F.D.A. Panel Backs a Drug to Increase Women’s Sex Drive
June 4, 2015 3:00 PM   Subscribe

“Critics say the improvement might only be modest, but oh what I would give for even a modest improvement,” The advisory committee to the Food and Drug Administration voted 18 to 6 that the drug, flibanserin, be approved. All of those who voted yes said approval should come only if certain measures are taken to reduce the risks of side effects.

After the second rejection, in 2013, some women’s groups, brought together by a consultant to Sprout, organized a campaign to press the F.D.A. into approving the drug. The campaign, called Even the Score, accused the agency of gender bias because it had approved Viagra and other drugs to help men have sex while leaving women without options.

UCSD’s Dr. Stahl pointed out that the FDA’s opposition to flibanserin started with questions of efficacy and is now focused on its side effect profile. The side effects of most concern to the F.D.A. were low blood pressure and fainting. While these were rare in the clinical trials, they seemed to raise the risk of accidental injury, with one woman having a concussion when she fell.Flibanserin can cause fainting and is sedating when taken with alcohol.

The meeting, at the F.D.A. campus in Silver Spring, Md., included nearly two hours of testimony from the public, an unusually large amount, with most speakers urging approval.

Supporters of the drug said that failure to approve it would discourage the pharmaceutical industry from pursuing treatments for female sexual disorder and that lack of an approved medicine would only cause women to use other drugs off label or seek help from dubious supplements hawked on the Internet.

“If it’s not approved, you won’t see another type of drug like this for ten years. Drug companies just won’t want to touch this therapeutic area.”
posted by TheLittlePrince (73 comments total) 15 users marked this as a favorite
 
Missed out adding on a parody ad created by the group "Even the Score" as part of their campaign.
posted by TheLittlePrince at 3:03 PM on June 4, 2015


"Viagra for women" is a really bad analogy, and I'm disappointed to see the press pick it up and run with it.

ED isn't necessarily correlated with sex drive, and Viagra wasn't even developed to treat ED; it's somewhat effective (and FDA approved) for treating pulmonary hypertension, and is routinely prescribed to women for that purpose.
posted by schmod at 3:11 PM on June 4, 2015 [10 favorites]


YES YES YES and anyone who comes into this thread making purile jokes about how this is a male plot like last time, I will cut you, this is a miracle if it actually works
posted by showbiz_liz at 3:11 PM on June 4, 2015 [9 favorites]


The drug discussed in this article is taken daily. In the pipeline there is also a take-on-demand female sexual desire drug, Lybrido, which is about to start Phase 3 testing now - and as mentioned in one of the above articles, the approval of the one drug might spur the development and approval of further drugs.
posted by showbiz_liz at 3:20 PM on June 4, 2015 [2 favorites]


Also, (admittedly speaking as a man) I'm not sure I agree with the accusations of gender bias. Viagra is extremely effective, whilst the demonstrated efficacy of flibanserin is minimal at best, and appears to be culpable for some potentially severe side effects.

I wouldn't have approved Viagra if it only led to a ~20% increase in positive sexual events, and potentially led to a loss of consciousness during physical activity.

Used responsibly, this could be great for the small population that it can help. However, given the medical culture in the US, I do not have a lot of confidence that it will be prescribed judiciously.
posted by schmod at 3:20 PM on June 4, 2015 [14 favorites]


Used responsibly, this could be great for the small population that it can help

Because Viagra is always used responsibly ?

WTF does "used responsibly" mean anyway and why is it always (i.e. only) we woman who must be so damn responsible with our sex drives?
posted by AGameOfMoans at 3:34 PM on June 4, 2015 [38 favorites]


demonstrated efficacy of flibanserin is minimal at best, and appears to be culpable for some potentially severe side effects.


QFT. This appears to be a classic example of astroturfing, where the drug company recruited a (legitimately under-served) patient population, and made an organization to make their naked play for approving an ineffective drug more sympathetic, more open to political pressure, and thus more likely to be approved. I hope that Lybrido is a better drug.
posted by lalochezia at 3:34 PM on June 4, 2015 [29 favorites]


This seems terrible. Weed doesn't make you pass out. I also don't think drugs you take every day are anything like Viagra. It's weird to make approving a crappy drug (that women will be pressured to take) into a feminist cause. Maybe we should have an "Even The Score--Find The Clitoris" movement. Or perhaps "Even The Score--Change A Fucking Diaper"

Or we could fund pelvic floor rehab. Or actually test rape kits so more and more women aren't getting assaulted by shithead serial rapists.
posted by internet fraud detective squad, station number 9 at 3:34 PM on June 4, 2015 [53 favorites]


demonstrated efficacy of flibanserin is minimal at best, and appears to be culpable for some potentially severe side effects.

This honestly seems like a drastic overstatement of "it is proven to work and can cause fainting"
posted by showbiz_liz at 3:43 PM on June 4, 2015 [1 favorite]


The argument that this sucks because women will be pressured to take it seems so insulting to the women who actually suffer from this condition. Not because they're sad they can't service their husbands anymore, but because loss of desire is horrible. Really, really horrible.

