pharmaceuticals

Is the New “Female Viagra” Really Just a Roofie?


Sex therapist Dr. Tammy Nelson answers all our questions about Addyi, which debuts this week, including just how effective the libido-“fixing” drug really is.



As a woman in mid life, I’ve lived through many phases of sexual desire. Every woman experiences different stress triggers and turn-ons, and over time those might change. For some women, a “dry spell” can feel like a chronic condition that needs medical attention. And now that un-juicy feeling has a name: hyposexual desire disorder. Once there is a diagnosis for a potentially large group of consumers, pharmaceutical companies rush in to fill the void.

October 17 is launch day for the new so-called “female Viagra” flibancerin, marketed by the pharmaceutical company Sprout under the brand name Addyi. An online debate has raged since the FDA approved the drug after heavy lobbying from feminist organizations, Even the Score and the National Organization for Women.

They argued that it wasn’t fair that men had a sexual-performance drug and women didn’t. But is this really something women need? Given my suspicions of big pharmaceutical companies, I took all my questions about Addyi to Dr. Tammy Nelson, renowned sex therapist and author of Getting the Sex You Want.

Who is the target audience for “female Viagra”?

They’re going for two audiences: The perimenopausal and post-menstrual women who might be dealing with age-related loss of libido. And women who are taking medications like SSRIs and birth control, which can either reduce, or totally eliminate desire. If you’ve been on birth control medication, particularly women who started in their twenties and who then were also prescribed SSRI anti-depressants, such as Prozac or Zoloft, the combination of these drugs can have the debilitating side effect of decreasing sexual desire. For a lot of women who have taken the combo, even when they come off of the birth control drugs in their 30s and 40s, perhaps to start a family, their desire does not come back for many years, if ever. That combo is a killer for desire. For some women it affects their desire and for other women it affects their capacity for arousal and orgasm. I’ll get to that distinction between arousal and desire later. 

Wow, that second profile you describe—that’s a lot of women!

A lot of women. Birth control pills totally changed a generation of women and it was an important thing, of course. It gave them a new freedom, and a new sexuality that they were not able to express without the pill. But what price do we pay for taking hormones that affect our capacity for desire? When these women go off birth control, and then have kids, they’re exhausted, some get depressed. They might be affected by the change in medication but also the stress of having a family. Having babies and small children is very stressful on a marriage.  There’s a pile of resentment in the middle of the bed that they just can’t crawl over. They don’t know how to talk to their partner about it, so often the result is they have no desire for sex and they feel like there must be something wrong with them. If they do go to couples therapy their partner might say, “there’s something wrong with her, fix her. Give her a pill.” Up until now, women may have been prescribed anti-depressants, which may or may not have helped.  When low sexual desire is the primary issue, now a doctor can say, “Well, we do have a pill for that!”

But what’s scary about this new drug is that studies show it’s going to damage your serotonin receptors. It was originally presented as an antidepressant and in the drug trials they found that it didn’t work, it made people more depressed. That’s why it didn’t get passed the first three times it went before the FDA. 

A failed anti-depressant is re-marketed as a medication to enhance sexual desire. That’s disturbing, to say the least. So what are the other side effects of this medication?

The first thing is that you absolutely can’t drink alcohol while taking Addyi, which is too bad, because a glass of wine is probably a better way for some of these women to break through their desire and arousal issues. Relaxation with a glass of wine can be a good way to de-stress for women who don’t have a problem with drinking, if the issue is  based solely on the daily problems of a life with a new family and a tense relationship. On this new drug, however, you can’t drink at all for the course of this treatment because there have been cases of women fainting. My first thought when I read about that was, Wow, this drug is like a roofie! Now a predatory guy doesn’t have to slip a roofie into a woman’s drink, he can just give her a glass of wine. Also, Addyi isn’t at all like Viagra where a man can take a pill and get a rush of blood flow to his extremities, which will help him with arousal. Because Addyi works on brain chemistry, it takes several months in your system before you feel any increase in desire. If it even works at all.

So a big red flag here is that men can take Viagra to resolve a physical problem—the inability to achieve an erection—on an as-needed basis, while women are being offered a drug that you have to take every day, has a low efficacy rate, messes with your brain chemistry, and takes even modest social drinking off the table. Why can’t women take Viagra, if what it does is increase blood flow to the sexual organs?

You can take Viagra and it will drive all the blood to your clitoris and vulva. You will get engorged, the same exact effects. It will help women whose arousal issues are about blood flow and reaching orgasm.

Let’s talk more about how men and women experience sexual desire and arousal.

