Posted by @chasing42
Viagra hit the market in 1998, and by 2012, was in the hands of over 8 million men around the world. Sales have reached close to 2 billion dollars a year, and the little blue pill that could has become a household name. In its short lifespan, it has entered our cultural vernacular in much the same way that the birth control pill did 40+ years ago, albeit without the same level of controversy. Many critics claimed it was a cure looking for a problem, but the term “erectile dysfunction” quickly reached American households with the speed and efficiency apparently lacking from a multitude of male genitalia. It was a biological problem with a pharmaceutical cure that was seen as heaven-sent for the millions of men who had been taught over generations that their self-worth was tied to their sexual prowess.
Almost from the time the FDA approved Viagra for use to combat erectile dysfunction, whispers began about gender equality and the need for a female equivalent. Surely men were not alone in suffering from biological roadblocks which prevented satisfying sex lives. It seemed an obvious banner for feminists to wave, and many quickly adopted the call for researchers to level the playing field. However, I question whether or not this knee-jerk reaction is an over-simplification of a much larger oppressive structure that has been building for well over a century. It’s important that, as critical feminists, we not jump so blindly onto the FSD (female sexual dysfunction) bandwagon without first questioning who is driving.
Recent debates over women’s reproductive rights, and reproductive justice more broadly are merely the current representation of a long history of the medicalization of women’s bodies and their sexuality. Even before the University of Pennsylvania founded the nation’s first medical school in 1765, control over women’s bodies and the shifting of medical responsibility from women to men was taking place and would have lasting effects on women, entrenching much of the oppression that now binds many women. As mid-wives were pushed out of the birthing experience, and deliveries transitioned from the home to the hospital, more and more men assumed roles of responsibility for the health and well-being of women’s bodies. While reproductive control was being subsumed by the increasingly male-dominated medical profession, so to was the construction and dissemination of knowledge regarding women’s sexuality.
This shift in control can be ironically and symbolically represented by the rise in the diagnosis of hysteria among women. This catch-all diagnosis is one of the oldest in Western civilization, and can be traced back 4,000 years, and was, for a majority of that time, solely an ailment which befell women. Among its many treatments, both stimulation to orgasm and abstinence from sexual activity were prescribed. Since women were not believed to possess any sex drive or desire, the paroxysm treatment was perfectly acceptable. Alas, male doctors were complaining about their achy wrists after so many stimulating treatments, and the electric vibrator was born in 1880. Today, as many as 1/3 of all American women own one of these “personal massagers”.
The rise of the social hygiene movement in the early 20th century positioned the focus of sexuality squarely on disease prevention. The risks of venereal disease were high, especially among soldiers during WWI. During this time, much of the sexuality research being conducted was done on men, for men, and by men. As before, women’s sexuality was of no concern because the prevailing assumption was that it did not exist, although I’m sure most women at the time would beg to differ, even if they didn’t have the words to articulate their desires. The underlying message to girls and women continued to be that it was not acceptable to be “sexual” in any way. However, our public images of women began to tell a different story.
Following the first world war, during the roaring 20’s, new beliefs about dating, relationships, and marriage led to shifts in courting behavior, along with dress among young people. Through radio and print media, and eventually television, girls and women received very distinct messages about what was expected of them. Although the definition of “beauty” changed with regard to fashion, very clear messages about body and appearance remained the definition of attractive became thinner and thinner.
These unrealistic expectations of girls and women culminated with the popularity of the model and actress Twiggy, whose thin frame created an unhealthy expectation that many attempted to emulate. Although cultural definitions of beauty have shifted away from such an unhealthy level of thinness (to some degree), the dangerous messages that girls and women receive on a daily basis have remained consist, as Jean Kilbourne has so brilliantly documented for almost 40 years.
While these expectations of beauty were being entrenched into the minds of generation after generation, the general belief that girls and women should avoid discussing sexuality and exploring their bodies was also cemented into the collective cultural psyche. This idea was reinforced by the continued focus on men in sex research. In addition, sex education courses, which have fluctuated widely in content and scope over the past 100 years, have failed to properly education young girls and women with regard to issues of desire and arousal, not to mention anatomy and physiology. Second wave feminist publications, such as Our Bodies, Our Selves, have attempted to fill this gap, but the misinformation and lack of information remains firmly entrenched in societal discourse.
