In March 1998, the FDA gave its seal of approval to the erectile dysfunction medication Viagra and, ever since, pharmaceutical companies have been trying to develop a female counterpart.
But while Viagra tackles the mechanical end of men's sexual dissatisfaction, increasing blood flow in order to assist and maintain erections, the search for its female counterpart has not usually focused on the similarly mechanical, often debilitating conditions affecting women, like vaginismus, chronic dryness or dyspareunia. Instead, pharmaceutical research has focused on increasing the female libido, offering a solution for a condition frequently referred to as hypoactive sexual desire disorder.
Then, 17 years after Viagra hit the market (and just four year ago), that dream was finally realized in the form of Addyi (generically known as flibanserin). Although it was marketed as a “pink Viagra,” Addyi's target is the brain, because it claims to actually increase the female libido.
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Unfortunately, Addyi didn’t quite gain the cult-like status of Viagra or its many counterparts. Partly due to its underwhelming effects — the drug promises just one extra sexually satisfying event per month — and partly due to the aggressive commitment it requires — users must take a pill every day, and entirely abstain from alcohol to avoid potentially serious complications — Addyi hasn’t found much of a fanbase.
That may be why drug manufacturers tried again on Friday, when the new medication for low female libido, called bremelanotide and marketed as Vyleesi, received FDA approval.
In some ways, Vyleesi is an improvement over Addyi. The medication (which is injected) has significantly fewer side effects; a clear boon to anyone who’s intrigued by Addyi but uncomfortable with the risks it presents. But like Addyi, bremelanotide offers its users only the most modest of results. And like Addyi, bremelanotide seems to completely misunderstand not just the female libido, but the entire concept of healthy sex and sexuality.
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While it’s undeniable that having a low sex drive can be a source of distress, the solution to that distress is not necessarily taking a medication that promises to amp up one’s sex drive. “Low sex drive” may sound like a simple, easy to diagnose issue, but it can mean many things to many people — one person’s “normal” level of desire is another’s nymphomania — and it can also be the result of a number of factors.
In some cases, a “low,” or even entirely absent, sex drive is a perfectly normal part of how someone relates to sex. In other cases, it’s the symptom of something else: depression, perhaps; the side effects from a different medication; a chronic illness; or menopause. (Notably, both Addyi and Vyleesi are intended only for pre-menopausal women, and neither treats low libido caused by other medications.)
And the distress that results from that low libido — distress that is often used to distinguish something like asexuality from HSDD — can also have a number of causes. Is the woman in question unhappy with her infrequent arousal because she herself craves more desire and eroticism? Or is she merely feeling ashamed because she’s not living up to an arbitrary standard of desire set by society — or, potentially, set by a pushy partner who feels that their libido should set the standard for intimacy within the relationship?
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When someone is struggling with feelings of shame and disappointment about their libido, it’s worth taking a beat to unpack all of these questions. It’s important to encourage people to think deeply about what role they want sex and intimacy to play in their lives, and what truly brings more pleasure into their lives. It’s important for people to consider whether their vision of “normal” and correct sexuality is one that’s based in their own desires, or whether they're responding to a message being imposed upon them by a society that treats sex and sexual pleasure as a one-size-fits-all experience, rather than something highly individual and personal.
Taking a pill (or, in the case of bremelanotide, a shot) doesn’t provide the answer to any of those questions; for many people, it may even prevent further inquiry. And that’s a significant problem, because our best sex lives aren’t brought to us by our local pharmacist. They’re brought to us by a deep, intimate understanding of our desires, our body’s capacity for pleasure, and the ways in which we enjoy being intimate with other people.
It is important to prioritize female pleasure, and it is significant that we’re finally having open conversations about some women’s dissatisfaction with sex. But in order to close the pleasure gap and truly help women everywhere live their best sex lives, we need more than a lackluster medication that promises to treat HSDD. We need to broaden our understanding of what healthy sex and pleasure actually look like, and encourage people to appreciate the diversity of sexual experience, rather than forcing themselves to live up to someone else’s expectations.
And none of that can be found in a pill bottle or medication vial — no matter how much money is invested in the search for a “pink Viagra.”