Female sexual response is multilayered. That much we know. Exactly what comprises those layers is another, more mysterious story. CBS reports that there are currently no fewer than 26 FDA-approved drugs on the market that boost male sexual performance — but there are exactly zero to boost female sex drive. It's not for pharmaceutical companies' lack of trying: For years, the makers of flibanserin have been attempting to convince the FDA to okay the drug, which acts on the neurotransmitters dopamine, norepinephrine, and serotonin and is the first medication designed to increase women's libido by altering brain chemistry rather than hormone levels. After one rejection in 2010 and another in 2013, Sprout Pharamaceuticals Inc., the company behind flibanserin, is submitting new findings on the safety and efficacy of the drug in hopes that the third time's the charm. But, the controversy around flibanserin extends beyond the question of whether it works.
Past efforts to develop drugs to increase female libido have focused on boosting blood flow to the genitals, similar to what Viagra does for men. The thing is, Viagra presupposes men's desire to have sex and merely gives them the equipment to do so; it addresses the hardware (emphasis on hard), not the software. Female sexual dysfunction, meanwhile, is defined as continuing issues with sexual response or desire that — and this part is operative — cause distress to the individual who experiences them. The ability to self-lubricate — to get wet — is only one small part of the puzzle.
Some see the approval of a drug that addresses female sexual desire as progress for women — as leveling the pharmaceutical playing field. Others fear that such a drug will further medicalize female sexuality and encourage the idea that women's patterns of desire should adhere to a certain standard. Unlike Viagra and similar drugs, which men take just before sexual activity, flibanserin's users would take the drug every day to increase their levels of dopamine and norepinephrin and suppress their levels of serotonin (which is known to mess with sex drive). Side effects include fatigue, nausea, dizziness, and sleepiness, and it's unclear what the drug's long-term effects might be.
If flibanserin is approved, it will only be available to women with sexual dysfunction who have not yet hit menopause. Before prescribing it, doctors will have to rule out confounding factors that could be to blame for low sex drive, including relationship and emotional problems, depression, and mood disorders. We don't actually know that female sexual dysfunction can exist in a vacuum, independent of such other factors — which is why, if the drug is approved, women struggling with low libidos will do well to explore other options before resorting to pharmaceuticals. When it comes to female sexuality, it's hubris to think that three neurochemicals can solve the entire equation. But, for some women, this development may one day offer hope, if not a silver bullet.
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