These parallel and contradictory strains of discourse, the over-medicalization of women and the construction of unrealistic body images, are important to understanding the latest push for “pink Viagra”. Flibanserin, the newest drug claiming to treat FSD, was rejected by the FDA in 2010, and again in 2013, but a PR campaign led by Sprout Pharmaceuticals (the maker of the drug) and others forced the FDA into reopening the discussion. Along with the expected claims as to the benefits to women suffering from FSD, these campaigns (including www.womendeserve.org and Even The Score) are focusing on the fact that there are currently 26 drugs on the market (really only 6 drugs marketed under different names), including Viagra, to treat erectile dysfunction, and no FDA-approved drugs to treat FSD. This has resulted in a co-opting of the women’s equality narrative, and has been reinforced by claims that the FDA is sexist in their approval process.
These efforts are troubling for a number of reasons. To begin with, concerns over female desire (interest in sex) and arousal (physical reaction to sexual contact) have been regularly conflated, to the point that they have been lumped into one general diagnosis, Female Sexual Interest/Arousal Disorder (FSIAD). This distorts the reality of two very different ideas, which have very different potential causes, and thus different potential treatments. In the search for a biological cause, which we can understand (and treat with a pill), we have failed to appropriately consider the social and psychological factors which influence desire. This is not surprising considering desire has been noticeably absent from even the most comprehensive sex education curricula. We’ve spent decades telling women not to explore or understand their bodies, and we are now jumping at the chance to medicate them based on a diagnosis without appropriate research to justify its existence. To date, there is no diagnostic test which indicates a biological cause for differences in desire. On the contrary, one of the main factors seems to be differences in desire between partners.
Furthermore, the comparison of Flibanserin to Viagra is misleading at best, and irresponsible at worst. Whereas Viagra is intended to be taken just prior to sexual activity on an as needed basis, Flibanserin is meant as a daily medication that builds up in the bloodstream. Our Bodies, Ourselves was one of many organizations that signed a letter to Dr. Janet Woodstock at the FDA, expressing just such concerns.
More to the point, however, the gender equity argument ignores the real safety difference between flibanserin and the drugs approved for men: a different indication for use, specifically the dosage and administration. All but one of the drugs approved for men are taken on an as-needed basis, whereas flibanserin, a central nervous system serotonergic agent with effects on adrenaline and dopamine in the brain, requires chronic — daily, long-term — administration. This raises toxicological concerns that make it appropriate for the FDA to subject flibanserin to elevated safety scrutiny. Substantial adverse events reports and drop-out rates in the trials rightly required serious consideration.
Previous sex research, conducted mainly on male subjects, provides us with little understanding of female sexuality, and fails to acknowledge biological differences. The Flibanserin case is just one instance of what some would call “disease mongering” or attempting to create illness where none exists. The economic motivates become clear in a situation like this, as Sprout Pharmaceuticals stands to make millions off of this drug.
Ultimately, the capitalist push for the FDA approval of Flibanserin relies on the perpetuation of myths about female sexuality. Supporters claim an epidemic of female sexual dysfunction, but that implies we know how female sexuality functions and we have established a baseline. Unfortunately, our inability to care about women’s bodies for anything other than reproduction means we don’t possess that understanding yet. As a result, we don’t even know if this drug will actually be effective, and strong placebo effects echo this concern. As the National Women’s Health Network states,
The reality is that no amount of public relations or slick marketing can get around the fact that the drugs currently being proposed for Female Sexual Dysfunction simply don’t work and may be quite dangerous. Poor efficacy, a strong placebo effect, and valid safety concerns have plagued all of the drugs that have been tested so far. There are many reasons why the proposed drugs may not have been effective in increasing women’s sexual enjoyment; chief among them is the heterogeneity of female sexuality and, of course, research demonstrating that sexual problems are mostly shaped by interpersonal, psychological, and social factors. Nevertheless, pharmaceutical executives will continue to drum up hype over the possibility of a “pink Viagra” because the profit market for this type of drug is estimated to be over $2 billion a year.
The push for FDA approval of “Pink Viagra”, whether in the form of Flibanserin or another drug, is only the latest attempt at controlling women’s bodies by characterizing aspects of their identity as biological concerns in need of a cure, which those in power sitting in a boardroom are none-to-happy to prescribe and profit from along the way. We continue to send girls and women the conflicting message that their value rests in their beauty but they should avoid too much familiarity with their body below that skin-deep appeal. The result is a gap in the understanding of desire and arousal, which drug companies are all to happy to fill with more pills regardless of the potential long-term consequences. There’s no question that these issues are connected, and the continued oppression of women is the tie that binds.