The Orgasm Industry.

Drug Companies Search for a Female Viagra

Since the launch of Pfizer's tremendously popular erectile-dysfunction drug Viagra in May 1998, pharmaceutical companies have scrambled to find the next big sex drug for women this time. Start-up pharmaceutical companies and enterprising physicians have jumped into the fray to treat what they see as an underserved market of tens of millions of sexually dysfunctional women.

Feminists tend to bristle at the term "dysfunctional" but acknowledge that many women don't enjoy sex. Some feminists say that women should welcome drug industry products that may provide some relief to those in desperate need of sexual help. Others argue that such products will stigmatize female sexuality and drive women to pop a pill when what they really need are better relationships and more sex education.

"No potion or pill will show you where your clitoris is," says sex writer Susie Bright. "No cream will enlighten you as to your unconscious erotic imagination."

Never mind the ongoing epidemic or sexual violence, spotty access to contraception, and the fact that most women with sexual difficulties say they are too busy and too stressed out to have sex. Pill-pushers with their eyes on the bottom line are eager to gear women up for high-tech sex with new creams, gels, and other products.

While ten million men around the world take Viagra, earning Pfizer $1.3 billion last year, the market for a prescription sex drug for women may be even bigger. According to a much-cited February 1999 article in JAMA: The Journal of the American Medical Association, 43 percent of all women suffer from sexual dysfunction, as opposed to just 31 percent of all men.

In April 2000, the Food and Drug Administration approved the first product to treat female sexual dysfunction, which it defines as decreased sexual desire, decreased sexual arousal, pain during intercourse, or inability to climax. The FDA-approved product, called EROS, is manufactured by Urometrics, based in St. Paul, Minnesota. It's a glorified vibrator that applies suction to the clitoris. It costs $359 and is sold by prescription only.

Dozens of other products to alleviate female sexual dysfunction, including body creams and even a remote-control device, are currently in clinical trials. Some of these products may make it to market as early as 2004, say drug company spokespersons.

Nastech, a nasal drug company, recently started the second of three Food and Drug Administration-required phases of clinical trials for its apomorphine hydrochloride product for women, which is designed to improve blood flow and lubricating secretions in female genitals. Apomorphine hydrochloride belongs to the family of morphine-derived drugs that includes codeine. The product would come in a small vial with a nasal spray applicator, which women would spritz into their nostrils about twenty minutes before having sex. The company expects to bring the prescription nasal spray to market within a few years.

BioSante Pharmaceuticals expects results from Phase 2 clinical trials of its female sex drug, LibiGel, by this fall. Women would rub LibiGel onto their shoulders or arms, releasing libido-increasing testosterone into their bodies for up to twenty-four hours. According to BioSante, as women age, their testosterone levels go down, and women who've undergone total hysterectomies have 50 percent lower testosterone levels. Studies show that testosterone-replacement therapy can boost sexual desire, according to a company press release. LibiGel may hit the market in four years, BioSante's CEO Stephen M. Simes says, and would cost about $1,000 a year for daily therapy, a sum BioSante expects insurance companies to cover.

"Just like men who take Viagra who don't have erectile dysfunction, there are individuals who will want to have an orgasm on demand," says North Carolina pain specialist Dr. Stuart Meloy. In January, Meloy was issued a patent for a remote-controlled neural-stimulation device to trigger orgasms. Three years ago, Meloy, like other pain specialists, noticed that a surgically implanted neural stimulation device routinely used to alleviate chronic pain sometimes triggered orgasms instead. He considered it a "funny, unwanted side effect," he says, until he realized that "this unwanted side effect was something that may be quite desirable in another clinical setting." Meloy expects to start clinical trials in the near future.

But who will want to spend $15,000 on a surgical procedure to have push-button orgasms? There are about 23,000 women with orgasmic dysfunction who are not responsive to simpler therapies, Meloy estimates, and CNN pollsters reported that 59 percent of women would want to have Meloy's device implanted in them. "Frankly, for that individual who has the cash in hand, it is kind of on par with cosmetic surgery," he says.

