Why 'Female Viagra' Isn't Actually a Great Idea

There's a new wonder drug in town. Addyi has been hailed as the "female Viagra," a wonder drug that could do for unsatisfied women what Viagra did for their horny middle-aged boyfriends. For several years, its makers have fought a long and controversial campaign to get FDA approval for the drug, and the FDA has rejected it on the grounds that it doesn't do enough to justify accepting the side effects. Then a PR campaign was launched, the FDA was put under intense pressure by feminist activists accusing them of patronizing sexism, and the drug was finally approved. It goes on sale in October; but the trouble is, it probably shouldn't.

Let's get past this "female Viagra" bullshit before we go any further. Addyi isn't any kind of Viagra. It couldn't be less like Viagra if it were trying to evade an email spam filter, and comparing them is doubly confusing because most people don't actually know much about Viagra to begin with.

When you take Viagra nothing actually happens; or at least nothing noticeable. Contrary to popular myth it doesn't suddenly increase your sex drive or make you instantly horny. It's not for increasing your libido. What it does is make it easier to get and maintain an erection once you're aroused, something that can be achieved pretty simply with a single dose. It's basically just hydraulics—a penis is a big dangling sack of blood, swinging around like an uncooked black pudding, and Viagra helps keep that sack pumped up.

Addyi—or flibanserin, to use its non-commercial name—is radically different. It started out in the 1990s as an experimental antidepressant, and works on the brain rather than the body, altering the balance of neurotransmitters like dopamine and serotonin in an effort to trigger parts of the brain involved in "sexual desire."

The effects are subtle—so subtle that you'd be forgiven for asking whether they really exist. In the trials the FDA looked at, the average woman started out reporting 2.8 "satisfying sexual events" per month. For women given a placebo, that went up to 3.7, and for women on Addyi it was 4.5 times per month. In other words, women who took Addyi had an average of 0.8 more "satisfying sexual events" in a month than women who just took a sugar pill. That's not much better than a rounding error.

Getting your extra eight-tenths of an orgasm takes a lot of work, too. Unlike Viagra, this isn't a question of just popping a pill, the lying back and thinking of England—you have to take Addyi for a month, during which time you can't drink alcohol. Amazingly, the research that looked at what happens when you mix alcohol and Addyi—bad things—was done almost entirely on men. Ironically, the drug can also react badly with some hormonal contraceptives, and like many medications it has a raft of side effects—fainting, low blood pressure, nausea, sedation, and in rare cases potential liver damage.

Is it really worth it? Seeking a woman's opinion, I turned to my friend Jennifer. A veritable expert on the ins and outs of orgasms, she gave me the following assessment: "If I'm taking a tablet every day that means I can't drink, in favor of orgasms, I want at least one or two orgasms a day. If it comes with risks of liver damage and syncope, I want five or six. And if I can't take the contraceptive pill, I want it to come with free condoms."

These benefits weren't compared with other interventions, either. Addyi might—just—work better than a placebo, but there are many other ways for women to improve their sexual experiences without resorting to a pill that's loaded with side effects: sex toys, a better partner, addressing any health or psychological issues, or just installing a new shower head.

This drug isn't for just any woman, though. It's aimed at women suffering from a newly described condition known as Hypoactive Sexual Desire Disorder (HSDD). HSDD is diagnosed when you have very low sexual desire that causes serious distress and/or relationship problems, but isn't accounted for by some other medical problem.

HSDD is a controversial disorder, with a whole bunch of problems that lead some people to question whether it's really a "disorder" at all. The first is what you mean by "low sexual desire." If you tell someone her sexuality is abnormal, you're making some kind of judgment about what "normal" is supposed to be, and really that's a cultural thing. It's the same issue psychologists had with homosexuality when it was still classified as a medical disorder illness—society has a long and bad history of saying anything that doesn't fit a very narrow definition of sexuality is a mental illness.

Even if you believe it's a real disorder, the chances are many women will be misdiagnosed, or coerced into getting the drugs by pushy partners.

In the best-case scenario, you're empowering women struggling with a legitimate condition to have more sexual pleasure. In the worst case, you're taking healthy women who don't meet society's expectations—or more likely the expectations of their men—and drugging them to be more compliant.

Which is it? Well maybe a bit of both, but the problem here is that now the FDA have approved it, doctors (from October) can use the drug pretty much however they want. The FDA can't say "only use Addyi for HSDD." Having approved it, all they can do is ask for prominent warnings of the side effects. The manufacturers have promised to hold off marketing it for the first 18 months, but after that it's fair game, and given America's obsession with prescription drugs, millions of women across America will be popping them like candy.

What happens to them after that? Who knows.

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