The Flibanserin Decision: Is the FDA Condescending to Women?

I find I am surprising people when I say I will be shocked and disappointed if the FDA agrees with its advisors and rejects Flibanserin, a new drug from Boehringer Ingelheim, shown to help some women recover sexual desire.

And I’m shocked and disappointed by agencies and colleagues who are condescending to women, assuming they are unable to think through marketing hype to make decisions about their own health.

In my menopause care practice, the women I see who are experiencing difficulties with their sexuality are often deeply informed about their conditions even before consulting me for help. They do not rely on advertising or television to inform their own sexuality. They consult experts. They consult their physicians. They are perfectly able to sort fantasy from reality.

Their concerns about their lack of desire are real. Their experiences of desire leaving them are real. The effect that this has on their well-being is real. And there are very few tools available to help them.

Maybe Flibanserin as a treatment for Hypoactive Sexual Desire Disorder (HSDD), isn’t the perfect tool for every woman experiencing depleted sexual desire. But for some women, some of the time, clearly it helps. Help begets hope, and as a doctor, I'll tell you that hope is as important as any pill in restoring good health.

I myself suspect that “HSDD” is an invention — a committee invented a new name for a cultural issue as old as time. There has never been and will never be a time in human history when the libidos of men and women match up perfectly forever. I am not interested in medicalizing what may be a woman’s normal or even beneficial biological response to stress and aging — our libidos may well drop for very good reasons.

Nevertheless, I have had women in my office, losing sleep, depressed, miserable, because the lack of intimacy where it is wanted often has a domino effect, destroying communication, trust, a couple, a family. For these women, overcoming our ancient biological responses to stress — in a modern world where stress is constant — is what they want and need, and as a doctor, I would like to be able to help them.

I really don’t think the pharmaceutical companies are the bad actors in this case. Human tensions create business opportunities. You can’t blame a pharmaceutical industry for doing what it does. But I do worry that the FDA will overstep by taking this choice away. The side effects reported in the trials are not life-threatening. They are not ubiquitous. They are a risk many of my patients may be perfectly willing to take for any advantage, even a slight one.

We are able to make our own decisions about what is best for our health and our lives. Really.