Questioning the search for a Viagra for women
New quest has pros and cons
Following the phenomenal success of the drug sildenafil (Viagra) in treating sexual dysfunction in men, pharmaceutical companies have recently focused intense interest — and research funding — toward finding a comparable drug that will offer the same benefits to women.
But medical knowledge about the causes and characteristics of sexual problems in women lags behind that of men, say researchers who have studied female sexuality. And attempts to find a pharmaceutical remedy may be oversimplifying a complex set of problems.
A recent issue of the British Medical Journal1 contained a report questioning whether pharmaceutical sponsoring of drug research targeted at female sexual dysfunction was inappropriately medicalizing female sexuality.
"To build similar markets for drugs among women, companies first require a clearly defined medical diagnosis with measurable characteristics to facilitate credible clinical trials," journalist Ray Moynihan wrote in that article. "Over the past six years, the pharmaceutical industry has funded, and its representatives have in some cases attended, a series of meetings to come up with just such a definition."
Pharmaceutical sponsorship of these meetings has the potential to bias research in favor of narrowing perspectives on female sexuality to those that are normal and abnormal, with the goal of finding a treatment for the abnormal, Moynihan argues.
Used in the right ways — pharmaceutical sponsorship can provide much-needed help to an area of study long overlooked, say others.
Talk about cure premature
The basic physiological processes involved in female sexual functioning are not yet well understood even by researchers, let alone the clinical community, says Julia Heiman, PhD, a professor of psychiatry and behavioral sciences and director of the Reproductive and Sexual Medicine Clinic at the University of Washington in Seattle. So talk of finding a treatment is somewhat premature, she notes.
However, to say that all research aimed at evaluating pharmaceutical approaches are inappropriate at this time is not true either, Heiman says.
"What is probably true is that basic physiological processes, particularly of erection — less so of ejaculation — are more known for men than for women. They have been more researched over the last 20 years," she explains. "But then, men’s genital response has been of more interest in terms of various pharmacological treatments even before Viagra, it’s just that they were more primitive — injections and prosthetic devices, etc."
The effect is something of a 20-year head start on what is known about the physiology, anatomy, and neurophysiology in men.
"We don’t know as much about the anatomy and particularly the physiology and neurophysiology of the genital area in women," she continues. "But to say we don’t know anything is not correct. We know a lot about women’s psychology and sociopsychology in terms of sexuality."
Even in men, it’s important to understand the physical and psychological connection in sexual functioning — and the psychological aspects of male sexuality have often been ignored, Heiman notes.
Viagra doesn’t work for all men, she adds. And some men choose to stop taking Viagra after several months, indicating that resolving physical problems does not always resolve the entire problem.
More research about the physical aspects of female sexuality does need to be done, and that is where the current pharmaceutical focus can be helpful.
"Pfizer [the maker of Viagra] is not only funding research into treatments, but they have a lot of resources. They are also funding some basic science research, such as a nationwide questionnaire to women about sexuality," she says. "You can say they are biased in how they ask the questions, but they have involved some researchers with really good reputations. Some of the work that I have done on imaging female genitalia during arousal, Pfizer has funded that. Those are the things I am grateful for, because the NIH [National Institutes of Health] is just not interested in funding work like that."
Defining dysfunction
The concept of sexual dysfunction is a controversial one in the field of research into female sexuality, says Karen C. Rhines, PhD, an assistant professor of psychology at Seton Hall University in South Orange, NJ.
"To define dysfunctional’ or abnormal’ means you have a clear sense of the opposite — that is, functional’ and normal,’" she explains. "By and large, we don’t have a clear sense of that for many of the conditions we treat — including sexuality."
It is clear to many clinicians that their female patients are troubled by the problems they face functioning according to what they feel are accepted social norms.
"We consider something to be dysfunction if it is troubling to the client or his or her partners, in the areas of desire, arousal, orgasm, and pain."
The medical community has a long history of medicalizing and pathologizing many areas of female functioning and looking for biological causes to explain "abnormal" symptoms. So concerns about whether medical interventions are appropriate are valid, Rhines says.
"For conditions like sexual pain — vulvar vestibulitis, for example — I think medical intervention has been and will continue to be beneficial," Rines notes. "But for conditions like anorgasmia or, more seriously under study, hypoactive desire disorder, I think medical treatments alone will fail for most women because the root cause of the problem is psychological, not biological."
Search should continue
Like Heiman, Rhines says research into treatments for sexual problems in women should be done, even if a treatment that works for all — or even many — women is not found.
"I think there are concerns with painting female sexual dysfunction with a broad brush," she notes. "On the other hand, to suggest we need to reinvent the wheel with each troubled woman is equally problematic. I think we do need to move to controlled treatment-outcome trials, and, later, to treatment matching."
Although she doesn’t believe a panacea for female sexual dysfunction will be found, the search should still continue, she adds.
"As a field, and more broadly, as a culture, we need to re-examine the socialization of women around sexuality and provide some education about both women and men about good and effective sexual practices."
Heiman concurs. "When you look at Viagra, no there is no equivalent in women. Will there be? Who knows?" she says. "In a sense, I am not very interested in that. I am interested in what kinds of different things could help women."
Sources
• Karen Clay Rhines, PhD, Department of Psychology, Seton Hall University, 400 S. Orange Ave., South Orange, NJ 07079.
• Julia Heiman, PhD, 4225 Roosevelt Ave. N.E., Suite 306, Seattle, WA 98105.
Following the phenomenal success of the drug sildenafil (Viagra) in treating sexual dysfunction in men, pharmaceutical companies have recently focused intense interest and research funding toward finding a comparable drug that will offer the same benefits to women.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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