My male friend isn't exactly insensitive. He remembers birthdays, appreciates the occasional latte, sings to his cats and even uses hand cream regularly. But when a recent roundtable discussion between friends turned to the subject of a female Viagra, his skeptical questions and furrowed brow revealed a deep confusion about why women would ever need Viagra.
Questioning why insurance companies should be expected to cover Viagra for girls, he patiently explained that men need to have an erection in order to have sex, whereas women's absence of arousal and orgasm doesn't mean an inability to do the deed.
The women surrounding him at the table, in varying degrees of intensity, immediately pounced. Are male erection and ejaculation all that defines the act of sex? And what would be the purpose of sex then, they asked. Procreation or pleasure?
Their responses clearly weren't directed only toward him, and he pondered their questions thoughtfully, like a person studying one of those mind-bending puzzles that require thinking outside of the box. The fact is, his first reaction to the notion that a woman's need to achieve orgasm is medically necessary was exactly like that of the medical establishment, which has offered little in the way of products or assistance. Until very recently, there was not even talk of products that might assist women with their sex lives, let alone medical coverage. Women still must pay out of pocket for birth control pills, even if they are deemed medically necessary, while most men get Viagra compliments of their HMO.
My reaction time was slowed by flashbacks to the sex education classes at my Midwestern Catholic school. The priest, usually the church pastor, would usher the boys into another room while the nuns of St. Robert School delved into sex talk with the girls. I remember frequent references to abstinence, marriage and lots of diagrams of the womb, but recall a void around discussion of orgasm, sexual pleasure or masturbation.
I never found out exactly what the boys talked about with the pastor.
Not surprisingly, the study of Female Sexual Dysfunction is an entirely new field. It was only two years ago that researchers discovered that the clitoris is actually 50 percent larger than previously thought. For decades the female organ has remained a mystery to most people -- which may explain why another dear male friend, discussing female circumcision, once inadvertently substituted the word "clavicle" for clitoris.
If the hunt for a female Viagra proves anything, it's that the medical community, like most of American culture, is not only relatively clueless about what women want when it comes to sexual pleasure, but it can't even decide whether or not it's important.
Crème de la Cream
Leland wilson can talk about the female sex organ as easily as other people talk about kidney failure or a heart attack.
"This is an organ that is necessary for us to function," states Wilson, founding president of Vivus Inc. "Just like people should have good kidneys and a strong heart, they should have a good, healthy sex life."
Wilson began working for Vivus, a pharmaceutical company specializing in the sexual dysfunction market, in 1991. Over the past decade he and founder Vergil Place created Muse and Alibra, two external, cream-based treatments for male erectile dysfunction that were initially extremely popular.
"We sold $129 million that first year," Wilson says. "Then Viagra was launched and, well, the rest is history."
Rather than shut its doors as 6 million men eagerly began popping pills to aid in erection, the company restructured to focus on new markets. Vivus quickly found that treating women's sexual problems was virtually unexplored territory. After years of laboratory tests and patents, the company has begun clinical trials on Alista, a new cream they hope can rock the world of women's sexuality in much the same way Viagra has done for men.
"Alista is a very elegant, very light cream that goes on the clitoris. It causes vasal engorgement, or the flow of blood to the clitoris, and stimulation," Wilson says. "We believe we are in the lead of Female Sexual Dysfunction research."
Wilson reports that Alista has performed extremely well in the first phase of clinical trials, also known as tolerance studies. The next phase involves a much larger sample of women and studies conducted at multiple sites.
Once a mysterious, rarely discussed organ, people like Wilson are focusing on the clitoris as a key to treating the newly labeled disorder known as Female Sexual Dysfunction, or FSD. In recent years, dialogue about women's sexual woes has drawn hundreds of doctors into international workshops and has catapulted pharmaceutical companies into a mad scramble for cures.
Hot on the Trail
Since the viagra sucess story, which has brought in more than $1 billion each year for Pfizer Inc., drug companies now see the untapped women's market as ripe with profit-making possibilities. Even after spending $94 million on pill-pushing marketing campaigns, Viagra producers rake in nearly $3 billion each year. Vivus has met with stiff competition in the race for FDA approval of new treatments for women. Dozens of companies, from herbalists in Ireland to doctors in Australia, are hot on the trail to find a female Viagra. And no wonder. According to the Network for Excellence in Women's Sexual Health, a new group of doctors led by sisters Laura and Dr. Jennifer Berman, Female Sexual Dysfunction is "an age-related, progressive and highly prevalent problem affecting 30 to 50 percent of women."
