‘A very patriarchal attitude’: why is female desire still not taken seriously? | Documentaries

forArbara Gattuso had been happily married for decades when, in the late 2000s, she signed up for a clinical trial involving a potentially revolutionary new drug. She and her husband once had a satisfying sex life, both before and after childbirth. But at some point during her menopausal years, her desire disappeared. It wasn’t stress, burnout, or relationship problems, although her lack of sexual desire certainly contributed to that. It was like a mysterious vaporization, like “someone pulled the plug,” she recalls in a new documentary about flibanserin, the experimental drug that offered potential relief.

Flibanserin was originally developed as an antidepressant by the German company Boehringer Ingelheim, but has instead shown promising results as a treatment for low sexual desire in females, acting on neurotransmitters in the so-called “sex center” in the brain. In a video of the experience filmed by Dr. Irwin Goldstein, the “godfather of sexual medicine” and chief consultant on Viagra — the revolutionary blue pill for men with erectile dysfunction — Gattuso appears almost dizzy. She said she was chasing her husband again. She felt “extraordinary,” like “a new woman on this drug.” It’s been delivered.

That was in 2010. It’s shocking how weird this footage looks and looks now, as it seems like this should have been an obvious accomplishment with back-to-back results. But as the Paramount+ documentary The Pink Pill: Sex, Drugs, and Who’s in Control makes clear, the path to getting flibanserin — often called, somewhat cynically, “the female Viagra” — for women struggling with their libido was anything but clear, riddled with regulatory barriers, drug price gouging, sexist double standards, and a profound societal disinterest in female choice, pleasure, and experience.

Although the U.S. Food and Drug Administration (FDA) approved flibanserin, sold under the name Addyi, for premenopausal women with hypoactive sexual desire disorder (HSDD) in August 2015 (and, as of last December, for postmenopausal women), most women are not aware that a female sexual desire drug exists, let alone that it is available. “Until she was approached about producing the film, I had never heard of this drug,” said director Aisling Chin Yi. “I never thought to go and talk to my doctor about my sex life. The only thing the doctor asked me was, ‘Should I have sex or not?’ And whatever answer I gave, it always seemed like the wrong answer.”

The Pink Pill examines the extent to which disinterest in female sexuality, beyond reproduction, persists throughout the American medical establishment. As many sexual health doctors, gynecologists, and urologists can attest, most medical school curricula do not include sections on female sexual health, libido, or clitoral anatomy. When Viagra was introduced in 1998, the medical establishment quickly embraced a drug that was seen as a miracle cure for a physical problem in men. But the conversation around female sexual desire and orgasm has remained stagnant, often beginning and ending with “it’s complicated.”

Frustration with this indifference and its disappearing desire led Cindy Eckert, a pharmaceutical entrepreneur based in Raleigh, North Carolina, to buy flibanserin for $5 million in 2011, after Boehringer Ingelheim decided not to fight for FDA approval. Eckert, a hyper-feminine 2000s businesswoman with a penchant for all things purple, renamed the drug Addyi after Dr. Addison Grey, Kate Walsh’s character on the popular medical drama Grey’s Anatomy who represented the ethos of the drug because, as she says, “women live life on their own terms.” Her company, Sprout Pharmaceuticals, completed the necessary trials, showing that Addyi improved the sex drive and sex drive experiences of women with HSDD. By October 2013, it was ready to go on the market, subject to FDA approval. Although Addyi acts on neurotransmitters in the brain, more like antidepressants, the FDA assigned its review to its urology division — a drug better suited to Viagra, which works to relax muscles and increase blood flow to the male genitals. The US Food and Drug Administration rejected it, claiming that the side effects – namely dizziness, nausea, fatigue and low blood pressure – did not outweigh the benefits.

The issue of side effects – basically, why is craving worth it for women? – He continued to follow the medication as he sought regulation. The Pink Pill collects an important archive of recent history of the role of “female Viagra” in the culture wars of the 2000s, as Sprout mounted an aggressive lobbying campaign ahead of the hearing in 2015. Some of the backlash was predictably snooty: “Maybe you know [flibanserin] “By its old name – wine,” Jimmy Fallon joked on The Tonight Show. Some were more entrenched, such as opposition from those who believed that sexual desire disorder was a fictional condition to condemn women for their lack of sexual drive, and low sexual desire being medically treated in the name of pharmaceutical profit, with no medical consensus on what constitutes “normal” sexual desire.

