The HSRC, a linear model of sexual response, posits that orgasm invariably results from sexual stimulation—or that it ought to, in sexually healthy or “normal” individuals.
It has been the primary medical model of sexual response for both sexes since its inception, but the validity of the HSRC has recently been challenged by some psychologists who state that it does not accurately fit “the female experience of sex.” While a revision to the linear HSRC may indeed be timely (for everyone!
I wonder if it’s because whereas men are understood to be natural penetrators, sexually “healthy” women are understood first and foremost as receptors? An erection can be easily managed with drugs, creating a situation in which a penis can be used for sexual intercourse. But what if desire—for both (or all) sexes and genders—is more complicated than something as easily measurable as an erection? These questions raise other important queries about what we want from sexual medicine more broadly. How do we currently assess sexual problems?
How do we know if a treatment is working? These are questions that are generally not attended to by pharmaceutical companies or even the psychologists running these companies’ drug trials, and all of their answers depend on what kind of sex we believe to be most optimal—for men, and women, to be engaging in (usually—and importantly as our sexual culture is so deeply rooted in heteronormativity—with each other). Images on a Google search for “women’s sexual dysfunction” show either sad women alone, or women with men in a situation indicating their relationship is damaged by the changes to sexual intimacy. The editor could not readily find images from this search that involved women with other women as their partners. The history of Addyi illuminates what pharmaceutical companies and the medical industry more broadly appear to think of these questions (or rather, not think), and attests to how stakeholders in these realms have continued to implement rigid ideas about sexual difference in regards to dysfunction and desire, making broad, sweeping claims about men’s and women’s sexuality in the process. ), it is important to consider how an “alternative sexual response model” designed for women only and based on a categorically feminine framing of sexual health and pathology preserves the myth that women’s desire is inherently different from men’s desire, and perpetuates the notions that women are: 1.) less driven than men by spontaneous or internal sexual needs 2.) more likely than men to engage in cost-benefit analyses of sex as they consider possible non-sexual rewards or incentives to be gained from a given act (thus the shift to the language of “interest” in FSIAD) 3.) more likely than men to feel desire only or primarily when “triggered” by an initiating—and tacitly male—partner. Insofar as it supports and is supported by the alternative female sexual response model, the FSIAD diagnosis continues to perpetuate these myths, purporting that because women are less sexual than men are by nature, a lack of spontaneous desire on its own should not lead to a low desire diagnosis for them. According to this logic, instead, it is only the women who are unable to motivate a rational, incentive-based “interest” in sex who should receive the diagnosis of FSIAD. Unlike the “unresponsive” (dare we say frigid?) woman, then, a healthy, sexually functional, or normal woman is understood to be rationally receptive and responsive to her partner’s overtures, eventually priming herself to engage in sex with him, to bring her low-desiring mind into line with her lubricated and vasocongested body. But: what of the “disordered” women who are unable to respond? Well, there are a variety of treatment modalities now available—including, most recently, daily maintenance prescription pharmaceuticals designed to change female brain chemistry. With this long-standing tradition of framing women as less sexual and less desiring than men in mind, let’s come back to a consideration of current treatment practices. Pharmaceutical and hormonal management of female sexual dysfunction is a terrain currently being carved out further in the neoliberal marketplace. One of the most important changes recently occurred with the release of Addyi—the first FDA-approved sexual enhancement drug designed specifically for women.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Priligy Generic Dapoxetine | 60mg | 10 Pills | 47.63€ 45.36€ | |
| Cialis Professional | 40mg | 180 + 4 Pills | 618.23€ 588.79€ | |
| Cialis Professional | 20mg | 20 Pills | 78.33€ 74.60€ | |
| Levitra Soft Tabs | 20mg | 360 + 20 Pills | 682.21€ 649.72€ | |
| Kamagra Soft Tabs | 100mg | 32 Pills | 120.11€ 114.39€ | |
| Viagra Generic | 200mg | 20 Pills | 61.69€ 58.75€ | |
| Levitra Original | 20mg | 22 + 2 Pills | 138.55€ 131.95€ | |
| Viagra Soft Tabs | 100mg | 120 + 8 Pills | 232.21€ 221.15€ | |
| Levitra Generic | 20mg | 30 + 4 Pills | 70.59€ 67.23€ | |
| Viagra Generic | 150mg | 120 + 8 Pills | 177.58€ 169.12€ | |
| Viagra Generic | 200mg | 270 + 10 Pills | 379.76€ 361.68€ | |
| Kamagra Oral Jelly | 100mg | 21 Sachets | 95.92€ 91.35€ | |
| Kamagra Oral Jelly | 100mg | 10 Sachets | 54.55€ 51.95€ | |
| Cialis Generic | 60mg | 10 Pills | 41.22€ 39.26€ | |
| Kamagra Oral Jelly | 100 mg | 30 + 5 Sachets | 136.20€ 129.71€ |
But Addyi is not only the first sex drug marketed to women, it is the first drug ever to target desire or libido in humans.
