“Go and get yourself fixed up, Sheila.” Flibanserin and Hypoactive Sexual Desire Disorder

Colbert’s “Cheating Death” segment usually contains some quality snark. This particular piece opens with a satire on hormones being pushed to women throughout the lifecycle.

Then, starting at 2:10:

Stephen Colbert: “Next up: Heart Health. Folks: Drugs called “statins” are effective in lowering cholesterol. That’s why I crush statins on my bacon chilli corndogs. But a study unveiled Sunday shows that when taken preventively, the statin drug Crestor dramatically reduces the risk of heart attack, even in people with normal cholesterol. This is a great breakthrough in the battle to find things to prescribe to people who don’t need them.

But, of course, some Hippocratic oafs don’t wanna prescribe it.

Random Dr: “If we’re talking about lifelong therapy for health people, I think we need a cautious approach, to do this.”

Colbert: “Sounds like someone hasn’t gotten enough free Crestor pens. Now, true, the drug costs a hundred dollars a month, but that’s a small price to pay to not have the heart attack that there’s no way of knowing if you would have had. But if you’re still hesitant to medicate yourself when you’re healthy, Prescott introduces – VAXACREST! Vaxacrest eliminates your concerns about taking Crestor for no reason by dramatically increasing your cholesterol count until your heart is pumping liquid nacho cheese. Side effects of Vaxacrest may include fallopian tapeworm, runaway gums, and Mind of Mencia.”


Statins can be a useful drug in those with heart disease or at high risk for it. However, as Colbert notes, the pharmaceutical industry has a deep interest in developing large, lifetime markets. Healthy young people who will live for many years and who are worried about their health are the ideal market – they can afford their drugs, and they’ll be taking them for a long time.

The false binary of “invented” and “real” disorders is blurry enough*; aren’t we all worried about our health? Is anyone actually in 100% perfect health? Doesn’t everyone want to live forever? Don’t we all want to “fulfil our potential”, to live the same way we think our idols do, to not feel like we’re missing out on something?

There are a lot of possible responses to not being quite where you’d like to be in life – or not quite where you “should” be. But the pharmaceutical industry would like you to turn to drugs, not just as first-line treatment, but as “prevention”. And the best way to sell drugs to well people is to convince them that they’re sick.

Hypoactive Sexual Desire Disorder

News sites have been abuzz this year with “Hypoactive Sexual Desire Disorder” in women. Because it’s new? Nope! Because it’s increasing? Nope! Because there’s a drug trial in process? Yup!

Selling testosterone to women for HSSD never quite got off the ground. A few take it, but the spectre of hairiness and a deeper voice is rather off-putting to a lot of women (and/or their male partners) – not surprising, when these things are so deprecated by those who enforce rigid gender binaries and ideas of “femininity”. What’s the point of boosting your desire if the treatment makes you “unfuckable”? Now that there are non-androgenic drugs in the pipeline, pharm companies are rubbing their giant paws together, dollar signs throbbing.

The Washington Post (among many others) a few weeks ago reported the results of a study of the prevalence of HSDD in women.

In a double whammy for the female gender, new research shows that 40 percent of women report sexual problems, but only 12 percent are distressed about it. […] But 12 percent of 83 million U.S. women aged 20 to 65 is nothing to scoff at, noted a related editorial in the November issue of Obstetrics & Gynecology. […]

Overall, 43.1 percent of those surveyed reported some kind of sexual problem: 39 percent reported diminished desire, 26 percent reported problems with arousal, and 21 percent problems with achieving orgasm.

Only 12 percent, however, reported significant personal distress associated with this problem.

Here’s a clue, folks – if there’s no distress, it’s not a “sexual problem”. It’s the way things are. Asexual is a fine way to be. Not wanting as much sex as a partner does is a fine way to be. Not wanting as much sex as the folks in romantic comedies or porn flicks is a fine way to be. Not wanting as much sex as your doctor tells you you should be wanting is a fine way to be.

Desire that’s less than average but that doesn’t bother the desirer isn’t “diminished”; it’s the amount of desire a person has, no less, no more. Not getting aroused when you don’t want to isn’t a “problem”, it’s a perfectly ok state of being. Not orgasming, if you don’t want to orgasm, is what it is – you living your life. Defining women’s lack of constant availability of sex as a “problem” when it’s not a problem for the woman is rape culture at its finest – women’s bodies as vessels for men’s pleasure, problematic only when they say “No.”

And the “double whammy”? I guess that’s because women are just not distressed enough about the fact that some of them have things on their minds other than lying down and spreading ’em. If you’re going to be frigid, you could at least be dismayed, ladies. Defective on two counts!

Diagnostic Criteria for HSDD

There’s a big knot in the clinical definition of HSDD, and it’s an ugly one. The official criteria can be found here, and they are:

1. Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person’s life.

2. The disturbance causes marked distress or interpersonal difficulty.

3. The sexual dysfunction is not better accounted for by another mental disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

“Or interpersonal difficulty”. In other words, if your sexual desire is at a statistically low level that you’re perfectly comfortable with, and your partner yells at you and throws things because he can’t get his end off, you have a disease.

