Flibanserin: A Feminist Issue

Everyday Health July, 2015

Everyday Health July, 2015

I get up every morning and am unable to begin my day without it. I have been warned of possible side effects: palpitations, high blood pressure, anxiety, tremors, insomnia, and nausea. I weigh the risks, consider the quality-of-life benefit, and go for it. Every single day.

Aah, that first cup of coffee. It’s good to have a choice.

Then we consider flibanserin.

Feminist Views on Flibanserin

Feminism: the belief that men and women should have equal rights and opportunities (Webster’s Dictionary).

Some so-called feminists are using the discussion about possible FDA approval of flibanserin, also referred to as “female Viagra,” as an opportunity to leverage their views. This drug treats lack of lust, known as hypoactive sexual desire disorder, or HSDD, in women, which is an absence of sexual thoughts, fantasies, or desire for sex that causes distress or interpersonal difficulties.

But many vocal opponents of this new drug have an anti-pharma agenda. They have declared that the risks are so great that the FDA should not approve this drug, which has been shown in clinical trials including 11,000 women to make a meaningful and positive difference in quality-of-life.

A true feminist (who can be male or female) would want to ensure that the bar is no higher for a drug intended for women than it is for a drug for men. A true feminist appreciates that a woman, given good information, is smart enough to decide if she is willing to take a medication that may cause some dizziness, may make her a little sleepy, and has a very small risk of unpredictable fainting. Just as men get to decide if they are willing to take a drug and risk side effects including low blood pressure, visual changes, cardiac arrest, or penile fracture to ensure an erection capable of intercourse.

In my recent NPR interview, the other guest on the show, Leonore Tiefer, PhD, identified herself as a feminist who was only trying to protect women from the evil pharmaceutical company that has medicalized sex to make money. Really?

Why Drugs Get an FDA Green Light

While pharmaceutical companies are profit motivated, it is the job of the FDA to ensure that capitalism and greed do not get in the way of patient safety. The FDA must ensure a drug is beneficial and that the risks do not outweigh the benefits. In the case of flibanserin, the science is solid. Flibanserin is not for everyone, but this new drug will help many women in significant ways.

It’s good to know that the FDA does not give in to public campaigns, as demonstrated last week when the FDA advisory committee voted 18 to 6 to recommend approval of flibanserin. This decision was based on the science about the drug.

I have no financial interests in this drug or the company that owns it, Sprout Pharmaceuticals. But I do have an interest, on behalf of my patients, in sexual-health drugs for women getting the same attention, research, and development as sexual-health drugs for men do.

Why Doctors Work on New Drugs

I am offended on behalf of my esteemed colleagues, who have consulted with Sprout to do research or participate in clinical trials, and have been accused of speaking out on behalf of flibanserin because they have a financial interest. No amount of money could get expert academicians Sheryl Kingsberg, PhD, David Portman, MD, and James Simon, MD — all have spoken about this drug — to say things that are not scientifically true or in the best interests of their patients.

I have consulted (and been compensated for my time and expertise) by other pharmaceutical companies. For every company I consult for, I turn down 20 other companies because the science is not solid enough. I do not preferentially recommend one drug over the other based on a relationship with a company. As an example, in my book Sex Rx, I discuss four options for alleviating vaginal dryness and state that all are equally safe and equally beneficial. I then ask women to make their own decisions based on solid information and personal preference. I am transparent about which companies I consult for, and it is insulting to my colleagues and to me to hear accusations that we give biased information based on compensation for our expertise or research.

I have also heard these critics tell a patient with true HSDD to work on her relationship. This advice is the equivalent of telling my patient with severe vaginal atrophy to schedule a date night, buy new lingerie, and take a bubble bath to decrease the excruciating pain she has every time she attempts intercourse.

For women whose low desire is caused by a relationship issue, talk therapy is the right path. But women with HSDD, where something is happening biologically, deserve access to medical treatment options.

Female Viagra: A New Choice

If flibanserin is approved (and I hope it is), I will identify which patients are appropriate candidates. I will tell many, many women they are not. If someone is an appropriate candidate I will educate her about possible side effects. I will let her know that she should be very careful about drinking alcohol because, while 60 percent of the women in the flibanserin trials self-identified as social drinkers and had no problems, some had side effects. If she chooses to take the drug, I will let her know that not all women respond, and that if she is one of the non-responders, she should discontinue the medication.

Women who are who given good information will make smart choices. It is paternalistic (the attitude or actions of a person, organization, etc., that protects people but does not give them any responsibility or freedom of choice), not feministic, to do otherwise.

And now I am going to finish my cup of coffee.