Originally posted in Times of Israel

Women want to want. Their partners want them to want. And Sprout Pharmaceuticals has some women believing that with the new pill Addyl (flibanserin), dubbed ‘pink Viagra,’ their dormant libidos can be stirred again.

The most important sexual organ is the brain, and neurochemistry governs pleasure-seeking behaviors. Flibanserin works directly on the brain by raising levels of certain brain chemicals responsible for sexual excitation, (dopamine and norepinephrine) while lowering levels of serotonin, which dampens sexual responsiveness.

It is not known when and if this product will be available in Israel, but, expect that it will ‘arouse’ controversy here, as it has around the world, since being approved by the FDA last August.

Ever since Pfizer hit the jackpot in the late nineties with Viagra, the successful erectile dysfunction treatment, drug companies have been scrambling to find a pill for women that will help them function as well, and after several unsuccessful trials, Sprout introduced flibanserin. ‘Pink Viagra’ is, of course, a misnomer. While Viagra targets blood flow to strategic areas, flibanserin targets desire, rather than arousal. It is the pill intended to make women ‘want’ to engage in sex in the first place.

So what could be controversial about that? After all, studies have shown that up to 43% of women are reported to suffer from s sexual dysfunction. Why not fix that by taking a pill?

Because, say some practitioners, ‘female sexual desire disorder’ is a construct, created by ‘Big Pharma’ to make women feel inadequate if they aren’t as spontaneously ready, willing or as eager as their male partners to engage in sex, or if they don’t desire sex as frequently. This point of view  is  advocated  by  a grass roots campaign  called  The New View,  which criticizes the medical community for medicalizing female sexuality.  They urge colleagues to consider that lack of desire not be chalked up to medical pathology, but that sexual problems can be due to socio-cultural, political, economic, psychological and relational contexts, whereby women may lack education and autonomy, or may experience guilt or shame around sex and pleasure.

However proponents of the drug jumped on the feminist bandwagon and reframed the low libido cure as a women’s rights issue as well, emphasizing that women have ‘equal rights’ to medical research and treatment of sexual concerns. After all, declared the influential ‘Even the Score’ website, ‘it’s time to give women the options they deserve for the treatment of sexual dysfunction’ In fact, Jewish Women International, self-described as ‘a women’s organization deeply concerned about healthy women, quality marriages and thriving families’ joined the FDA hearings, advocating the approval of flibanserin. The hearing also addressed safety concerns, as flibanserin is associated with symptoms of nausea, fatigue, dizziness and insomnia, and if it is combined with alcohol, can be dangerous.  However, advocates were able to demonstrate safety, citing a 2015 review study.

And then, this past Monday, the prestigious journal, JAMA (Journal of the American Medical Association) published findings, indicating that while some women report mild benefit, it is simply marginal in comparison to the risks. The research, coming from the Netherlands, is based on five published and three unpublished studies on 5,900 women.

This is indeed a blow to the women (and their partners) who were hoping for a magic cure for low libido. But it is not a big surprise to those of us who regularly treat women and couples who are often in a great deal of distress over elusive desire. Why a woman might lack the drive to engage in sex cannot be reduced to one single factor, whether it is chemical imbalances in the brain, hormones, lack of sleep, anxiety, a past history of trauma or abuse, or relationship conflicts. Often, a combination of factors is at play.

This does not necessarily mean that there is no value to this pill for some women, particularly when used together with other interventions. If there are women for whom the pill is effective and safe, that’s great. More likely, understanding more about sexuality and gender differences related to sex, getting more educated, (and sometimes getting more sleep), communicating effectively with your partner and experiencing vitality in multiple areas of life can help too. Here  is some information about female desire, that couples often find helpful:

• Women’s sexual desire is complex and involves not only biological drive but also multiple motivations for engaging in sex. If a woman is not motivated to have sex, perhaps she should find out why. Could she be depressed, angry with her partner, or bored with what’s happening in the bedroom?
• Motivation for having sex doesn’t necessarily involve ‘feeling desire’.  Women are motivated to engage in sex for reasons which include emotional closeness and intimacy, but more importantly, the knowledge that once she gets started, more often than not,  she will get aroused and have a satisfying experience, even if she isn’t crazy about the idea at the outset. After all, a woman doesn’t always feel a great urge to go to Zumba at 9 pm when it’s raining, but when she pushes herself and goes she will usually say, “that was great. I’m so glad I did that!”
• In some traditional cultures, women may not desire sex because they are not autonomous and don’t have a choice or a voice, or even possess basic knowledge and education about how sex works.  Judaism emphasizes that mutuality and consent are fundamental to sexual interaction, but cultural messages that women must fulfill the man’s need for sex or he will looks elsewhere or otherwise act sinfully, continue to pervade premarital education. This message cuts across all societies, as the Western media inundates women with ‘sex tips to keep your man faithful.” Having sex just to keep your man calm doesn’t necessarily inspire passion and desire.
• Hormonal changes, particularly after childbirth or related to menopause can affect libido, as can other medical issues such as chronic illness, or certain medications and treatments.
• Relationship dynamics and power struggles in marriage can contribute to sexual withholding and perpetuate discrepancies in sexual desire. Sometimes a couple is simply not communicating effectively. Perhaps the woman feels taken for granted, or maybe she has some things she would like to try, but has been labeled with “low desire” for so long, that she doesn’t see her own wanting as legitimate.
• If a woman “doesn’t desire sex” either spontaneously or when planned, this doesn’t mean she has a dysfunction. Multiple roles as caretakers, professionals, mothers, housekeepers and wives, can be exhausting and interfere with viewing sex as a place to experience joy and ‘letting go’ and turns it into another chore to check off the list. Rather than focus on “why don’t you want” how about asking, “what is it that you do want?’