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The chemistry of a woman's desire

New drug would work on women's brain, not on her genitals

There's an illustration I keep at my desk that says just about all that needs to be said about the difference between men and women when it comes to sex.

For men, there is a picture of a simple on-off switch that appears to be permanently in the "on" position.

The illustration of a woman's sexual desire looks like the dashboard of the space shuttle. And there is no way to tell if the system is on or off.

An advisory committee of the Food and Drug Administration has recommended to the agency that it approve the prescription of Flibanserin, a drug intended to restore sexual desire in women who report that their libido is so low it is affecting their relationships and their emotional well-being.

It is called the "female Viagra," but it doesn't work like the drug prescribed for erectile dysfunction, which causes blood to flow into his genitals in order to sustain an erection. It is designed to treat hypoactive sexual desire disorder in premenopausal women. HSDD is defined by the Mayo Clinic as "persistent or recurrent lack of interest in sex that causes personal distress."

This new drug, which could get FDA approval in August and be available by the first of the year, does something more complex than Viagra. It works on the brain's neurotransmitters, helping the brain respond to excitement. That's pretty complex chemistry when compared to the flood-the-zone nature of Viagra.

Flibanserin was rejected twice by the FDA, but feminists and advocates for women's health formed an alliance called "Even the Score" and used the power of social media to galvanize support. And, some say, bully the FDA.

The name of the group reflects the fact that the FDA has approved 26 medicines for sexual disorders in men, and zero for women. The fact that the drug's manufacturer, Sprout Pharmaceuticals, is a member of the coalition has raised eyebrows.

The controversy over the drug has caused an unusual rift among the women who have worked so hard for so long to assure access to birth control and abortion. One side fears the side effects associated with the drug and is alarmed by the public relations campaign for its approval. The other side has accused the FDA of being sexist and having no regard for the health concerns of women.

There are those who say that women are already over-diagnosed and over-medicated by a patriarchy that seeks to either profit from women's health concerns — this is predicted to be a blockbuster market — or keep women in check. And there are those who say that if men were not such inept and selfish lovers, women might recover their longing for sex.

And still others, doctors among them, fear that women will chase dangerous alternative treatments and supplements if an approved drug is not available under a doctor's guidance.

The drug is not designed to make women hypersexual but to restore sexual desire to a "normal" level, whatever that is. But one of the criticisms of the drug is that it had only a "modest" effect in trials — again, whatever that means — and the improvement is said by its detractors to be not worth the risks, which include dizziness and fainting.

It isn't easy for civilians like me to evaluate the efficacy of any drug, let alone one freighted with this much political baggage. But this much is clear: Women deserve a satisfying sexual experience, and if this isn't the drug that can make it happen, find one.

Susan Reimer's column appears on Mondays and Thursdays. She can be reached at sreimer@baltsun.com and on Facebook and Twitter.

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