Numerous national magazines, including Vogue, have heralded the movement to address ladies' libidos as the latest wave of the sexual revolution and feminism's new best friend. But critics, including numerous sexual therapists who advocate therapy rather than immediate medication, believe the pharmaceutical companies' drive for profits is fueling a dangerous dialogue, one that tells women they need to pop pills or dab clitoral creams to truly enjoy sex.
Those condemning the hunt for a female Viagra haven't slowed the flood of new products now being tested. County Cork, Ireland, once known as the "Port of Tears" because so many immigrants left their families from its shores, is quickly earning a new reputation thanks to a residing doctor's new female Viagra pill, called Femagro. Dr. Ronan Gleeson, a Cork-based doctor and herbalist, has invented a pill for post-menopausal women struggling with lowered sex drives. The bright pink Femagro pills feature yohimbe, a controversial herb known as "the love bark." He has also developed larger, higher-dosage hot pink capsules.
At the University of Texas-Austin, researchers aided by NitroMed pharmaceutical company are developing a similar formula containing yohimbe and nitric acid. Both pills are meant to increase blood flow to the vaginal area and induce arousal. Initial animal tests in Texas appear successful and Gleeson reports that women have had positive responses, but neither pill has yet received FDA approval. Still, Gleeson's pills sell for nearly $10 each, and he is looking to sell his Femagro pills over the Internet. Femagro is currently available after consultations with Gleeson.
Much of the focus in finding femmes an equivalent to Viagra has centered around topical creams, gels or manual devices rather than pills. Perhaps this is because initial suspicions that male Viagra pills would have identical effects on women haven't held up in clinical trials.
"A topical cream takes the medicine right to the organ. Whereas Viagra circulates throughout the body, the cream provides a high concentration right to the clitoris or penis," Wilson says. "Oral is very convenient, but I don't know that the technology would work as a pill."
Dr. Jed Kaminetsky, who produces another topical treatment known as Dr. K's Dream Cream (www.femalesexualtherapy.com), has taken the same approach to treat women's problems. He says it can help treat problems stemming from a range of troubles, from "nerve damage" to "long-distance bike riding."
Kaminetsky is so confident in his product that his wife was the subject of initial trials.
Vivus Inc. initially had little trouble patenting their discoveries about treatments for Female Sexual Dysfunction, mainly because so few researchers had bothered to explore women's sexuality during the early '90s. Historically, the limited medical studies about women and sex focused on procreation, not pleasure.
Last October, nearly 500 specialists gathered in Boston for a massive international conference, "New Perspectives in the Management of Female Sexual Dysfunction Forum," which featured nearly 100 workshops devoted to discussing ladies and their libidos. Even the Journal of American Medical Association conducted a massive study about feminine pleasure, the National Health and Social Life Survey. It found that 43 percent of women, in comparison to 31 percent of men, have experienced sexual dysfunction. NextMed, makers of another clitoral cream, estimates that nearly 50 million American women struggle with sexual problems.
While men's issues have been thoroughly researched for several decades, and Viagra is even covered by staunch insurance companies, female sexuality research is nearly virgin turf.
"For years, women's sexual complaints have been neglected by the medical establishment. But no more," boasts the introduction to For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. The book, which becomes available in hardcover this month, provides more than 300 pages of details about sexual problems, women's anatomy and female sexual response.
"The field of medicine is only just beginning to address female sexual function complaints," says Laura Berman, who co-authored the book with her sister, Dr. Jennifer Berman. "The medical community is only starting to get a knowledge base to deal with these problems."
Part of the difficulty in talking about this newfound disorder is the broad laundry list of symptoms covered under the umbrella of Female Sexual Dysfunction. In 1998, a panel of health care providers finally came together to better define women's woes, which mainly center around lack of desire, decreased arousal, difficulty achieving orgasm and pain during sex. Official problems linked to FSD include hypoactive sexual desire disorder, a deficiency of sexual thoughts and fantasies; sexual aversion disorder, a phobic aversion to sexual contact with partner; sexual arousal disorder, inability to achieve or maintain sexual excitement; orgasmic disorder; and sexual pain disorders. Possible causes given feature an equally extensive list, including decreasing estrogen levels due to menopause, high blood pressure, smoking, sedentary lifestyle, neurological diseases, as well as emotional and relationship issues such as low self-esteem, depression or being involved in an unsatisfying or abusive relationship.
"It is crucial to understand that not all female sexual complaints are psychological, and that there are possible [medical] therapeutic options," the Berman sisters write.
Despite the historic silence around issues of the clitoris, the two Boston-based sisters have created an undeniable buzz in mainstream press. They've been interviewed for The New York Times, NBC, Good Morning America, Larry King Live, and were most recently spotted amid the Prada pumps and Versace designs in last month's Vogue. The article references the movement as "feminism's next wave."