One that needs drugs, according to the pharmaceutical industry, just as soon as they have a drug you might be willing to take.

capsulesThis is where the drugs come in.

Drugs made by Boehringer Ingelheim, who funded this study, and who are funding ongoing clinical trials into flibanserin, a drug that fiddles with neurotransmitters. The funding is the bit we know about. Who knows whether this study, or any other, was written by the scientists and clinicians whose names are on it? Wyeth has been ghost-writing “scientific” journal articles on hormone replacement therapy for years, according to the New York Times, even after it was shown to be causing breast cancer. The pharmaceutical industry has no scruples when it comes to hoodwinking doctors and damaging or killing women for a profit.

And so, we will continue to receive press releases from Boehringer Ingelheim, uncritically regurgitated by the mass media. They will continue their “Bouquet” trials, whose acronyms coincidentally resemble a series of flowers, which chicks lurrve – ROSE (Researching Outcomes on Sustained Efficacy), DAHLIA, VIOLET, DAISY, ORCHID, SUNFLOWER and MAGNOLIA. The Bouquet studies aim not to investigate HSDD and flibanserin, but explicitly to “demonstrate the efficacy and safety of flibanserin to support regulatory approval of flibanserin to treat this common and distressing condition.”

The ROSE study is now completed, though it’s not yet published in a peer-reviewed journal. Did it even attempt to measure satisfaction with treatment, or happiness? No. But the women in the study apparently reported an increase in mean desire score and in “satisfying” sexual events, and in Female Sexual Function Index score. And an increase in urinary tract infections. W00t.

The Real Double Whammy

In other news, the company has also applied for a patent for the Use of flibanserin in the treatment of obesity. A drug that advertises that it will make women skinny and gagging for it? Can you imagine a bigger pharmaceutical gold mine?


* A closing note: There are traps and pitfalls to critiquing and debunking Big Pharma’s drive to pathologisation, and I face those pitfalls full-on. Pathologisation is but one side of the coin; the other side is the denial of real problems both by the medical industry and by wider culture. Both of those issues are huge, and they’re interlinked, and I’ve posted about both of them. There are a number of Hoydenizens whose illness have been denied, dismissed, and ridiculed – and who ourselves have been pathologised, sometimes in derogatory and threatening ways, for feeling the symptoms of our illnesses. I’m one of them. When the reality of our problems is institutionally acknowledged, it tends only to be acknowledged in contexts and in ways that benefit the medical industries, not in ways that benefit us. Our illnesses are accepted when there’s a drug available, and not before. If there is no drug available, we are misdiagnosed with a disorder that doctors do feel comfortable attempting to treat. We are shoehorned into boxes into which we do not fit.

Please don’t read this post, or any of this series, as denying the reality of stigmatised disorders. Just as some people very much benefit from statin drugs, for example, there may be people who might benefit from the other treatments I’m going to discuss. This series is intended to critique the motives and behaviour of the megapharmamedicopatriarchoindustrial complex in aggressively expanding their markets, and the ways in which bigotry and capitalism intertwine in that process. If it’s not yours – don’t pick it up.

Categories: ethics & philosophy, gender & feminism, health, medicine, skepticism

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22 replies

  1. Spot on L!
    The medical industry is also trying to medicalize perfectly natural lowering of testosterone levels with age (despite low testosterone being a good way to lower the risk of prostate cancer progression and baldness), and the criteria are analogous to those you cite for females.
    Great feedback loop for big pharma … make the old goats randy, demanding, ….
    Did you catch "The Role of Medical Language in Changing Public Perceptions of Illness" (doi:10.1371/journal.pone.0003875) in PLoS ONE which goes into the quantitative detail of how relabelling a condition affects perceptions of its severity, even when the full description of the condition is given to the test subject?  They studied well-known conditions, as well as the (beloved of Big Pharma) "newly medicalized disorders".

  2. Amen, sister. I just don’t see how you can define something as a problem or dysfunction if the person experiencing doesn’t feel it as such. And who the hell decided that women should always be sexually available, and if they aren’t it’s a medical issue, anyway? Why isn’t it OK for a woman to just not want to get laid?
    And seriously, an obesity treatment too? WELL SIGN ME UP! I can just be the patriarchy’s ideal woman then, a size 2 on my back with my legs spread all the time!
    slave2tehtink’s last blog post..Little Altars Everywhere

  3. Great post!
    I found out that the skeevy ob/gyn professor at my medical school that creeps out a lot of the female students was involved in that libido enhancing research. I was not surrpised.
    Just like I was not surprisedwhen I read about Wyeth. Thanks for mentioning that, too.

  4. Wow. Just: wow. Absolutely none of this surprises me, but this particular medicalization just smacks so unabashedly of the car-crash between misogyny, problematizing people for profit, and outright lying with real medical consequences it’s especially disgusting.
    And slavetotehtink, ‘size 2 on my back with my legs spread all the time’ – seriously. Reading this, I was having visions of those evil electric pencil sharpeners that moan when you stab the pencil into their ‘vagina.’
    Theriomorph’s last blog post..Gilly goodness.

