhance their lives. This raises some obvious questions, each of which she bats away.

What if women who are distressed by their sex lives really want a libido drug?

"Medicine is not a retail operation," she says. "It's not a consumer-demand issue. Just because people want things doesn't mean it should influence definitions, classification, research."

If pushed, she will agree that in the best of all possible worlds, yes, a medical option would be part of the vast arsenal of tools to help improve women's sex lives, along with therapy, couples counseling and so on. But this isn't the best of all possible worlds, she says. It's a world where the drug companies set the agenda, and if and when they start selling pink Viagra, it'll stigmatize women who aren't interested in sex, even if they're not bothered by that lack of interest.

Okay, but what if a drug company created a libido enhancer for women and sold it in a way that didn't imply that women who weren't interested in sex have a problem?

"That's like asking me, 'If people sprout two heads, should they wear two little hats or one big one?' I can't get with that assumption."

Mention Tiefer's name to physicians in the sex medicine field and they sound exasperated very quickly. To their ears, there is something self-interested in an argument from a psychologist who says counseling is the answer.

"Go back to the '50s and '60s and it was said that 95 percent of erectile dysfunction was psychological," says Andre Guay, a urologist in Massachusetts. "Then urologists get involved, and now we know that 95 percent of it is medical. That's taken a lot of people away from consulting with psychologists. They're worried about losing the other half of their business."

For the record, Tiefer says the number of men she treats has never even dipped. Perhaps talk therapy will always be part of any comprehensive approach to helping both women and men who want more lust in their lives. (All of Goldstein's patients see a psychologist who is part of his staff.)

But the more you know about what is happening in research labs around the world, the more the debate about female Viagra starts to seem a little quaint. We're getting closer and closer to understanding sexual gratification in its most basic chemical terms.

A small group of neuropsychologists, for instance, are using technology to pinpoint exactly what happens, biologically speaking, in the mind of women in sexual ecstasy. One of those is Barry Komisaruk of Rutgers University, co-author of "The Science of Orgasm." In his Newark laboratory he is at work on research that you really need a smock and a PhD to attempt. He's hooking up women to functional magnetic resonance imaging -- a kind of souped-up MRI, which tracks neural activity in real time -- getting a brain image as they self-stimulate.

He now has what is arguably the least romantic account of female sexual satisfaction ever: It's a flood of the hormone dopamine to a part of the brain called the nucleus accumbens. A pill that could produce that experience would be no substitute for a relationship, he acknowledges.

"And I see the potential for abuse by pharmaceutical companies, who have been guilty of creating illnesses to sell drugs. On the other hand, if a woman is distressed by the lack of sexual desire in her life and we can help her, why not?"