Tens of thousands of people quit perfectly effective antidepressants because they just can't handle the sexual side effects, as I did recently. I felt amputated. I didn't want to date anymore because of it.

If it doesn't come back, which is apparently possible, I would kill for access to this drug. Even if it isn't a massive, dramatic change. Even if there are potential side effects. Because this is a serious problem that causes real distress to a lot of people.
posted by showbiz_liz at 3:52 PM on June 4, 2015 [36 favorites]


This honestly seems like a drastic overstatement of "it is proven to work and can cause fainting"

Which, hilariously, does not actually distinguish it from Viagra which can also cause fainting and other ill effects by way of precipitously lowering blood pressure if taken in combination with other heart medications. I mean, sure, they tell you not to do that, but when was the last time any drug had 100% compliance with doctors' instructions?
posted by Joey Buttafoucault at 3:53 PM on June 4, 2015 [2 favorites]


The argument that this sucks because women will be pressured to take it seems so insulting to the women who actually suffer from this condition. Not because they're sad they can't service their husbands anymore, but because loss of desire is horrible. Really, really horrible.
Although the two North American trials that used the flibanserin 100 mg qhs dose showed a statistically significant difference between flibanserin and the placebo for the endpoint of SSEs [satisfying sexual events], they both failed to demonstrate a statistically significant improvement on the co-primary endpoint of sexual desire. Therefore, neither study met the agreed-upon criteria for success in establishing the efficacy of flibanserin for the treatment of [Hypoactive Sexual Desire Disorder].
Just sayin'.

Of course lack of sex drive is a problem worth solving. This -- a failed antidepressant Sprout's trying to shove onto the market any which way they can -- ain't the solution.
posted by Sys Rq at 4:03 PM on June 4, 2015 [15 favorites]


FUCK YES: IT'S PINK!
LET NO ONE BE CONFUSED!
WOMEN PINK PINK WOMEN SALES YES!
posted by eyesontheroad at 4:08 PM on June 4, 2015 [13 favorites]


But is there any other drug that shows "a statistically significant difference between the drug and the placebo for the endpoint of SSEs [satisfying sexual events]," and if not, why is this drug not worth having for that reason alone?

Of course it could be far better, but it's not nothing. And nothing is what we currently have.
posted by showbiz_liz at 4:13 PM on June 4, 2015


But is there any other drug that shows "a statistically significant difference between the drug and the placebo for the endpoint of SSEs [satisfying sexual events]," and if not, why is this drug not worth having for that reason alone?

I only meant to respond to your insinuations that this drug helps improve sexual desire.

It doesn't.

If you want to take it, go nuts, but all it's been "proven" to do is sometimes barely improve sex while you're having it. It won't make you feel like having sex in the first place, however, so if that's your problem, the actual benefit is pretty much moot, no?
posted by Sys Rq at 4:20 PM on June 4, 2015 [5 favorites]


all it's been "proven" to do is sometimes barely sometimes barely improve sex while you're having it

SOLD !
posted by AGameOfMoans at 4:26 PM on June 4, 2015 [4 favorites]


I don't find it insulting to acknowledge rape culture or sexism and the way they intersect with our long tradition of pathologizing women's sexual desire (or lack thereof).
posted by internet fraud detective squad, station number 9 at 4:26 PM on June 4, 2015 [6 favorites]


WTF does "used responsibly" mean anyway and why is it always (i.e. only) we woman who must be so damn responsible with our sex drives?

Sorry. I meant "prescribed responsibly."

Viagra also carries similar risks, and is definitely overprescribed. However, when this drug is barely more effective than a placebo and carries real risks (and has a huge profit motive from its corporate backer)..... it's an interesting moral question of whether or not the FDA should approve this.
posted by schmod at 4:27 PM on June 4, 2015 [5 favorites]


And we do have something. Weed. I'm completely serious.
posted by internet fraud detective squad, station number 9 at 4:30 PM on June 4, 2015 [20 favorites]


Weed just makes me sleepy - not sexy.
posted by AGameOfMoans at 4:34 PM on June 4, 2015 [11 favorites]


I wish we'd get on with the serious cannabis research, because I'd LOVE it if they could pull out and bottle the sexy effects of weed somehow. (Don't get me wrong, weed owns, but there are lots and lots of circumstances where I'd want the sexy effects without the high-as-fuck effects.)

And... I mean, I get where you're coming from. But the patriarchy gets you coming and going. You can say, this is pathologising a lack of desire, but on the other hand, it also sucks when that lack of desire causes real distress but is ignored or treated as trivial because "women are just less sexual then men."
posted by showbiz_liz at 4:41 PM on June 4, 2015 [6 favorites]


[One comment deleted. Do not bring your hand-wavey thought experiments about false rape accusations in here.]
posted by LobsterMitten (staff) at 4:50 PM on June 4, 2015 [10 favorites]


I'm writing the remake to How Stella Got Her Groove Back. Hold, please.
posted by OnTheLastCastle at 4:51 PM on June 4, 2015


To just fucking TMI all over the place, I'm in chronic pain for a lot of the time, and it is amazing how weed is just like *put the pain over here and get on with the fun your body is aching to have."
posted by angrycat at 5:00 PM on June 4, 2015 [11 favorites]


Don't confuse a lack of desire with not even wanting to have that desire in the first place. Across all spectrums of gender, knowing that you should feel desire but aren't, or wanting to feel that desire but not being able to - Those are real problems. I've felt this on the male end of the spectrum - Other meds fucked it up really bad, and it took me forever to recover. Viagra and others don't make a damned bit of difference if you are feeling sexually dead. It's a problem if you want to be sexually close, and literally cannot because that part of you just isn't working. It's difficult for both parties - It's very easy for the other person to start thinking that there is something wrong with them, or that you don't find them attractive anymore. It's a giant spiral of suck for everyone involved. Treatment for that would be miraculous - Even at an incredibly minimal level.