Whereas Viagra affects (men’s) physiology only—it changes the hydraulic workings of the penis by increasing blood flow to the genital region, producing an erection in the case of so-called “impotence,” and in some cases increasing testosterone levels—Addyi affects (women’s) neurocircuitry. It goes right to the source of the so-called problem: the human—or rather the human female—brain.
But what if chemical imbalances are not the real—or at least originary—reason behind any given woman’s low desire? What if desire is actually so subjective and relational that it is impossible to isolate it in the neurotransmitters of one single individual? Sociology and gender studies researchers have examined the psychosocial, cultural, and political factors that affect desire and pleasure—and which produce gender differences in these experiences—for some time.
[4] But the quest for the inappropriately named “pink Viagra” has been one that has consumed doctors and drug-makers for the last couple of decades, after the release of sildenafil (the generic name for Viagra) and its ensuing multi-billion dollar popularity. Finding a “feminine” equivalent to Viagra has also proved a huge failure, though, as drug after drug was tested and rejected. I wonder if this is because there is no clear corollary to an erection (specifically as an erection is understood as necessary equipment for penile-vaginal intercourse) in women, or at least nothing as visible? I wonder if it’s because whereas men are understood to be natural penetrators, sexually “healthy” women are understood first and foremost as receptors? An erection can be easily managed with drugs, creating a situation in which a penis can be used for sexual intercourse. But what if desire—for both (or all) sexes and genders—is more complicated than something as easily measurable as an erection? These questions raise other important queries about what we want from sexual medicine more broadly. How do we currently assess sexual problems? How do we know if a treatment is working? These are questions that are generally not attended to by pharmaceutical companies or even the psychologists running these companies’ drug trials, and all of their answers depend on what kind of sex we believe to be most optimal—for men, and women, to be engaging in (usually—and importantly as our sexual culture is so deeply rooted in heteronormativity—with each other). Images on a Google search for “women’s sexual dysfunction” show either sad women alone, or women with men in a situation indicating their relationship is damaged by the changes to sexual intimacy.
The HSRC, a linear model of sexual response, posits that orgasm invariably results from sexual stimulation—or that it ought to, in sexually healthy or “normal” individuals. It has been the primary medical model of sexual response for both sexes since its inception, but the validity of the HSRC has recently been challenged by some psychologists who state that it does not accurately fit “the female experience of sex.” While a revision to the linear HSRC may indeed be timely (for everyone! ), it is important to consider how an “alternative sexual response model” designed for women only and based on a categorically feminine framing of sexual health and pathology preserves the myth that women’s desire is inherently different from men’s desire, and perpetuates the notions that women are: 1.) less driven than men by spontaneous or internal sexual needs 2.) more likely than men to engage in cost-benefit analyses of sex as they consider possible non-sexual rewards or incentives to be gained from a given act (thus the shift to the language of “interest” in FSIAD) 3.) more likely than men to feel desire only or primarily when “triggered” by an initiating—and tacitly male—partner. Insofar as it supports and is supported by the alternative female sexual response model, the FSIAD diagnosis continues to perpetuate these myths, purporting that because women are less sexual than men are by nature, a lack of spontaneous desire on its own should not lead to a low desire diagnosis for them. According to this logic, instead, it is only the women who are unable to motivate a rational, incentive-based “interest” in sex who should receive the diagnosis of FSIAD.