Feminists publicized and politicized women's raw deal in bed decades before drug companies began researching their corporate solutions to the problem. But the women's sexual health movement, with its self-help books, sex-toy shops, sex therapists, and masturbation workshops has never been particularly profitable. The ultimate solution to women's sexual problems, say some, is more time, less stress, better education, and attentive partners--hardly the stuff of glossy brochures for thousand-dollar prescription treatments.

"Women really want a sense of self-empowerment and self-efficacy," says Leonore Tiefer, feminist sex therapist and professor of urology and psychiatry at Albert Einstein College of Medicine. "They don't just want products to choose from." The search for a female Viagra, Tiefer says, exploits for profit "the lack of sex education and sexual freedom we have in this country."

Such products may help a small fraction of women, the National Women's Health Network program director Amy Allina told me, but "in the context of today's health care system structured around profit and patentable products, many women may be sold drugs that they don't need and that can hurt them" with the side effects.

To make it big, drug companies need to mass-market their prescription sex products. Pfizer doesn't market Viagra exclusively to the 5 percent of the U.S. male population that suffers from erectile dysfunction. Pfizer sells Viagra by selling romance.

Urometrics, the maker of EROS, plans to run spots on radio stations and in print media in ten cities around the country, says the company's public relations spokesperson, Saunya Peterson. Both LibiGel and Nastech's nasal spray are also likely to be advertised directly to consumers, the companies say. "Like Viagra, this is something consumers will be hearing about directly," says Matthew Haines, director of corporate communications at Nastech.

"Their marketing implies that you can passively sit back and let the `chemical' do the work for you," says Bright. "But we already have powerful sexual [chemicals] in our bodies. They're called hormones."

"We are all susceptible to promises that things will be made better," says Carol Ellison, a sex therapist who surveyed 2,632 U.S. women about their sex lives for her book, Women's Sexualities: Generations of Women Share Intimate Secrets of Sexual Self-Acceptance (New Harbinger Publications, 2000). She found that women want more free time, less stress, and loving relationships to feel good in bed. But if that's the case, why would women seek medical solutions for nonmedical problems?

"Women are very anxious to improve their sex lives," says Tiefer. "The illusion of sex that is promoted by the entertainment media is that sex is just one big orgasmic scream after another, but that is not what most people's experience is like."

Women who turn to sex drugs may be more than disappointed. Says Ellison: "When a drug doesn't solve your problem of low sexual desire, which is based on your partner not helping out with the kids or taking time to feel close to you before sex, then the woman turns around and says, `What's wrong with me?'"

"We need to be cautioning the public right now," says Judy Norsigian of the Boston Women's Health Book Collective.

Others, such as Pulitzer Prize-winning writer Natalie Angier, author of Women: An Intimate Geography (Anchor Books, 2000), say that women need as much information and support for having orgasmic sex as possible, whether from a friend or a drug-company ad on television. If a product could help even a small fraction of women, she says, it's worth it, given women's widespread trouble with achieving orgasms.

"Most women, if not all women, are capable of learning how to become readily orgasmic," says Angier. When feminists say that women's sexuality is more about intimacy than orgasm, "you end up with a lot of dissatisfied women."

Cultural critic Ellen Willis agrees. "If people are sexually unhappy, anything that helps them is fine," she says. Sex drugs should be seen as "one more resource in dealing with sexual problems. If I have a headache, it may have some larger social cause, but in the meantime I'm going to take aspirin."

The race to find the female Viagra started in 1998, the year Viagra was released. Two telegenic sisters--urologist Jennifer Berman and sex therapist Laura Berman--spearheaded a popular crusade urging women to consider medical solutions to their sexual problems. The two were "convinced that women could benefit from the same medical attention to sexual problems that was given to men," they write on their web site, www.newshe.com.

In the summer of 1998, they founded a women's sexual health clinic at Boston University to combat female sexual dysfunction. With their mentor, erectile dysfunction pioneer Dr. Irwin Goldstein, they organized the first ever conference on female sexual dysfunction a few months later. Their quest transformed them into the darlings of the sex-drug industry, and the Bermans were soon giving a paid lecture about new sex treatments on an industry-sponsored yacht trip. They also appeared on a raft of television and radio programs, including The Oprah Winfrey Show and Good Morning America, explaining how women could combat the female sexual dysfunction epidemic.