An effective drug in this field should absolutely exist, and of course it should only be used with consent and knowledge, and a risk analysis - like any other med.

This isn't (as far as I know, correct me if I'm wrong) the sort of thing you'd slip into someones drink for some nefarious purpose - Just because someone now has the ability to experience desire, it doesn't mean they will suddenly be attracted where they weren't before. I doubt it would fix a relationship that had bigger issues going on as well. I also don't think that this is being proposed as something to take when you don't want sexytimes but your partner does.... At least I sure as hell hope that isn't how it is being proposed. That would be a problem. But this is also not how desire works in this context. Low or nonexistent desire isn't the same thing as actively NOT desiring.

Advertising is where I see the fears expressed in this thread coming into play. Of course, in my world, drugs would never be advertised to the consumer to begin with... but that's where I could see some of the problems people are seeing here come to light.

Correct me if I'm wrong on any of this - i'm basing this off of a male perspective, but as someone who thinks that an answer for anyone who has gone through this is a good thing.
posted by MysticMCJ at 5:05 PM on June 4, 2015 [7 favorites]


The closing quote in the NYT article sums it up for me. Dr. Adriane J. Fugh-Berman: A mediocre aphrodisiac with some scary side effects.

When used outside of the ideal situation of clinical trials, the 20% improvement will evaporate and the side effects will expand. The former because it has to be taken every day to work increase a pleasurable sex result once a month - in other words, compliance issues. The latter because of more chances for interactions and compound effects with diseases in the real world.
posted by dances_with_sneetches at 5:07 PM on June 4, 2015 [2 favorites]


"But is there any other drug that shows "a statistically significant difference between the drug and the placebo for the endpoint of SSEs [satisfying sexual events]," and if not, why is this drug not worth having for that reason alone?"

Weirdly, I fell down the wikipedia hole on this a couple weeks back after seeing someone advertise Melanotan II on a research chems site (I was looking into ether for an alternative process photography book I was reviewing, and so my search history is mainly horrible poisons, heavy metals and archaic psychotropics).

There are a bunch of drugs that look promising, perhaps even more promising than flibanserin. Some of them are already prescribed — bupropion works on dopamine pathways, and seems to have an interesting disinhibition mechanism (it's prescribed as an anti-depressant but also to help cut addictive behavior like alcoholism, gambling or smoking, but for some people it goes the other way and can lead to compulsive gambling or sex). Bupropion has the advantage of already being approved by the FDA.

One of the things that makes this extra complicated is that the erectile dysfunction drugs are often working on a fairly simple mechanistic model — they don't do anything about desire, they just shift blood pressure to make it easier to sustain erections. And while some drugs (like bupropion again) do reportedly increase female genital blood flow, it's a relatively small percentage of women with lower than normal sex drives whose problem can be solved purely by increasing blood flow.

The background of flibanserin as an anti-depressant is important and gives a better model for thinking about it than viagra. Depression is a really complex neurochemical imbalance with significant cultural cofactors. So is sexual desire. Lots of people have trouble with anti-depressants; they're in no way one size fits all and a lot of people have to go through multiple months-long regimens to find one that works for them. And over the history of anti-depressant development and prescription use, we've seen a lot of problems with side effects, e.g. prozac increasing suicide risk in adolescents. And we still don't (someone correct me if my chemistry knowledge is out of date) know exactly how most anti-depressants work — we have a decent idea of what receptors they bind to, and that in general slowing neurotransmitter re-uptake helps normalize levels of e.g. serotonin, but the chemistry is largely based on observation first rather than a reliable brain model, unlike a lot of other drugs that get used all the time. Compared to, say, antibiotics, prescription neurochemistry is far cruder and more a frontier than settled territory. (Again, if a pharmacology chemist knows better, I'd love to be corrected on this, since it mostly comes from talking to doctors.)

Being skeptical of flibanserin isn't denying that diminished female arousal isn't a real, serious problem any more than being skeptical of emerging cancer treatments is denying that cancer is a real, serious problem. In fact, that both are real, serious problems is a reason to increase skepticism because people who suffer from them are more likely to be desperate to do anything that might help, which has long been a recipe for snake oil. That a seeming astroturf campaign has rallied people around this is even more reason to be skeptical.

To get back to your question: There are other drugs, and flibanserin may not be worth having because the risks may be that a lot of people pay a lot of money for a dubious treatment of a real problem while simultaneously suffering currently under-investigated side effects that may cause serious harm to some of them.