Unlike the “unresponsive” (dare we say frigid?) woman, then, a healthy, sexually functional, or normal woman is understood to be rationally receptive and responsive to her partner’s overtures, eventually priming herself to engage in sex with him, to bring her low-desiring mind into line with her lubricated and vasocongested body. But: what of the “disordered” women who are unable to respond? Well, there are a variety of treatment modalities now available—including, most recently, daily maintenance prescription pharmaceuticals designed to change female brain chemistry. With this long-standing tradition of framing women as less sexual and less desiring than men in mind, let’s come back to a consideration of current treatment practices. Pharmaceutical and hormonal management of female sexual dysfunction is a terrain currently being carved out further in the neoliberal marketplace. The editor could not readily find images from this search that involved women with other women as their partners. The history of Addyi illuminates what pharmaceutical companies and the medical industry more broadly appear to think of these questions (or rather, not think), and attests to how stakeholders in these realms have continued to implement rigid ideas about sexual difference in regards to dysfunction and desire, making broad, sweeping claims about men’s and women’s sexuality in the process. In the earliest years of the twenty-first century, a German company, Boehringer Ingelheim, owned the patent to the generic version of Addyi—called flibanserin. After flibanserin was shot down for approval by the FDA in 2010 and then again in 2013 (both times because the drug’s side effects appeared to outweigh any benefits to low-desiring women in clinical trials), Boehringer Ingelheim sold the rights to the patent to a U.S.-based fildena 120 pharmaceutical company—Sprout Pharmaceuticals. After running new clinical trials that showed slightly lower side effects but only a marginal improvement in satisfactory sexual encounters for women with low desire, flibanserin was finally approved by the FDA in August 2015. The drug was to be made officially available for public consumption in October 2015. In the interval between approval and release, before Addyi hit the shelves last fall, Valeant—a much larger, Canadian pharmaceutical company—bought Sprout Pharmaceuticals, in a $1 billion deal. Valeant is the current owner of the rights to Addyi. So, we know that Addyi has the potential to make a lot of money for big pharmaceutical companies, but what does it actually do? Addyi is considered a norepinephrine-dopamine disinhibitor, or NDDI, when compared to other antidepressants (it was initially formulated as an antidepressant before being remarketed as a sexual dysfunction drug). This means that its mechanism of action involves allowing for more uptake of norepinephrine and dopamine, while decreasing levels of serotonin in the brain. Dopamine in particular has been found to be associated with sex drive and pleasure[5]. According to studies conducted prior to FDA approval in 2015, women who were taking Addyi reported that the average number of times they experienced “satisfying sexual events” rose from 2.8 to 4.5 times per month. It is important to note that women receiving a placebo in the same study also reported a significant increase in “satisfying sexual events,” though—an increase of 2.7 to 3.7 times per month.
One of the most important changes recently occurred with the release of Addyi—the first FDA-approved sexual enhancement drug designed specifically for women. But Addyi is not only the first sex drug marketed to women, it is the first drug ever to target desire or libido in humans. Whereas Viagra affects (men’s) physiology only—it changes the hydraulic workings of the penis by increasing blood flow to the genital region, producing an erection in the case of so-called “impotence,” and in some cases increasing testosterone levels—Addyi affects (women’s) neurocircuitry. It goes right to the source of the so-called problem: the human—or rather the human female—brain. But what if chemical imbalances are not the real—or at least originary—reason behind any given woman’s low desire?
What if desire is actually so subjective and relational that it is impossible to isolate it in the neurotransmitters of one single individual? Sociology and gender studies researchers have examined the psychosocial, cultural, and political factors that affect desire and pleasure—and which produce gender differences in these experiences—for some time. [4] But the quest for the inappropriately named “pink Viagra” has been one that has consumed doctors and drug-makers for the last couple of decades, after the release of sildenafil (the generic name for Viagra) and its ensuing multi-billion dollar popularity. Finding a “feminine” equivalent to Viagra has also proved a huge failure, though, as drug after drug was tested and rejected. I wonder if this is because there is no clear corollary to an erection (specifically as an erection is understood as necessary equipment for penile-vaginal intercourse) in women, or at least nothing as visible? Side effects were also experienced by many women who took Addyi in the study, including dizziness, nausea, fatigue, sleepiness, insomnia, and dangerously low blood pressure, particularly when combined with alcohol consumption (even just two glasses of wine). This image shows the highlighted side effects of Addyi (flibanserin).
This again raises the question of who this drug is actually for—is it for the woman who lacks desire, and suffers because of this lack? Or, is it for her purportedly more virile partner (who in many cases, is male)? In a recent article in the New York Times published immediately following the FDA approval of Addyi, Dr. Irwin Goldstein, a sexual specialist based in San Diego, similarly stated that women might be willing to put up with the side effects in order to garner the benefits: “Some women might find the risk of side effects acceptable if their relationships are in jeopardy because of a lack of desire.” It seems ironic that the very cost-benefit analyses or interest schemas that women are thought to “naturally” or “biologically” engage in when it comes to sex are here being prescribed to women by doctors in the sociopolitical sphere (of which conceptions of the “natural” and “biological” are arguably a part).