  5. Great post. Can you imagine how men who are sexually inept or inconsiderate would love this medical backing in the sack?
    Her: [any of] You’re a lousy partner, you don’t respect me, you don’t do housework so I’m too tired now, you’re too rough with me, you’re not rough enough with me, I don’t find you attractive anymore, I don’t WANT to.
    Him: Are you taking your medication?
    Very binary hetero-sexist example. OTOH if you’re defined by society as female and want to take T for more face hair & a deeper voice in a gender queer way, that’s defined as mentally ill too.
    What really bothers me is with psych babble about sex is, youth who don’t have much sexual experience to gauge this by are faced with so many online mental health sites suggesting that depression or mania are the “treatable” causes of low or high libido based on crude quizzes.
    What about factors like self satisfaction and respect in relationships, rather than self-pathology?

  6. When will they come up with a drug to treat misogyny? I have a whole crapload of anecdata that suggests a man who has disdain seeping out of his pores, who thinks sex is something women must be tricked or forced into, will face a fuckton of interpersonal difficulties when dealing with me. Come on, pharmaceutical industry! This shit gets in the way of my sex life, since nothing turns me off faster than realizing my potential partner is an assface.

  7. This is horrendous!
    I speak to both men and women who are distressed about lack/loss of libido, and although the causes are varied, in many cases it’s the result of taking anti-depressant medication. I would suspect that this new drug being a psychoactive medication, would have the potential to negatively interact with anti-depressants.

  8. Lovely logic. Any woman not gagging for it must be ill.
    Interesting the specific targetting of women in the test (traditionally, drug trials are conducted on Men except where products are biologically gender specific). Do women ALWAYS have lower libidos than men? Do sexy young lesbians spend their time sipping tea and knitting together.
    Deus Ex Macintosh’s last blog post..British Bail-out Bingo

  9. Great post. Big pharma is the 21st century version of Big Tobacco. They’ve obviously been good students. The pathologising of human behavioural responses that may happen to fall outside of some invented notion of “normal” asks some very fundamental questions about health care practices.
    And who, pray tell, will decide what is the “normal” level of sexual activity for women (or men for that matter?)? I suspect they wont be reading Beverly Whipple’s work – I see a panel of 17 year old males….

  10. Any woman not gagging for it must be ill.
    And any woman gagging for it too much is a nymphomanic.
    *shakes fist at the world*

  11. Possible tagline: You don’t need Foreplay, you need Flibanserin…
    Deus Ex Macintosh’s last blog post..Naked Rambler Rumbled

  12. Possible tagline: You don’t need Foreplay, you need Flibanserin…

    I’m thinking jingle. Can we make them rhyme, somehow, and work in a “fatty mcfatfat”?

  13. “I’m thinking jingle. “:
    Don’t be frigid, don’t be fat
    Flibanserin can help with that!

  14. An excellent post!
    Also, ‘the female gender’? Pardon me?

  15. Here’s an older article from the Guardian which quotes from Carl Spana, president of Palatin Technologies, which was researching a drug to promote female sexual arousal, PT-141 (now bremelanotide).

    ”The drug can only be administered as a nasal spray – which isn’t good for seducers. You can’t put it in a drink and sticking it up a girl’s nose is hard to do surreptitiously, after all.”

    Yeah, all their intentions are just terribly noble, and are all about helping women out.
    This particular drug, by the way, was originally investigated as a sunless tanner. Its proposed use for sexual arousal purposes was suspended recently on the FDA’s recommendation due to its effects on blood pressure. The company is now investigating it for use in haemorrhagic shock.

  16. “The drug can only be administered as a nasal spray – which isn’t good for seducers. You can’t put it in a drink and sticking it up a girl’s nose is hard to do surreptitiously, after all.”
    brain explodes

  17. I actually suffer from greatly reduced sexual desire – it’s a side effect of my anti-depressants. I’ve mentioned it as an annoyance to my doctor a number of times, although the mentions appear to slide off her like water off a duck’s back. Presumably if I said my partner was complaining about my lack of interest in sex (which he isn’t) I’d be prescribed something to deal with the “problem”. But me saying I’m a bit peturbed by my missing libido obviously doesn’t count.
    Meg Thornton’s last blog post..Welcome to 2009

  18. the first thing i thought was, “hello new date rape drug.” you KNOW that will be its most common use. it gets rid of that pesky consent issue yanno. now she’ll want to, shebang!

  19. You can tell it’s 2009 when we have a pill that is the answer to practically everything….
    “Got bad legs? Try these new HEALTHY LEG PILLS – they work!”
    “Want a bigger penis? Take “PENIS GROW”, it’s instant, it’s magic!”
    “Are you sick of everything? Take FU-KITOL and be instantly happy!”
    “Want to desire your ugly partner? Flibanserin – it’ll turn you on!”


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