Something else that is worth remembering: The ugly fact that there may not be a drug for this that is safe and effective. We put a lot of faith in the notion that humans can fix anything if they push hard enough at it, but there are still a lot of conditions for which no effective treatment exists and it's not always because it's not a priority to fix it. Sometimes it's because there is no effective treatment.

Psychopharmacology has done a world of good for me and my wife is a pharmacy librarian. I believe in better living through science. I want there to be a treatment for women who aren't having the sex they want. But that doesn't mean flibanserin is the way, or even that there is a pharmacological intervention that will work.
posted by klangklangston at 5:08 PM on June 4, 2015 [29 favorites]


We put a lot of faith in the notion that humans can fix anything if they push hard enough at it, but there are still a lot of conditions for which no effective treatment exists and it's not always because it's not a priority to fix it. Sometimes it's because there is no effective treatment.

That's a big 'yet,' though. We've only even been trying to develop drugs this way for what, 100 years? I definitely take your point, but as that post yesterday about the previously unknown brain/lymph connection demonstrates, we are very very far from exhausting all possible avenues for developing medical treatments.

I want this drug to succeed because I want research money to pour into trying to better understand sexual desire, in order to make a better one. I'm not convinced that will happen without some initial "well this KIND OF works" drugs coming to market.
posted by showbiz_liz at 5:16 PM on June 4, 2015 [2 favorites]


"This isn't (as far as I know, correct me if I'm wrong) the sort of thing you'd slip into someones drink for some nefarious purpose - Just because someone now has the ability to experience desire, it doesn't mean they will suddenly be attracted where they weren't before. I doubt it would fix a relationship that had bigger issues going on as well. I also don't think that this is being proposed as something to take when you don't want sexytimes but your partner does.... At least I sure as hell hope that isn't how it is being proposed. That would be a problem. But this is also not how desire works in this context. Low or nonexistent desire isn't the same thing as actively NOT desiring."

It's complicated too by the current conception of three systems working within sexual desire (at least as far as I know; I know there are some sex researchers here and I'd love to hear their opinions on whether the Kinsey model still holds and the drug in general): There's one system that checks the reasons you may want to have sex (excitation); a second system checks all the reasons you may not want to have sex (inhibition); and a third system that regulates the physical responses to sexual desire. Like many things, they're a combination of trained (learned) response and underlying physical instinct. Flibanserin seems to work on both sets of neurochemical systems; Wikipedia claims it "resets the balance," but that seems like a dubious simplifying gloss.
posted by klangklangston at 5:17 PM on June 4, 2015 [3 favorites]


Of course it could be far better, but it's not nothing. And nothing is what we currently have.

Well, there's maybe Wellbutrin, but that's off label, (apparently) not much studied, not widely known, and not often used for the purpose.
posted by dilettante at 5:25 PM on June 4, 2015


Wellbutrin is bupropion's brand name; I mentioned it above.
posted by klangklangston at 5:27 PM on June 4, 2015 [2 favorites]


That's got its own possible side effects, of course. For me it was random intense crying jags, which are only considered sexy by a small percentage of the populace. (I have heard good things from others though.)
posted by showbiz_liz at 5:30 PM on June 4, 2015 [4 favorites]


I'm really concerned that stuff like this will end up being a fix for women who would be comfortable with their sex drives if they weren't pressured by society and their partners to have more sex, kind of like how I worry about overprescriptions of ADD/ADHD meds for kids who just aren't good fits for the mold schools expect kids to fit into.
posted by NoraReed at 5:36 PM on June 4, 2015 [9 favorites]


And we do have something. Weed. I'm completely serious.

yes, there is nothing that makes me wanna bone down more than me having a panic attack and then throwing up while crying. it is hot like fires.
posted by poffin boffin at 5:37 PM on June 4, 2015 [27 favorites]


I am so conflicted about these drugs for a whole bunch of reasons. One is that there's wanting and wanting--there's a difference between, oh, being attracted to someone but never being in the mood and being attracted but feeling pressured and having stopped feeling attracted to someone at all. And wanting is complicated. I am not at all convinced that the existence of a pill that makes people more... more what? More responsive to genital . Anyway, I'm not convinced that this pill will solve anything or, honestly, be much of an improvement over a placebo.

I am furthermore not convinced medications for this are ever going to be all that effective, mostly because as I said there's a whole lot of etiologies and reasons tied up in "I don't desire sex but I also want to desire it" and it's going to be very difficult to figure out exactly what is going on there in order to get the right pill into the right patient. Viagra is considerably simpler because all it does is facilitate erections--it's not acting on anything mental. Viagra mostly just makes it easier for erections to happen, it doesn't necessarily have much to do with desire.

I dunno. I completely feel the desire that people with low desire have for an equivalent to Viagra, but... I don't think it's that simple. And I don't even think that popping a pill would solve anything. Even if it did--if it worked by lowering inhibitions or if it worked by making sex sound really appealing or if it worked by just revving up libido--I think that that hypothetical pill would be incredibly ripe for abuse on a basic consent level.

