“Pink Viagra”—Not Pink, And Not Viagra

And that’s why it doesn’t exist.

But let’s back up a few steps.

On March 27, 1998 the FDA approved Viagra as the first oral treatment for erection problems. It went on sale later that year, and was soon followed by Cialis and Levitra, variants of the same drug. All three are now currently in use.

As my essay in Playboy back then predicted, the drug was hugely successful, misunderstood and misused, and expected to perform miracles. It hasn’t.

It doesn’t make angry men sweet, doesn’t make clumsy men graceful, doesn’t make weak backs strong, and doesn’t make drunk men sober. As the manufacturers themselves will tell you, these drugs aren’t aphrodisiacs, and so they don’t make bored men randy.

They make it easier for blood to hang out in the penis, facilitating erection under certain rather narrow circumstances.

Because only a small fraction of sexual frustration is caused by erection problems—and only a fraction of erection problems can be fixed with Viagra—the search has continued for other sexual enhancement products. These have ranged from vibrators to testosterone creams to porn to SM gear to shares of Apple stock. Each has advantages and drawbacks. Since none is a panacea, the search continues.

More specifically, people want a drug that can increase desire. People have wanted this for at least 3,000 years of recorded history, presumably longer. The Bible, Sophocles, Dante, Shakespeare, and the Bronte sisters have all discussed the need for such a product.

And so less than ten years ago, our very own FDA was asked to evaluate the already-existing drug Flibanserin as a “pink Viagra”—a treatment for “female sexual dysfunction,” a vague condition that variously featured low desire, low enjoyment, or genital discomfort or lack of feeling.

Exactly five years ago, after huge campaigns both promoting and denouncing the drug, the FDA rejected it, citing Flibanserin’s side effects and limited efficacy. Health activists cheered, grown men wept, venture capitalists tore their hair, and life went on.

At the time, I wrote that the process of defeating the drug had reinforced the myth that female sexuality is more complex than male sexuality, and that the “comprehensive approach” that anti-drug activists were suggesting was already being tried by mainstream sex therapy, and proving inadequate. At the same time, I was skeptical about the drug’s usefulness.

Now Flibanserin is back in the news, as the FDA is reconsidering its rejection. This is the same drug, but the conflict now has a different narrative: pro-drug activists are condemning the FDA’s alleged sexism, demanding that women have as many options as men for treating sexual difficulties.

What nonsense. There is no drug to enhance sexual desire or enjoyment in men. And the FDA’s rejection of Flibanserin for women has nothing to do with sexism. The FDA isn’t pro-men or anti-women. It’s pro-pharmaceutical corporation. It will approve every drug it possibly can, given the available clinical data and prevailing political pressure (see its handling of Emergency Contraception and at-home abortion drug RU-486).

Anti-drug activists are complaining about Big Pharma’s “disease mongering,” an oversimplification. There IS unexplained loss of desire in both women and men, along with loss of desire and physical discomfort. After we rule out the usual suspects—depression, lousy relationship, poor body image, toxic religion, medication side effects, mommy & daddy issues—neither medicine nor psychotherapy has much to offer people. And yet this problem undermines the quality of life for millions of adults.

Is the mechanism of low desire and low enjoyment different for men and women? My guess is that there are several bio-psycho-social mechanisms driving the problem, with some unique to each gender, while others are the same for both genders.

Should we take a pill for this? Should we need a pill for this? Should we demand a pill for this? Viagra was a genuinely disruptive technology, abruptly inserting erections in couples that hadn’t seen one in years. It helped some relationships, and made others way more complicated.

But that’s nothing compared to a drug which will increase desire. If that ever comes to pass, the politics of how it will be used in a given couple will make the bloody Roman Empire look like Woodstock.

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