For most men, desire can come first. They experience the desire for sex and then they achieve arousal, in the form of an erection. Women often need to be physically aroused before they can achieve that feeling of desire. I might not feel desire until right before I reach orgasm when I reach an arousal plateau where I say, “Yes! I’m totally into this.”

For women, arousal and desire really happen in our head. Studies have shown that women are capable of being physically stimulated by watching various sex acts to measure their arousal levels but they might not perceive that they are being turned on, regardless of what’s actually happening in their body because they haven’t reached a state of desire. I have to be turned on enough, where I think—now I’m into it! If I’m thinking I hate you, get away from me, my body can be stimulated and I could still be saying to myself I’m not into this. Because I’m not feeling that desire in my head. I’m turned on means I’m aware of the physical changes and I think to myself—wow, this is really hotThis medication is designed to help create that feeling in her head but it has potentially dangerous brain-altering side effects, the evidence isn’t there in terms of how well it works, and if you drink alcohol, you fall down on your face and pass out.

Are we still dealing with a lack of understanding of how to arouse women, the need for foreplay?

Not foreplay so much, but really all the time play. I always say that if you want to have sex with a woman on Saturday you have to start on Wednesday. It takes a lifestyle of arousal to create desire. If everything else in your life is stressful it’s not going to happen. You want her to come to the party, but what are you doing to make her want to come to the party? It’s about making sex more fun. But we really do need to take a look at how many drugs we’re taking that are lowering desire. I see patients all the time who tell me they have no libido and then they give me a list of medications they’re taking. Maybe they aren’t on SSRIs, but they’re using over-the-counter allergy medication, or cholesterol medication, or blood pressure medication, or birth control pills, and every one of those drugs has sexual side effects. So many drugs affect blood flow. Think about antihistamines—the whole point of them is to take away the puffiness, the inflammation. Everything you put in your body affects sexual desire and arousal. 

We’re living in times when people want a simple solution for everything. So we’re often taking a lot of drugs with the best of intentions.

The women who go to their doctor to get treatment for low desire are women who are interested in having more sex. They’re motivated and are seeking a “cure.” Unfortunately, I do think this is the new “dysfunction” just like hysteria was for women before.

There is something very 19th century about this diagnosis.

And now the attitude is we can fix this, we’ll give you a pill. It’s so Western and male-driven, where the whole point of sex is to get to the finish line, which has traditionally been about the male ejaculation. Viagra is the No. 1 prescribed medication of all time. Pfizer has made so much money. They’re so invested in this way of looking at the issue. So why wouldn’t a drug company want to find the “pink Viagra?”

One of my fears about Addyi is that women are going to take it, and because the efficacy rates are poor they’re going to feel like a failure. And those women who have serious issues around physical pain such as vaginismus, or sexual abuse, or post-traumatic stress, or a history with orgasmic dysfunction are going to take this drug instead of getting sex therapy or good treatment for the actual psychological issue that might be underlying some of the greater problems.

There are real physical issues such as age-related issues of menopause—but many women might be pulling away from sex with their partner because they sense something is wrong in the relationship, such as betrayal or abuse.

Women are very intuitive so sometimes our bodies know before our heads know what is going on in our relationship. Women exist in their bodies in a different way than men because we have to let someone in, physically, emotionally, sexually. We will protect ourselves if we sense that there’s any danger whatsoever. Often sex shuts down long before the relationship is over.

So to force the issue, to say there’s something “wrong” with the woman is to deny that inner voice we have that is perhaps trying to tell us something. I hate to say this because it sounds so dramatic, but my concern about this drug is that it is a subtle form of “roofie-ing.” It’s like—you’re drugging us so we’ll have sex with you.

It seems like we’re missing an opportunity to find more positive ways to increase natural sexual desire.

This is a call to women to find their voice. If sex isn’t working for you the way you are having it now, then you have to find your voice and figure out how to make it work for you. This is a time that’s so important for women right now, whether it’s about sexual desire, rape, or politics. Women, where are you? It’s time for us to rise up. Don’t have robotic sex because you’re drugged. Come forward, find your voice, learn to talk about what you desire, talk about the kind of sex you want. Your partner doesn’t want to have sex with you because you’re drugged either. They want you to be into them. They want you to be present. 

So what positive steps can women take to begin this conversation with their partner?

I always ask my patients to focus on what has worked for them in the past. If you focus only on what isn’t working now you’re going to get stuck in that space. Think about what has worked before and what you appreciate in each other and then expand on that, tapping into your fantasies, the ideas in your head, because that’s where the ON switch is. It’s also where the OFF switch is. It’s not in a pill.

AN INDEPENDENT FREE PRESS HAS NEVER BEEN MORE IMPORTANT.

Your financial support helps DAME continue to cover the critical policies, politics social changes impacting woman and their allies.