Of course, this is all coming from someone whose baseline feelings about sex are apathetic sliding to disinterested as a matter of course, and also a person who has invested pretty heavily in a model that says I'm not the broken one and this is okay for a person to be. (I think the only reason I don't currently fit the new DSM V criteria for HSDD is because they slotted in a "well if they identify as asexual this doesn't apply" clause into this round, which is... problematic.) So while I feel pretty strongly how much it can suck to have a strong disconnect between wanting and wanting to want... I don't know. I'm pretty uncomfortable and ambivalent here.
posted by sciatrix at 5:38 PM on June 4, 2015 [4 favorites]


I think that that hypothetical pill would be incredibly ripe for abuse on a basic consent level

This argument makes me uncomfortable, because it basically seems to be saying "if a woman gets horny, she is then unable to consent to sex." Because these pills (real and hypothetical) aren't vodka, they don't remove your ability to reason or disable you - they just make you able to get horny.

It really does seem, to me, to be rooted in the idea that "women wanting sex" is something that is primarily a benefit to men, and that women should fear or disregard or deliberately downplay their own sexuality because it's just another tool of the patriarchy.
posted by showbiz_liz at 5:46 PM on June 4, 2015 [14 favorites]


This whole situation just seems really problematic. I really don't like how it's being framed as a feminist issue, especially since the group pushing this narrative is spearheaded by the drug's manufacturer. It's also very misleading and disingenuous to equate this drug to Viagra, because their function and mechanisms are very different, but that seems like part of the general campaign of obfuscation and confusion to detract from the problems this drug has.

There are real, legitimate concerns here about both the efficacy of this drug and its side effects. It's clear that this is a very personal issue for some posters in this thread, but you can't just push those real concerns aside.

I don't know, it really seems like a drug manufacturer is wrapping a mediocre product that maybe shouldn't be approved in the mantle of feminism to pressure the FDA. The FDA shouldn't be forced into taking action to "even the score", it should be objectively evaluating drugs for efficacy and safety.

Yes it's a problem that women's sex drives haven't been the focus of enough R&D, but that doesn't mean that the answer must be this drug, and it's certainly not helpful to deflect legitimate, research-derived criticism as attacks on women or feminism in general.

It may even be the case that nothing is the better option. If this drug really turns out not to be all that effective and to have harmful side effects and bombs spectacularly, that's also going to chill the desire for further development.
posted by Sangermaine at 5:48 PM on June 4, 2015 [10 favorites]


why is it always (i.e. only) we woman

it's so totally not. read the bazillion threads on chronic pain medications.
posted by j_curiouser at 5:50 PM on June 4, 2015 [5 favorites]


Would you take a pill every day to have sex once more each month? [spoiler: No 75.82% Yes 24.18%]
posted by unliteral at 5:55 PM on June 4, 2015 [1 favorite]


There are real, legitimate concerns here about both the efficacy of this drug and its side effects. It's clear that this is a very personal issue for some posters in this thread, but you can't just push those real concerns aside.

To be clear I'm not pretending this drug is a super great perfect miracle cure. I just think bringing it to market will ultimately do more good than harm. In terms of side effects, it is apparently less dangerous than basically every prescription drug I've ever taken - if this thing was causing, like, strokes and seizures, they wouldn't have approved it, no matter how much astroturfing went down - and although its effect is relatively slight, it's not statistically insignificant. And if it is successful in the marketplace - since we live under capitalism and that's what's required - then there will be increased interest in funding further research in this area.
posted by showbiz_liz at 5:59 PM on June 4, 2015 [2 favorites]


WTF does "used responsibly" mean anyway and why is it always (i.e. only) we woman who must be so damn responsible with our sex drives?

Um, not taking it with alcohol, not using it if you have some other condition where you have low blood pressure or where low blood pressure would cause issues, or being careful about what activities you engage in lest you faint and hit your head.

You know, being aware of the side effects and taking them into consideration just like you would with any other drug. At least, that was my read on the comment.

Cannabis' effects vary widely. For some it will enhance their sex drive, for others it will shut it down. In some it might first be one and then the other, it might depend on the strain, dosage, or it might change based on some other variable. It's really a land of contrasts.

I wish we'd get on with the serious cannabis research, because I'd LOVE it if they could pull out and bottle the sexy effects of weed somehow.

This exists, it's called Foria. I'm a guy, I don't know anyone who has tried it, but some gals on the internet have and written about it (NSFW text).

I don't even remember how I ran across it but your comment rang a bell for me so I thought I'd share but I don't really know much about it so exercise caution before purchasing (if that's even possible in your area or if you have a friend to act as a proxy). The searching for that half-remembered article showed me that home-made versions exists but I'd exercise even more caution going that route.
posted by VTX at 6:03 PM on June 4, 2015 [4 favorites]


This argument makes me uncomfortable, because it basically seems to be saying "if a woman gets horny, she is then unable to consent to sex." Because these pills (real and hypothetical) aren't vodka, they don't remove your ability to reason or disable you - they just make you able to get horny.

It really does seem, to me, to be rooted in the idea that "women wanting sex" is something that is primarily a benefit to men, and that women should fear or disregard or deliberately downplay their own sexuality because it's just another tool of the patriarchy.


