More Culture:

September 04, 2015

Does 'female Viagra' pathologize asexuality?

Asexuals and health experts fear spread of misinformation

Carol*, a University of Pennsylvania student and self-identifying asexual, likes to give hugs. Long, air-restricting kinds of hugs.

And while she’s given them out hundreds of times with little added thought, she was surprised when her best friend perceived it as a symbol of lust, not friendliness.

“He didn’t believe [I’m asexual] because I hugged him. I get stuff like that all the time,” Carol, an administrator for asexual student group PennAces, told PhillyVoice. “He was one of the first people I came out to and he never said anything, so I assumed he was cool with it, but sad because he was into me. Then two years later he asked me ‘What is asexuality?’ and it upset me because I felt he should have asked that before. And when I tried to explain, he laughed at me the entire time. So, you know, you deal with this stuff.”

Then she laughs.

“People have a wild interpretation of what sexuality is supposed to be.”

That’s what troubles her and many other asexuals about flibanserin, the so-called “female Viagra” that received FDA approval last month and goes by the trade name Addyi. Her concern is not over the pill itself, but the public’s takeaway: that women need more sex to be satisfied.

“I think the narratives that make people take or get prescribed the drug is more of an issue,” Carol explained. “I don’t think [flibanserin] pathologizes asexuality, but it could be used as a weapon against asexuality as something that is already pathologized.”

Carol cited “corrective rape” – assaults against people to “cure” their sexual orientation -- and ignorance in the medical community as examples of how asexuality as an orientation is already perceived as pathological. And while she emphasizes she thinks pills like flibanserin have their place, any sensationalism of “female Viagra,” she said, stands to validate the dialogue that there’s a normal amount of sex all women should be having – including asexuals.

Nor is she alone in her skepticism of messaging. Jay Davis, founder of Asexual Visibility and Education Network, told the New York Times in August that flibanserin’s inevitable advertising campaign stands to send the message that asexuals are “broken.”

The concern isn’t without cause, either. Reported attitudes toward asexuals are more negative than any of their LGBT brethren. Recent research discovered they are more likely to be dehumanized than other sexual identities and are susceptible to discrimination when it comes to employment and finding a home.

As a result, Carol and others are often treated as if their feelings are invalid, she said, causing many of them – like herself -- to hide their sexual identity.

“[Sex] can be a difficult conversation to enter for asexual people because there’s this fear that something’s wrong about them,” Jaymie Campbell, professional development manager at Mazzoni Center, told PhillyVoice.

“I think that’s a reflection of societal norms, or a societal imperative that everybody has to be sexual in some way. The dominant conversation isn’t, ‘Are you having sex?’ It’s ‘What sex are you having?’”

And it’s a narrative, frankly, that transcends asexuality and impacts any female who has a low libido and may be just fine with steering clear of intimacy.

“There’s so much pressure for women to be sexual,” Sabitha Pillai-Friedman, a sex therapist and director of Widener University’s human sexuality program, told PhillyVoice. “And of course, there’s a mixed message: On one hand, young women are told all this information about how to be chaste and not have sex, and then they’re suddenly thrown into a situation where they have to be sexual or overly sexualized. And if they’re not, they’re given a pill. But I really feel that sexual desire issues need a broader treatment plan.”

By that, she’s referring to everything from psychology to sexual therapy to urology.

Still, experts are careful to note that drugs like flibanserin are not inherently bad. Pillai-Friedman said any drug that can cause even a slight increase in interest for distressed women is “worth a try.” Feminist groups, meanwhile, have praised flibanserin as a historic first step toward leveling the playing field with men.

Echols: I think there are people who think this pill is the end-all, be-all and - this is key - you can’t force treatment on somebody who doesn’t have anything wrong with them.

On a medical level, the drug is significant in its lofty ambition to treat the prevalent condition hypoactive sexual desire disorder, which, according to research from the Journal of Sexual Medicine, is thought to impact anywhere from 16 to 75 percent of women.

But despite the progress, flibanserin is not exactly revolutionizing the field of sexual health.

Here’s how it works: It’s a mood-altering drug that’s not unlike an antidepressant, even though it failed when tested for that purpose. What researchers did find is that it decreases serotonin – the opposite of anti-depressants -- while increasing dopamine and norepinephrine. (The increased serotonin in anti-depressants can lower libido.)

In flibanserin’s clinical trial, women who reported instances of sexual satisfaction rose from 2.7 to 3.7 times a month while on a placebo; women receiving the actual pill reported an increase to 4.5 instances – significant, but no game-changer.

And it’s certainly no Viagra.

Karolynn Echols, an associate professor of obstetrics and gynecology at Cooper University Hospital, told PhillyVoice the key difference between flibanserin and Viagra is that the former treats desire, not arousal. It’s also a drug that requires daily adherence, avoidance of alcohol and will not work in post-menopausal women or those who take antidepressants, the most likely candidates to see Echols. Thorough multi-disciplinary evaluations are also necessary to determine whether a woman with low libido qualifies as a strong candidate for the drug.

“Calling it female Viagra is just a marketing ploy,” she told PhillyVoice outright. “And that’s scary.”

The issue at hand, she said, is misinformation. Beyond the fact that asexuals cannot be treated with sexual desire drugs, she explained, many who do come to her distressed are actually experiencing pelvic pain or have experienced trauma. Others report low libido but have no desire to address it as a problem.

“I think there are people who think this pill is the end-all, be-all and - this is key - you can’t force treatment on somebody who doesn’t have anything wrong with them,” she said, referencing asexuals in particular.

“And if [a woman does have] something wrong, meaning decreased libido, decreased desire, you have to find out why. I don’t think most physicians are prepared to do that. Because sexual dysfunction is not easy -- especially in females.”

For Carol, the misinformation she wants to quell is the notion she’s fixable or experiencing a phase. Asexuality isn’t a pill-treatable condition; it’s an orientation.

“The way a gay man feels about a woman, or the way a straight woman feels about other women? That’s how I feel about everybody else,” she said. “We need people to understand that we’re not an illness.”

*Carol requested her last name not be used.