Carol Rinkleib Ellison, a psychologist specializing in sexual counseling, isn't one to mourn public discussion about female pleasure. She recently wrote Women's Sexualities: Generations of Women Share Intimate Secrets of Sexual Self-Acceptance. Ellison says the current hoopla around Female Sexual Dysfunction is hardly a reason to celebrate.
"I hate the word dysfunction. I feel like it tells women they either function or they're broken," Ellison says. "The kind of publicity that the pharmaceutical and medical communities put out is all about medicating, putting the problem in the genitals. Often, if we listen to our bodies and we're not responding, that can be saying something about our relationships."
Basically, no pill will help someone who hates her partner. And no cream will substitute for real communication around intimacy issues. There's more to sex than the blood flow to the clitoris.
Last October, Ellison met with sexual counselors throughout the United States and Canada in order to address concerns about the Female Sexual Dysfunction movement. The meetings resulted in a lasting organization, the Working Group for a New View of Women's Sexual Problems, which attended the big Boston conference to protest its emphasis on dysfunction. The group, led by Boston-based therapist Leonore Tiefer, describes itself as "clinicians and social scientists deeply concerned about the increasing medicalization of women's sexuality by urologists and the pharmaceutical industry."
They see the FSD and female Viagra frenzy as fueled by dollar signs, not empowering women. They would rather see a movement that addresses the complexity of factors affecting women's sexuality, such as socio-economic status, access to sex education, ability to communicate to partner about desires, and history of sexual abuse.
"We're so sexualized in our culture," Ellison says. "Women are taught that if our genitals aren't all hot and bothered that we're not normal. For a lot of women this isn't about a medical dysfunction, but women are often too tired or too busy for sex."
Ellison's Women's Sexualities book strives to put women's sexuality in women's own words. She found that many females interviewed ranked emotional closeness before and after sex and feeling loved as having greater significance to them than the number of orgasms achieved.
"I think our language is a language of performance and work, rather than that we create mutual pleasure," Ellison says. "Doctors make these great claims based on [tests performed on] rabbit genitals, and very small samples of women. Many of these claims are over-generalized, and dangerous because they sound very scientific."
Touched by Angels
"Why are we rushing to provide pills for adult women and yet continue to provide abstinence-only sex education for girls?" asks Deborah Tolman, Ph.D., a supporter of Ellison's new group. She is only one of the many women who noticed that girls interested in sexuality while growing up get labeled as "boy crazy," "slut" or "easy." The virtuous virgin receives praise. Then those girls grow up to be women who are told they have a disorder for not being sexual enough.
Even Female Sexual Dysfunction leaders Laura and Jennifer Berman don't make any promises of miracle cures found in a pill.
"The ideal approach to FSD is a collaborative effort between therapists and physicians. This should include a complete medical and psychosocial evaluation, as well as inclusion of the partner or spouse in the evaluation and treatment process," the Berman sisters write.
Just like the glaring difference between silence about teen girls' sexuality and pushing pills on adult women for not being sexual enough, the medical community is exhibiting wildly inconsistent behavior. Doctors and drug companies are making an awkward jump from utter silence about women's sexuality to a hyperactive frenzy of workshops, research and new treatments. Some say it's hypocritical that doctors are now trying to pass themselves off as experts in a field in which they have limited information. Carol Queen, Ed.D., says that few classes in most medical schools emphasize women's sexuality.
"All of a sudden, especially since Viagra, doctors see that treatments are available. And the medical community is quickly remaking itself as an expert in this field," says Queen, a sexologist and director of continuing education at Good Vibrations. Compared to doctors, the legendary San Francisco shop has a much longer history of providing women with ways to explore sexual functioning.
When asked about the difference between one of her shop's vibrators or suction devices and the new Eros, Queen laughs.
"The short answer is nothing, except that your insurance company might pay for it," Queen says. "Now there is a medical device a doctor can prescribe. But all along the doctors could have been asking their patients if they'd tried vibrators, sex toys and masturbation. A lot of doctors just don't know to ask this stuff."
She believes doctors are in an awkward position where they learn little in medical school about women's sexuality.
"Then they go to seminars, and get pumped with information at conferences sponsored by drug companies," Queen says. "What Good Vibes wants to do is not set ourselves up as medical experts, but experts about sexuality."
The shop also disagrees with the medical establishment's tendency to treat women's sexuality as solely an issue for those in relationships. Good Vibrations is gearing up to celebrate National Masturbation Month in May, and hoping to raise consciousness about sexuality and women's pleasure.
"Some wait for their prince to come, and they come, too," Queen says. "But others don't want to wait."