With Addyi, Many See the Need to Proceed with Caution

Addyi treats a condition called hypoactive sexual desire disorder.
Addyi treats a condition called hypoactive sexual desire disorder.
The drug flibanserin, which will be sold under the trade name Addyi (rhymes with “paddy”), is expected to go on sale sometime in October.

It took three tries to gain US Food and Drug Administration approval for Addyi, and the recommendation to grant approval was opposed by six of the 24 members of the panel of FDA approvers. The main concern voiced by those opposed to approval was that the drug simply doesn’t work well enough to outweigh what can sometimes be serious risks.

At some point in its evolution, flibanserin acquired the nickname “female Viagra,” or sometimes “pink Viagra.” But Addyi affects brain chemicals and must be taken regularly, long term, while drugs like Viagra can be taken as needed and work on circulation hydraulics rather than neurotransmitters. Enthusiasm for Addyi has been tempered by medical and social concerns.

Does Addyi Pathologize Women Who Don’t Fulfill Sexual Norms?

According to University of Victoria Sociology and Women’s Studies professor Thea Cacchioni, it wasn’t until recently that sex manuals even addressed a female audience. From medieval times until approximately the middle of the 20th century, sex manuals were written for men who wanted to improve their sexual skills.

But by the 1950s, the focus shifted toward women, with “helpful” books on how women could hold onto their husbands by learning to experience desire and pleasure, lack of which was the fault of the women themselves. Cacchioni worries that pills like Addyi could add to the feeling some women have that sex is a “chore,” telling The National Post, “I do think there will be a lot of partners who will think, ‘Oh, I don’t need to try anything different. I don’t need to put my own work into this. I can encourage her to get a prescription from her doctor and that will solve everything.’”

Stephen Colbert: “Perfect for the Happy, Sexless Marriage”

Even late night television host Stephen Colbert weighed in with a humorous take on what Addyi means in 21st century America. He starts by noting the amazing medical advances being made in the science of “bonerology” – namely drugs like Viagra. Then, after giving the standard definition of hypoactive sexual desire disorder (lack of sexual desire that is not due to relationship troubles), he pronounces Addyi as “perfect for anyone who’s in a happy, sexless marriage.”

Colbert also mentions perhaps the biggest catch that goes along with taking Addyi: the fact that you have to abstain from alcohol while taking it. Addyi is taken every day, long term. “Date night is back, ladies,” he says. “Pour yourself a big glass of wine, and then pour it down the sink.” But, he concludes, it’s OK, “because nothing gets you in the mood like staring at your longtime partner stone-cold sober.” Which brings us to detractors’ biggest safety concern.

Women Taking Addyi Must Abstain from Alcohol

The FDA would not approve Addyi until Sprout Pharmaceuticals provided study information on how Addyi affects driving and how alcohol interacts with the drug. Doctors who want to prescribe the drug must warn women not to drink while they’re on it, and they have to go through an online educational program about the drug and pass an online test to be certified to prescribe it. Pharmacies that want to dispense it have to be certified as well.

It’s a big deal that the target population for Addyi – premenopausal women – includes a sizeable proportion of drinkers, with the Centers for Disease Control and Prevention estimating that among non-pregnant women ages 18 to 44, about half reported drinking alcohol within the past 30 days, and approximately 15% reported binge drinking at least once during the past 30 days. Will this end up being a deal-breaker for women? We’ll have to wait and find out.

One (Male) Doctor’s Opinion

In The Grand Junction (Colorado) Free Press, Phil Mohler, MD says he thinks people are being misled by the marketing hype surrounding the drug. For one thing, Addyi is expected to sell for around $400 per month, which is almost as much as the average new car loan payment. Will women find this price fair for the typical one additional “sexually satisfying event” per month the studies of flibanserin noted?

He also emphasizes that Addyi is not “female Viagra,” because it is “about brain juices and desire, not blood hydraulics and performance like Viagra.” Plus he says it’s disingenuous to think that the average person is going to completely separate sex and alcohol. Mohler acknowledges that there are “absolutely” gender inequalities in medicine, but, he says, Addyi is not the answer.

Another Male Doctor Weighs In

Another doctor, writing in the National Catholic Register, has a more positive take on Addyi. OBGYN Patrick Beeman says that many women are motivated to seek a solution for low libido because of “that particular feminine sensitivity to what lies deeply in the nature of marital sexuality itself: namely, mutual self-gift.” He states that using the drug to “force women to do something against their will” would be wrong, however.

Catholic OBGYN Patrick Beeman believes Addyi has a place in loving, committed marital relationships.

Beeman believes the drug for this market is strong partly because “femininity quite naturally tends toward giving and caring.” In other words, women love their partners and are willing to ask doctors to prescribe drugs that will make them more receptive and assertive sexually. He thinks that men tend to seek treatment for sexual dysfunction not out of chivalry, but to boost their own sexual satisfaction. He concludes that “just because there’s money to be made doesn’t mean there isn’t real, authentic love to be made too.”

Does Buyout of Sprout Pharmaceuticals Hint Addyi Will Be a Blockbuster?

The amount of money to be made could be considerable, and nobody believes that more than Valeant Pharma, which announced in late August that a wholly-owned subsidiary of Valeant would acquire Sprout Pharmaceuticals on a debt-free basis for approximately $1 billion cash, plus shares of future profits based on achievement of certain financial milestones. The company plans to leverage its global scale in order to register flibanserin internationally.

Some people may call Addyi “female Viagra,” but don’t expect it to be advertised during NFL games. The drug comes with many caveats, and until it’s actually made available, there’s no knowing if it will be as big as its status of first prescription drug aimed at treating female sexual dysfunction would lead people to believe. It won’t be until later in the year that we’ll learn whether women believe that paying $400 per month and giving up alcohol is a price they’re willing to pay for the possibility of increased sexual desire.

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