Female Viagra: Do women really need it?

A pill to boost women’s sexual desire could be approved next month. But does ‘female sexual dysfunction’ really exist?

How much (or little) sex is normal? And what’s dysfunctional? A friend told me how she spent a giggly, girlie evening discussing exactly this with a group of women in their thirties. Their confessions were surprising. “They were all competing. Not over who was having the most sex, but who was having the least. Most of the ones in couples were having it a maximum of once a week, although the men wanted it a lot more often. But it didn’t bother anyone — they were happy in their relationships. It just made them laugh.”

If the drug companies have their way, though, this happy-go-lucky attitude may not be around for long. Next month, the case for a new pill called flibanserin, designed to elevate female sexual desire, will be heard by the US Food and Drug Administration. It’s a “pink Viagra” that can be marketed like Prozac to any woman who can be convinced she has “female sexual dysfunction”. It’s the pharmaceutical industry’s wet dream. And US approval would mean that there would be a good chance of the drug being introduced over here. Originally designed as an antidepressant, flibanserin affects levels of the feel-good hormone serotonin.

According to reports in the US, it causes slightly less than one more “sexually satisfying event” (which can be interpreted however you like) a month.

Does anyone really need it anyway? A male friend recently admitted to me that he and his wife didn’t have sex for a year after their first child was born. Sleep would have helped them a lot more than a pink sex tablet. Most people do seem to accept that sexual appetite is about personal preference; frequency is less important than quality and life can get in the way.

Even sex experts hate putting a norm on sexual desire. The problem is, we always think we should be having more sex than we are. “Six times a month is often given as a norm,” says Dr Petra Boynton, a sex researcher at University College, London, quoting the National Survey of Sexual Attitudes and Lifestyles from February this year. “Although if you ask people how often they think it is normal to have sex, they will answer four times a week, which is hugely high. Who has time for that?”

There will always be women, of course, who think that everyone else must be having it bigger, better and more often than them. This week, Orgasm Inc, an extraordinary, revelatory documentary about female desire and the pharmaceutical industry, had its premiere in New York (the BBC plans to screen it later this year). One of the most memorable subjects in Elizabeth Canner’s film is Charletta, a woman in her forties who believes she is “diseased” because she has never achieved orgasm during intercourse. She agrees to be a test subject for a device called an “orgasmatron” and has electrodes inserted into her spine. It doesn’t work. She is shocked — and relieved — to learn later on in the film that 70 per cent of women can achieve orgasm only in the way that she has always experienced it: through direct clitoral stimulation, not penetrative sex. So much for her “disease”.

The documentary was a labour of love for Canner, who comes from Vermont. It started ten years ago when she was asked to edit some erotic videos for a company testing “orgasm creams” for women. “In their trials they were saying 43 per cent of women suffer from sexual dysfunction, and I thought: ‘If so many women have this disorder, why have I never heard of it?’ I discovered that there are many ways to make women feel they have a disorder when they absolutely don’t. There has to be a sense of something you are not achieving, the idea that you’re not as sexy or as beautiful as you should be.”

“These companies are on their way to creating a sexual version of social anxiety,” says the feminist author Susie Orbach. (The term “social anxiety” is often lampooned as a way of medicalising shyness.) Orbach believes that the modern obsession with wanting to put a number and norm on desire entirely misses the point. “Sex can be a form of play, an expression of love or of commitment. There are so many different things it can be,” she says.

For the record, the Kinsey Institute, which promotes research into sex, suggests that 18 to 29-year-olds have sex an average of 112 times per year, 30 to 39-year-olds an average of 86 times per year, and 40 to 49-year-olds an average of 69 times per year. But these numbers are meaningless to us as individuals, says Ray Moynihan, a regular contributor to the British Medical Journal and the author of Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction, out later this year.

In Moynihan’s view numbers are just a useful tool for the drug companies to make us feel inadequate.

“There is a deliberate attempt to construct new norms that are unrealistic,” says Moynihan. “If you want to prey on people’s vulnerabilities, it’s a good business to be in. That’s not to deny that there is a fair degree of sexual dissatisfaction out there. For some people sexual difficulties can be debilitating. Those people may benefit from a medical label.”

There are many conditions where you need to see a doctor, such as vaginismus, pain during or after sex, complications after a traumatic birth, mental health issues or a history of abuse.

The good news for women — depending on what the FDA decides next month — is that so far these companies’ attempts to find wonder sex drugs have failed spectacularly. The testosterone patch Intrinsa, prescribed for women who have posthysterectomy problems with libido, was approved in Europe but failed to gain FDA approval in the US.

In Moynihan’s view it’s not an impressive drug: “All the independent assessment bodies who looked at it gave it the thumbs-down.” Even Pfizer, the company that invented Viagra, has given up looking for a sexual cure-all for women, saying that women’s sexual issues are “too complex to be fixed with a pill targeting the genitals”.

So the only remaining area to market to women is constant desire for sex. “But sometimes not wanting sex is a good response to your mental health or your circumstances,” says Dr Boynton. “People can get anxious if they think, ‘I haven’t felt like it much for a month.’ But maybe you’re knackered, maybe you’re not getting on with your partner, maybe you’ve put on weight, perhaps you’re in a rut. A drug will not solve those problems.”

She worries that these drugs could make people overlook other solutions. “What if they were to trial these drugs against giving women lessons in self-confidence? Or compare it with couples counselling? Or even a bottle of wine?”

Professor Brett Kahr, chairman of the British Society of Couple Psychotherapists and Counsellors, agrees that many sex issues are psychological. “I have seen couples who have not had sex for literally decades,” he says, adding that the existence of such marriages is the great hidden secret of British sex lives. “After several sessions of psychotherapy — and having worked through some murderous rage — often they will come back and say: ‘Guess what? We have enjoyed physical intimacy for the first time in seven years.’”

Honesty, patience and communication help, it would seem. They’re also free and don’t have any side-effects. Neither does basic knowledge of human anatomy. As Carol Queen, the director of a vibrator museum featured in Orgasm Inc, shrieks: “Is a drug going to help? Maybe if it has a picture of a clitoris on the back of the box.”