The FDA questioned the possibility of sedative effects, asking whether “a woman might take flibanserin the night before and wake up the next morning and fall asleep and take her kids to school,” as Dr. Anita Clayton, a psychiatrist at the University of Virginia and Addy’s advisor, recalls in the film. “There was a very paternalistic attitude.” Data showing an increase of one “successful sexual event” per month were dismissed as ineffective – even though women with untreated HSDD may experience one or two such events per year.

The bias that comes up through the FDA approval process boils down to, “Well, we don’t know if it is or not.” [Addyi] “This is necessary,” Qin Yi said. “But that’s not the question that was ever asked when it comes to male sexual dysfunction. It’s absolutely essential, if you’re a man with a penis, to be able to do what you want with it. And those were not the same considerations for women. (The FDA, which has denied any accusations of sexism, did not respond to requests for interviews with the filmmakers. “I’ll give the FDA the benefit of the doubt that they were in the middle of getting a Doggie Ed,” Chen Yi said, referring to the Elon Musk-led merger that devastated the department.)

Not to mention that a lot of women required They wanted to come back, and they felt less complete without her. “You’re a mother now and you focus on these things. That’s behind you,” says one ADHD patient in the film, frustrated by her lack of options and the prevailing narrative that says, “Well, after you have kids, that goes away…” Losing libido was “devastating,” says another, as menopause reignited her previously constant libido. “I felt like someone killed me.” Both Gattuso and her daughter testified at a public FDA hearing on the drug’s approval, speaking emotionally about the impact their low libido had on their lives. Opponents of the drug put the burden back on them. One recommended instead trying what worked for her: “Switching friends, chocolate, coffee, certain episodes of Grey’s Anatomy, porn, upgrading my vibrator, reading Fifty Shades of Grey, a removable shower head, and accepting myself and the libido I come with.”

After much debate, the FDA approved Addyi in 2015. Eckert subsequently sold Sprout to pharmaceutical giant Valeant for $1 billion. But the victory came with a big warning: a black-box warning, the most dangerous level available, for side effects such as dizziness, nausea and headaches. Doctors had to perform a test to prescribe it. Pharmacists had to take a test to fill out. Women prescribed Addyi had to sign a pledge not to drink alcohol. (Viagra, on the other hand, came with a recommendation to take it only He should Avoid alcohol.)

Faced with declining sales, Valeant doubled the price of Addyi to $800 per prescription, making the cost of the drug prohibitive. Then, in 2017, they postponed it entirely. What was once a promising frontier in female sexual health is now essentially closed. “How can you pass on something so cool to women and then tear it down?” Gattuso says in the film. “After all this work, all this emotion, we’re at square one again. And we still are.”

Eckert was able to buy Addyi back from Valeant and start over. The drug is back on the market again – yet if you Google it, the first thing you’ll read is still a bold warning about side effects. Adeyeye’s supporters see a very stubborn double standard. Chen Yi noted that there are 26 approved drugs to treat male impotence, partly because there is no one-size-fits-all drug. “That’s obvious, but for this drug and for women, it’s like, well, if this could be a potential side effect, then the risk isn’t worth the benefit,” she said. “The only benefit is that women may enjoy their sex better. Do you know how many medications cause nausea, dizziness, and headaches? These are the things that almost every medication has on the side of its package.”

She stressed that the dividing line is choice. “You should be able to have this discussion with your body and your doctor, rather than having someone remove it as an option for you.” The film places this pursuit of pleasure in the context of a very different medical landscape than it was when Addyi first premiered, in a post-Royal world where women’s reproductive rights are under assault, healthcare for trans people is criminalized, and bodily autonomy across the board remains fragile.

The film concludes that whether it is abortion or orgasm, there is nothing insignificant or unimportant about the choice. “You may think it is funny and trivial to say that a woman enjoying sex with her husband is essential,” Qin Yi said. “But this right being taken away is exactly what ties into all the other rights that can be taken away from you, which are being taken away in the United States now.”