Well, that gets into what it means to consent, right? We talk about it being dubious and potentially rapey to have sex with someone who is drunk or who has impaired judgement, partially because even if they're down in the moment, with inhibitions absent, they might have chosen very differently while sober. Is it consent if you're not in full possession of your faculties? Note that I'm thinking here of cases where women are unknowingly slipped this thing, not women who take it out of their own free will. Why does that make it better if you modify the judgement of someone in a more specific direction?

Fuck. I don't think I'm articulating any of this well. But this really isn't bothering me on a level of "someone let men get sex women didn't intend them to have." It's actually bothering me on a much more personal, how-does-this-impact-me-myself level than that. I'm going to try and take a stab at explaining why.

Personally, this thing horrifies me on a deep level as a woman who is not into sex. Something that fucks around with my level of desire for things? It makes me feel less like "oh well men might get sex that women don't want" and more like "someone is fucking with my personhood on a very deep level and potentially trying to make me want things I don't want." And that's a feeling I have from a long, long history of watching people who study sexuality and especially people who are fronting for these drugs basically frame the disconnect in desire here as "you're broken, let me fix you." I'm not fucking broken. And hey, I might be projecting here, and I'm sorry if I do hurt anyone by mistake, but. Yeah.

The thing is, I have totally artificially knocked my libido into overdrive before. And while that's irritating to me, it doesn't actually increase my interest in any particular person. If they were selling this thing as "increase your libido/motivation!" I wouldn't give a shit, because sex drive is like.... if sexual attraction is the direction of a vector, sex drive/motivation is kind of like the magnitude, and I can see wanting to amplify that magnitude without messing with the direction. But the thing here that is getting me is that they're not marketing it with that level of specificity, they're marketing it as a way to make women want sex. And that has the potential to pressure lots of women like me, or women who have lower baseline levels of sexual motivation but who aren't on the asexual spectrum, into going "your basic level of sexuality is not okay, but we can fix that!" It's not, after all, as if that's a message that is foreign to women.

I'm going to take a step back now, I think, because like I said I don't think I'm articulating this well at all. But I'm super unhappy with the oversimplifications I see in the marketing for these drugs, and I don't think it's anti-woman to express reservations about that.
posted by sciatrix at 6:09 PM on June 4, 2015 [9 favorites]


Something that fucks around with my level of desire for things? It makes me feel less like "oh well men might get sex that women don't want" and more like "someone is fucking with my personhood on a very deep level and potentially trying to make me want things I don't want." And that's a feeling I have from a long, long history of watching people who study sexuality and especially people who are fronting for these drugs basically frame the disconnect in desire here as "you're broken, let me fix you." I'm not fucking broken. And hey, I might be projecting here, and I'm sorry if I do hurt anyone by mistake, but. Yeah.

This makes a lot of sense, yeah. Actually, because my experiences with low desire were caused by medication, I can completely relate to this in the opposite direction - the idea that some chemical is not just giving you some assistance, but is changing the fundamental nature of you as an individual.

If this drug is pushed on people who don't really want it for themselves, but for society/a partner/whatever other reason, that will be a travesty, and there should be some safeguards in place for when doctors are considering prescribing it (as there are for many other meds). That's not something that just applies to this one drug, it's something that will have to be dealt with going forward for any future related drugs. And I think the ascendant asexual movement will be part of making sure that happens.
posted by showbiz_liz at 6:17 PM on June 4, 2015 [4 favorites]


yes, there is nothing that makes me wanna bone down more than me having a panic attack and then throwing up while crying. it is hot like fires.

yeah, it has side effects and doesn't work for everyone

b/c it's a drug
posted by internet fraud detective squad, station number 9 at 6:27 PM on June 4, 2015 [4 favorites]


Personally, this thing horrifies me on a deep level as a woman who is not into sex. Something that fucks around with my level of desire for things?

But this is a very individual thing. I am also not into sex, for reasons that remain mysterious to me - I just have a very low sex drive and no sexual response to physical or mental stimulation. But, I'm curious, and when springtime comes around I have the thought in the back of my mind that it might be nice to find a lad and bone him. I never do it, though, because it's a more abstract thought than physical desire; I know it would just be an unsatisfying and potentially embarrassing encounter.

I'd take a drug that increased my level of desire in a heartbeat. I might find out I didn't like it - it's pretty nice to be so normally undistracted by all of those complicated interpersonal romance- and sex-related maneuverings. And, like you, my lack of interest in sex stuff is part of who I am. But I would love the opportunity to try it out.

So I'll be there when they make such a drug, even if it's marketed in a scuzzy way (which is really likely). They probably won't make one in my lifetime, though.
posted by Kutsuwamushi at 6:45 PM on June 4, 2015 [2 favorites]


This is an answer to prayer.
posted by fraxil at 6:45 PM on June 4, 2015


The drug companies preyed on women with antidepressants - A lot of women are against this.
posted by stevep2007 at 6:46 PM on June 4, 2015


I think people should be able to take this drug if they want to because I think people should be able to take almost any drug if they want to (excepting things like antibiotics) but it sounds like a really ineffective drug with a risk of significant side effects. Not comparable to Viagra in the least. Viagra also carries some risk of side effects but is extraordinarily effective. If all drugs were as effective as Viagra we'd be living in a better living through chemistry utopia.