While more are listed in the full packet, this so-called “Black Box” Warning indicates that whatever benefits Addyi may have, they certainly do not come without cost.
| Country | Regulations Status | Approval Process | Regulatory Body |
|---|---|---|---|
| USA | FDA regulates dietary supplements | Requires safety testing before sale | FDA |
| EU | Classified as food supplements | Compliance with EFSA standards | EFSA, local authorities |
| Australia | TGA oversees supplement safety | Pre-market assessment | TGA |
| Canada | Health Canada regulates dietary supplements | Licensing required | Health Canada |
It is not to be taken lightly. Despite these very real side effects, many clinicians and practitioners have vocalized their support for the drug, stating that the potential benefits may outweigh the potential harms. Bat Sheva Marcus of the Medical Center for Female Sexuality (MCFS) in New York City, “Drug trials have shown those women who take the drug are more receptive to sexual stimulation and have more satisfying sexual activities.
In the earliest years of the twenty-first century, a German company, Boehringer Ingelheim, owned the patent to the generic version of Addyi—called flibanserin. After flibanserin was shot down for approval by the FDA in 2010 and then again in 2013 (both times because the drug’s side effects appeared to outweigh any benefits to low-desiring women in clinical trials), Boehringer Ingelheim sold the rights to the patent to a U.S.-based fildena 120 pharmaceutical company—Sprout Pharmaceuticals. After running new clinical trials that showed slightly lower side effects but only a marginal improvement in satisfactory sexual encounters for women with low desire, flibanserin was finally approved by the FDA in August 2015. The drug was to be made officially available for public consumption in October 2015. In the interval between approval and release, before Addyi hit the shelves last fall, Valeant—a much larger, Canadian pharmaceutical company—bought Sprout Pharmaceuticals, in a $1 billion deal.
Valeant is the current owner of the rights to Addyi. So, we know that Addyi has the potential to make a lot of money for big pharmaceutical companies, but what does it actually do? Addyi is considered a norepinephrine-dopamine disinhibitor, or NDDI, when compared to other antidepressants (it was initially formulated as an antidepressant before being remarketed as a sexual dysfunction drug). This means that its mechanism of action involves allowing for more uptake of norepinephrine and dopamine, while decreasing levels of serotonin in the brain. Dopamine in particular has been found to be associated with sex drive and pleasure[5]. I like to think of it as helping you feel your sexual hunger.” It is remarkable that Dr. Marcus makes reference to women being “more receptive to sexual stimulation” in the above quote. This again raises the question of who this drug is actually for—is it for the woman who lacks desire, and suffers because of this lack?
According to studies conducted prior to FDA approval in 2015, women who were taking Addyi reported that the average number of times they experienced “satisfying sexual events” rose from 2.8 to 4.5 times per month. It is important to note that women receiving a placebo in the same study also reported a significant increase in “satisfying sexual events,” though—an increase of 2.7 to 3.7 times per month. Side effects were also experienced by many women who took Addyi in the study, including dizziness, nausea, fatigue, sleepiness, insomnia, and dangerously low blood pressure, particularly when combined with alcohol consumption (even just two glasses of wine). This image shows the highlighted side effects of Addyi (flibanserin). While more are listed in the full packet, this so-called “Black Box” Warning indicates that whatever benefits Addyi may have, they certainly do not come without cost.
It is not to be taken lightly. Despite these very real side effects, many clinicians and practitioners have vocalized their support for the drug, stating that the potential benefits may outweigh the potential harms. Bat Sheva Marcus of the Medical Center for Female Sexuality (MCFS) in New York City, “Drug trials have shown those women who take the drug are more receptive to sexual stimulation and have more satisfying sexual activities. I like to think of it as helping you feel your sexual hunger.” It is remarkable that Dr. Marcus makes reference to women being “more receptive to sexual stimulation” in the above quote. Or, is it for her purportedly more virile partner (who in many cases, is male)? In a recent article in the New York Times published immediately following the FDA approval of Addyi, Dr. Irwin Goldstein, a sexual specialist based in San Diego, similarly stated that women might be willing to put up with the side effects in order to garner the benefits: “Some women might find the risk of side effects acceptable if their relationships are in jeopardy because of a lack of desire.” It seems ironic that the very cost-benefit analyses or interest schemas that women are thought to “naturally” or “biologically” engage in when it comes to sex are here being prescribed to women by doctors in the sociopolitical sphere (of which conceptions of the “natural” and “biological” are arguably a part).