10 years after Viagra, where's women's magic pill?

Viagra turns 10 this month, and didn't time just fly?

It seems like only yesterday we started guffawing at the ads on TV for the little blue pill and its "erectile dysfunction" rivals — footballs tossed through tires, faucets erupting. The spots ended with a list of potential side effects that sounded like a satire. More than four hours? Ouch.

However discomfiting the commercials, the Food and Drug Administration's approval of Viagra on March 27, 1998, is a landmark day in the history of sex. And about five minutes after word of the magical med went global, the question first was asked: Where is the women's version of Viagra?

The short answer: They're still working on it. A bunch of companies have tried and failed to create "pink Viagra," as it's often called. Other companies have drugs in late stages of clinical testing, including a gel that recently began a make-or-break nationwide study with several thousand women. Give us five years, maybe less, say the most optimistic researchers and doctors.

Though it's unclear exactly how many women would ask for a prescription, no one doubts that the first company that gets to market a remedy for female sexual dysfunction, as it's formally known, will earn a fortune.

But as this race reaches what could be its final lap, not all the spectators are cheering. Some, in fact, are booing loudly.

A modestly sized but fervent group of psychologists, academics and public health advocates contend that FSD isn't an authentic medical condition, or at least not the sort of problem that should be treated with drugs. These aren't the obtuse male physicians who for decades have been telling women distressed by their lack of libido that "it's all in your head."

The anti-FSD crowd is mostly women, many of them self-described feminists. The most prominent is Leonore Tiefer, a psychotherapist and clinical associate professor at New York University who has long decried what she calls "the medicalization of women's sexuality." Her critique centers, in part, on the way pink Viagra is sure to be marketed — with ads day and night, suggesting that women who aren't feeling frisky have a medical problem.

She and her allies — organized as the New View Campaign — are also galled that so much money and media attention are heaped on the lust drug, even before it exists, when for many women the solution to their libido problems isn't that exotic. Maybe they have a partner who hasn't a clue about technique. Maybe they're stressed out. Maybe they can't possibly get in the mood because they're so busy raising children.

On the other side of the FSD divide, allied with the pharmaceutical companies, is a group of physicians prescribing off-label treatments. (Off-label means the drug hasn't been approved by the FDA for that treatment.)

The highest-profile of the bunch is Irwin Goldstein, the director of sexual medicine at San Diego's Alvarado Hospital. He and Tiefer have debated the topic of FSD for a decade, but as far as he's concerned, there's really nothing to discuss. He has been using hormones to treat women, and he'll happily put you in touch with patients who will rhapsodize about the results.

On one point everyone agrees: The search for pink Viagra is proving trickier than anticipated.

There was PT-141, by Palatin Technologies of New Jersey, a drug inhaled via nasal spray and found, in preliminary tests, to produce friskiness in both men and women. In August, the FDA stopped clinical testing, citing concerns about a side effect: high blood pressure.

There was Intrinsa, a patch made by Procter & Gamble that transmitted testosterone into the bloodstream through the skin. Also dinged by the FDA.

And of course, long before modern medicine, there were zany experiments with ointments, insects and ground-up rhinoceros horns. The search for a female aphrodisiac is apparently as old as wooing.

With men, all a medication needs to produce is arousal — an erection. A guy will conjure lust on his own. A woman, on the other hand, can get aroused — or have the physical signs of arousal — and remain uninterested in sex. That's why Viagra doesn't work for women, even though it produces roughly the same physical effect — rushing blood to the nether regions.

"What we know is that very little of what's going on with women and sex is below the waist," says Anita Clayton, co-author of Satisfaction: Women, Sex and the Quest for Intimacy. "Almost all of it is above the neck."

So if lust is "above the neck" for women, how do you measure it? To win the pink Viagra sweepstakes, the FDA wants data demonstrating an increase in the number of a woman's "sexually satisfying events." But that's hard to define and fantastically varied.

A number of drug companies say they can clear the FDA's bar, no matter how high.

We'll see.

10 years after Viagra, where's women's magic pill? 03/14/08 [Last modified: Thursday, October 28, 2010 9:38am]

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