But they aren't, and this drug is no exception. It's essentially a placebo. Which I think people should be able to take because, hey, your body: But placebos shouldn't have significant side effects. Frankly it sounds like we'd be better off handing out M&Ms and telling people they are flibanserin. It would be roughly as effective, have fewer side effects, and taste like yummy yummy M&Ms.
posted by Justinian at 7:23 PM on June 4, 2015 [4 favorites]


Personally, this thing horrifies me on a deep level as a woman who is not into sex. Something that fucks around with my level of desire for things?

Everything fucks around with your level of desire for things (and every other emotion.) There isn't some "real" level of desire and emotion in your brain which is separate from the biochemistry. Drink coffee? You're messing with your emotions and desires. Stop drinking coffee? You're messing with your emotions and desires. Don't get enough sleep? Messing with etc. Get enough sleep? Messing with etc. Worried about messing with your emotions and desires so you sit in a silent room and stare at the wall meditating? Oops, you're messing with your emotions and desires.

There's no such thing as not messing with your brain chemistry and by extension your thoughts, feelings, and desires.
posted by Justinian at 7:27 PM on June 4, 2015 [21 favorites]


Prepare for a new wave of spam.
posted by Foosnark at 7:35 PM on June 4, 2015 [3 favorites]


Prepare for a new wave of spam.

Subject: FL1B@n$€R1N
posted by Xavier Xavier at 8:01 PM on June 4, 2015 [7 favorites]


2c-b actually works really (sometimes scarily & intensely) well as an aphrodisiac but like.... it's sort of like opening a jam jar with a sledgehammer.
posted by poffin boffin at 8:16 PM on June 4, 2015 [9 favorites]


in this metaphor the jam jar is your libido and not your lady parts.
posted by poffin boffin at 8:26 PM on June 4, 2015 [12 favorites]


...now you tell me
posted by showbiz_liz at 8:30 PM on June 4, 2015 [5 favorites]


call the ambulance
posted by showbiz_liz at 8:30 PM on June 4, 2015 [7 favorites]


"someone is fucking with my personhood on a very deep level and potentially trying to make me want things I don't want."

One can simply opt not to take the medication.
posted by space_cookie at 8:38 PM on June 4, 2015 [3 favorites]


Eh, I do understand how the feeling you might get from "this thing about myself which I consider normal is suddenly considered a disease to be gotten rid of" would be threatening in and of itself.

But with things like this, part of the diagnostic criteria for considering something a disorder now typically includes whether the person feels distress from their condition. If two people have the same level of low libido and one is distressed about it and the other one isn't, only one of those people has HSSD.
posted by showbiz_liz at 8:48 PM on June 4, 2015 [3 favorites]


"2c-b actually works really (sometimes scarily & intensely) well as an aphrodisiac but like.... it's sort of like opening a jam jar with a sledgehammer."

Huh, I didn't know that. Literally the only reason I was ever curious about Silk Road (but not enough to go through the crazy opsec required; too much of the advice started with "Buy an entirely new and clean laptop") was for r-chem stuff like that, since I've never seen it out in reliable form. In a weird way, legal weed has really decreased the casual drug options.
posted by klangklangston at 8:56 PM on June 4, 2015


The interactions with alcohol combined with the belief being created that this makes women want to have sex would make this an ideal date rape drug especially under our current rape culture, and I am worried about it coming to market for that reason. I hope regulators and the manufacturer take steps to make this use of it more difficult. This might include issuing guidelines preventing off-label prescription, adding a bitterant to the formulation so that it's harder to administer surreptitiously, or using a coating that isn't readily soluble in alcohol or water.
posted by Pseudoephedrine at 8:59 PM on June 4, 2015 [1 favorite]


It sounds like a really terrible date rape drug, though. That doesn't mean that evil idiots wouldn't try it because, hey, they are evil idiots. But the most common (by an order of magnitude or two) date rape "drug" is alcohol and nothing about this medication seems like it would change that at all.
posted by Justinian at 9:22 PM on June 4, 2015 [4 favorites]


The Wikipedia link says flibanserin is a 5-HT1a agonist and an 5-HT2a antagonist, which rang a little bell somewhere, and I found that LSD is an 5-HT1a agonist and a 5-HT2a agonist as well, and that the 5-HT2a agonism is shared by at least most hallucinogens, apparently including the endogenous ones -- and 5-HT2a antagonists block the action of LSD.

I'd very tentatively guess that taking flibanserin would make dream-like free association cognition harder to come by.
posted by jamjam at 9:37 PM on June 4, 2015 [3 favorites]


"It sounds like a really terrible date rape drug, though. That doesn't mean that evil idiots wouldn't try it because, hey, they are evil idiots. But the most common (by an order of magnitude or two) date rape "drug" is alcohol and nothing about this medication seems like it would change that at all."

