On Tuesday evening, the Food and Drug Administration announced that it had approved flibanserin, perhaps best (though erroneously) known as “female Viagra”— whatever you call it, it’s the first FDA-approved drug intended to treat low sexual desire in women. Advocates are exhilarated at the thought of a sexual-dysfunction medication for women, as there are currently five drugs already on the market to treat erectile dysfunction in men.
Critics, on the other hand, point out the teensy problem that the pharmaceutical company’s own drug trials have shown that Addyi (the brand name for flibanserin) doesn’t actually work all that well. The drug, which will likely be available to consumers in mid-October, is a daily medication, and has been associated with some decidedly unsexy side effects, such as dizziness, sleepiness, nausea, insomnia, and dry mouth. Alcohol exacerbates the side effects, so women taking Addyi are told to abstain from drinking as long as they’re taking it. And the payoff is modest at best: In clinical trials involving about 2,400 healthy, pre-menopausal women (their average age was 36), the women taking flibanserin reported up to one more “satisfying sexual event” per month on average, compared with the women who took a placebo. (“You mean you wouldn’t risk passing out or dizziness for the possibility of one more satisfying sex per month??” Lori Brotto, a sex researcher at the University of British Columbia and a leading expert on female sexual-arousal disorder, snarked on Twitter after the FDA announcement last night. Sex scientists: just like us.)
But maybe the bigger problem here — and, possibly, an explanation for Addyi’s underwhelming efficacy — is that many people fundamentally misunderstand the way sexual desire works, something Science of Us touched on back in June. There’s spontaneous desire, which is the way most people learn how the libido operates: You just want it, out of the clear blue sky, and that internal drive motivates you to go out and get some. And desire does indeed work like this for some people, but, crucially, most of them are men, said Emily Nagoski, a sex educator at Smith College and the author of Come As You Are: The Surprising New Science That Will Transform Your Sex Life.
Recently, however, the research is showing that there’s another perfectly normal and perfectly healthy way to experience desire: responsive desire, where arousal emerges not in anticipation of pleasure but in response to it. Ellen Laan, a sex researcher in Amsterdam, is often credited with pioneering this way of thinking about desire, which she once termed the “incentive motivation model of sexual desire.” As she defined it in 2008 in the journal Feminism & Psychology, “the experience of desire may follow rather than precede sexual excitement, and … desire emerges following sexual arousal initiated by a sexually meaningful stimulus.” Put another way: In contrast to those people who experience desire seemingly out of nowhere, plenty of others only begin to feel turned on once a sexy scenario has already presented itself. “Your partner comes over and starts kissing your neck, and saying sweet nothings, and your body’s like — oh yeah, that’s a great idea. We should do that,” Nagoski said.
And here’s the thing: Judging from comments made by women in those clinical trials for Addyi, Nagoski argues, at least some of them were likely experiencing responsive desire — only they perceived it as having a low libido. “When you listen to women telling their own stories, including the women who are out there trumpeting their great experience, what they say is, Once we got started, everything was great. It was getting started which was the hard part,” she said, referring to the testimonies some of the women gave before an FDA panel back in June. “And that’s textbook responsive desire.”
And, after all, it isn’t like there’s some minimum amount of sexual desire a person has to experience in order to be considered “normal.” There are asexuals, for one, who never experience sexual desire and are perfectly okay with that; there are also “gray sexuals,” who only feel attraction in very specific contexts. “What’s really required is that we shift from how much we want sex being the way we define sexual well-being to how much we like the sex that we’re having,” Nagoski said. “So pleasure is the measure of sexual well-being, rather than desire.” And that would mean that’s there’s no such thing as too low a libido unless you yourself are dissatisfied with your libido.
And maybe you are. But there are nonmedical ways to fix that. One recent study of people in long-term relationships, for example, found that when the couples were told to think about the good things sex could bring to their relationship, like happiness or intimacy, they subsequently felt an increase in the amount of sexual desire they felt throughout the day, as compared to couples who were not instructed to think of sex in this way. “What the research has shown us is that there are two key factors that differentiate couples that sustain a sexual connection over multiple decades,” Nagoski said. “Those things are a strong friendship at the foundation of the relationship, and the prioritization of sex.” The point being: Understanding the different types of desire is important, but even if you tend toward the responsive version and would rather tend toward the spontaneous one, there are ways to do that — although it, ironically enough, involves a little thinking ahead. A daily, marginally effective medication, on the other hand, may not be necessary.