Sexual dysfunction and curing it

I'm just going to steal all my stuff from Echidne now. Kidding--I had a lot of thoughts on this subject and didn't want to clog up her comments. The story is that a testosterone patch that increases women's sexual desire and satisfaction did not get approved by the FDA advisory panel. Echidne is pissed, and rightly so, about the panel's insensitive language when explaining the decision.

"I am not devaluing the importance of this symptom and its treatment," said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic and a panel member. "But I also don't want to expose several million American women to the risk of heart attack and stroke, with their devastating consequences, in order to have one more sexual experience per month."

They don't know if the drug has negative side effects or not, but they want further testing. My take on this is that there are so many reasons to be suspicious of this patch that each advisory panel member probably has different mix of reasons for the recommendation. Some are surely suspicious of the very notion that women should like sex, of course. (Bush's appointees are a good guess on this one.)

However, there are some very good reasons to be suspicious of this drug. For one thing, I'm not convinced that they have a good handle on what exactly they are supposed to be treating. Comparisons to Viagra are useful, but there are major differences between the problems that this patch treats and what Viagra treats. Viagra is for men who are experiencing desire but having problems with getting and keeping an erection. It's the old mind-willing-flesh-weak problem there. Contrary to folk legend, it's not an aphrodiasiac, though I'm not completely convinced that it can't work as one in part. But that's not what it's for.

The standard that they came up with to measure if you have a problem or not seems really hazy to me. Three times a month is bad, five times a month is cured? 43% of women have "sexual dysfunction", they say, but the definition is incredibly broad. Lots of things can make you not want to have sex with someone. There are medical conditions, sure. But there is also being angry at your lover. My friend and I were talking over lunch today about how all your desire can drain out of you all at once if the man you're seeing does something to piss you off.

And it's not that men don't have the same problem of getting angry and not wanting to be with someone. Men are generally no better at putting personal problems out of their mind in order to have sex with someone than women are, in my experience. But in our sexist culture we tend to ascribe more agency to men than women. So if a man doesn't want sex with one particular woman, we believe him. But we feel free to say that a woman has something physically wrong with her if the idea of sex with her husband fills her with ennui. A lot of what they deem sexual dysfunction can be cured by changing lovers to someone you like better.

My guess is that a lot of women don't have desire for sex because they don't orgasm. When it comes to sex, it's true that if you don't use it, you lose it. A patch might help, but it's not going to be a long-term solution.

There are some women who have definite physical problems, of course.

In testimony to the committee, groups including the American Association of Clinical Endocrinologists and Hyster Sisters, a support group for women who have undergone hysterectomies, urged approval of the drug. They said low sexual desire is a serious problem that can damage a woman's self esteem, relationships and overall quality of life.

"Unless you have experienced the lack of sexual desire you cannot completely understand the feeling of frustration and the sense of inadequacy I have," said Roslyn Washington of Silver Spring, Md., who tried Intrinsa in a clinical trial.

These women should be able to get access to help. But if women who have psychological reasons to avoid sex are getting lumped in with women who have physical reasons, then the drug's efficacy is probably questionable. I just want a good, solid definition of sexual dysfunction in women before they put out a drug to fix the problem.