With alcohol, it has synergistic sedative effects. I think it's a reasonable concern.
posted by klangklangston at 9:44 PM on June 4, 2015 [2 favorites]


Does it come in a form that can be slipped into a drink without altering taste? Is it synergistic with alcohol with one dose and not the every day dose that seems to be required for the on label use?
posted by Drinky Die at 10:15 PM on June 4, 2015 [1 favorite]


But is there any other drug that shows "a statistically significant difference between the drug and the placebo for the endpoint of SSEs [satisfying sexual events]," and if not, why is this drug not worth having for that reason alone?

Because the FDA doesn't (well isn't supposed to) approve drugs on the "meeeeeeeeeehhhhh" effectiveness scale.

My uncle spent 10 years as the CEO of biotech firm who's product was the re-application of an existing product on the market. After 10 years, 3 stages of trials, and $30 million dollars spent, the FDA came back with a rejection "well it works, but it doesn't work work".

I don't know for sure, but I believe it had very minimal side effects. The difference between it and the placebo was there, just not a big enough difference.
posted by sideshow at 10:34 PM on June 4, 2015 [1 favorite]


But is there any other drug that shows "a statistically significant difference between the drug and the placebo for the endpoint of SSEs [satisfying sexual events]," and if not, why is this drug not worth having for that reason alone?

Because the existence of a statistically significant difference doesn't imply that it actually is clinically significant. In this case, the difference in SSEs between the two groups in the trial was roughly one per month, on average. And these subjects were carefully screened before being included in the trial, so the generalizability of these results is unclear, at best, which means the true effect in the real world probably falls short of 1 extra SSE/month. Taken with the drug's side effect profile — it's essentially an antidepressant, in that it hits the same targets, so it'll exert similar effects — the tradeoff probably isn't worth it. This is a really weird decision by the FDA.
posted by un petit cadeau at 12:14 AM on June 5, 2015 [6 favorites]


Sprout lobbied and astroturfed their way to approval. The amount of cash they must have spent is staggering. But I guess when you stand to make billions you don't mind throwing tens of millions around.
posted by Justinian at 1:37 AM on June 5, 2015 [2 favorites]


I was about to say what un petit cadeau said.

Basically, beware big pharma. They do this sort of thing all the time. In the UK they campaign for their incredibly expensive drugs which produce only moderate improvements to be taken on by the NHS. How they do this? Well they find vunerable people who are desperate for any answer and adopt them as part of a campaign. It happens again and again. I don't know the particular story of this drug, but it sounds like it's not terribly effective (statistical significant isn't exactly meaningless, but it's really easy to achieve in practice) and so the FDA have to make a decision if the actual benefits outweigh the downsides. The reason they do this rather than individuals is that the overall effects are only observable in the aggreagate: it can be difficult for an individual to make a decision which distinguishes between the actual effects a drug is having and what is just their sex drive returning due to lifestyle change excetera.

That said, I don't think it's the end of the world the drug is approved or anything, I assume that the fact that it has reflects that at least some of the FDA believe it will improve people's lives, I'm just not a fan of these sort of campaigns.
posted by Cannon Fodder at 1:56 AM on June 5, 2015 [2 favorites]


I would be interested to see the health economic appraisal for this, but my googling has bought up nothing (which is fair, as if it hasn't gone through FDA for safety it is unlikely anyone's needed to get it through NICE or its analogues yet therefore anything so far will be internal).

I had a look, for curiosity's sake, at the cost utility evidence for viagra, and was surprised at the increase in measurable quality of life improvement (in this paper and this paper). Both papers have similar gains in quality of life (around 11-12 points), which because the drug wasn't particularly expensive meant they were deemed cost-effective (especially because the comparator was penile surgery).

It will be interesting to see how flibanserin compares if/when it gets a similar evaluation. Another quick search found this paper which looked at the impact of hypoactive sexual desire disorder on the quality of life scales and they look similar to the erectile dysfunction scores (quelle surprise).
posted by litereally at 2:36 AM on June 5, 2015


I'd very tentatively guess that taking flibanserin would make dream-like free association cognition harder to come by.

There's something weird and subtle and tricky about LSD's pharmacodynamics, the short version being that it seems to cause different downstream effects than many other drugs which bind at the same receptor (this is potentially a big deal, but the implications are beyond the scope of this conversation). So I would be hesitant to infer anything about a 5-HT2A antagonist based on the effects of LSD. The more relevant effect is that 5-HT2A antagonists seem to counter some of the dopaminergic disruptions seen in schizophrenia, with some potential applications in the treatment of mood disorders and addiction.
posted by dephlogisticated at 4:26 AM on June 5, 2015 [3 favorites]


Prepare for a new wave of spam.

I'm more curious how this will change Pinterest.
posted by srboisvert at 5:47 AM on June 5, 2015 [1 favorite]


Is it more effective than a couple of drinks?
posted by Jacqueline at 8:01 AM on June 5, 2015


Call me when they make a pill that goes grocery shopping, does the laundry, cooks dinner and balances the checkbook after working ten hours at the office. Me and Mrs. Bastard will both gladly sign up for the clinical trials.
posted by Cookiebastard at 12:16 PM on June 7, 2015


those are called servants and insurance won't pay for them either.
posted by poffin boffin at 12:57 PM on June 7, 2015


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