Meanwhile, University of Chicago sociologist Edward O. Laumann, author of a well-respected survey of sexual practices in the United States, reanalyzed data from his influential 1992 survey to look specifically at sexual dysfunction, a topic he previously covered only briefly. In February 1999, Laumann and his co-author, clinical psychologist Raymond C. Rosen, released their reanalysis in JAMA, one of the nation's foremost medical journals. "The results indicate that sexual dysfunction is an important public health concern," they wrote, coming up with the 43 percent figure for female sexual dysfunction.

Without Laumann's claim, female sexual dysfunction may have become another of hundreds of obscure medical syndromes and conditions. "Because it was published in JAMA, was based on a well-known survey, and there's so much interest in women's sexuality and drug treatment, it has attained this status [as] the most accurate figure we have," says the Kinsey Institute's Cynthia Graham.

But critics question whether Laumann's characterization of so many women as dysfunctional is really accurate. "Women may be saying they have these symptoms," says Graham, "but they may not consider it a problem."

Graham's point cuts to the heart of the notoriously murky world of sex research. What is a sexual problem and what isn't? Who decides? Who talks truthfully to researchers about their sexual lives and why?

Most well-known studies of sexual practices--such as those by zoologist Alfred C. Kinsey in 1948 and 1953, Masters and Johnson in 1966, and Shere Hite in 1976--are based on what volunteers chose to tell researchers. But in 1992, Laumann set out to find out what randomly selected ordinary Americans did in bed. The large majority of the 3,159 people his researchers spoke to in ninety minute face-to-face interviews were found to "feel loved, satisfied, and even thrilled by their sex partners," as Laumann and his co-authors wrote in The Social Organization of Sexuality (University of Chicago, 1994).

Sometime before 1998, Laumann became a consultant for Pfizer. He teamed up with Rosen, another Pfizer consultant. Rosen urged Laumann to showcase his data on sexual dysfunction in a medical journal where physicians would be more apt to see it, Laumann says. So Laumann reanalyzed his data and came to a different conclusion. In 1994, Laumann wrote, "comparatively few [men and women] are made to feel sad or afraid or guilty in their sex lives." But in his February 1999 JAMA article, he unveiled an epidemic of female sexual dysfunction.

Today, Laumann tries to distance himself from the conclusions in his article. "I've been somewhat annoyed that, because this study was published in a medical journal, it has been spun in a very medical direction," he says.

As Laumann puts it, the article shows that most of the women characterized as having female sexual dysfunction may simply be experiencing "normal responses to the challenges of life." Just more than half of the women characterized as suffering from female sexual dysfunction were those who reported a lack of interest in sex for a period of several months or more over the last twelve months. Another third or so reported arousal problems, that is, they reported having trouble lubricating for a period of several months or more in the past twelve months.

"If you have any kind of life at all," says Laumann, "you are going to have these problems" at some point. Plus, aside from lubrication problems, which many women remedy by using over-the-counter lubricating jellies, most of the other female sexual dysfunction symptoms decrease as women age, Laumann says.

The number of women who truly need medical intervention in their sex lives is probably tiny, Laumann says. "The vast bulk of the 43 percent are probably suffering from social stresses," he says.

Laumann says that corporate interests had nothing to do with the conclusions of his article for JAMA. "We were writing for doctors," he says, "so an interpretive spin was simply not possible."

As sex research becomes more beholden to the pharmaceutical industry, Tiefer says, there is a vested interest in painting a picture of sick women in need of new drug treatments. "Profitability motives" are driving research on female sexual dysfunction, she says.

In the past, medical experts condemned womens sexualities as hysterical, nymphomaniacal, or frigid. Today, according to Laumann's own admission, healthy women in normal life circumstances acquire a medical label of "dysfunctional." Laumann and physicians such as the Bermans consider the classification of normal female sexuality as dysfunctional a step in the right direction. At least now, they say, people are talking openly about women's sex lives.

And that's the irony. Feminists have been whispering, joking, yelling, and agitating about female sexuality for at least three decades. Now that a lucrative market is in view, the experts and entrepreneurs may deign to listen

Sonia Shah is a freelance writer and former editor at South End Press.