The Journey from Penis Envy and Lab Sex to Female Viagra

From the Oedipal complex to penis envy, the origin of psychology is tied to the study of sexuality. This makes sense; if psychology ignored the way sexuality affected people, it would be unable to understand the basics of the human psyche. Sexual theory only becomes a problem when people conflate psychology with morality. Moralistic ideas of proper sexuality were included in the Diagnostic and Statistical Manual of Mental Disorders. Homosexuality, hysteria and frigidity were all in the first edition of the DSM. While these exact disorders aren’t in the most recent DSM, the standards of morality and sexuality established in the Victorian Age remain. These historic biases must be acknowledged if psychology wants to properly diagnose and help patients.

Scientists have attempted to eliminate moral bias in psychology, but even the most thorough research has reinforced ideas of sexual norms. Beginning in 1957, William Masters and Virginia Johnson observed heterosexual couples having sex in their lab. Their research was radical for the time, especially for its acknowledgment of female sexual pleasure. Unfortunately, the biological model Masters and Johnson established relied on traditional ideas of sexuality. Sex was defined only as intercourse, which meant women who didn’t enjoy penetrative sex were — and are — viewed as having a dysfunction. This legitimized disorders like frigidity, which remained in future editions of the DSM, though the name and criteria of the disorder have changed. These norms have perpetuated fundamental misunderstandings about female sexuality which shape the pharmaceutical industry and diagnoses today. 

When pharmaceutical companies began producing drugs for sexual dysfunctions, historical biases influenced what disorders they researched. According to historic standards of sexuality, intercourse is the necessary conclusion of sex. The first sexual dysfunction drug, Viagra, addressed an inability to have intercourse. After the success of Viagra, pharmaceutical companies hoped to find similar profitability in the female market, so the race began for a “female Viagra.” The majority-male researchers were looking for a disorder that would prevent a woman from having sexual intercourse. Most physical disorders prevent women from experiencing pleasure or cause pain, but they don’t prevent intercourse, so the severity of these disorders were devalued. Researchers decided that the female equivalent was Female Sexual Dysfunction, the descendent of frigidity. FSD decreased the likelihood of sexual intercourse which gave it more historical legitimacy for the pharmaceutical industry. Researchers had decided which disorder to treat, but they struggled to find a biological solution to female sexual dysfunction. 

Over a decade later, Sprout Pharmaceuticals announced they had solved the complexity of female sexuality with their new drug Addyi. Addyi was designed to treat Hypoactive Sexual Desire Disorder, the diagnostic descendent of frigidity and FSD. HSDD is a real problem: many women don’t desire penetrative sex and are distressed by this lack of desire. The medical profession should look at underlying causes of the lack of desire and distress. There are reasons why women wouldn’t desire sex, many of which stem from historical biases. Media and slut-shaming tell women that sex and desire are immoral. Other women have had bad experiences with sex, often because of an overemphasis on penetrative sex and ignorance of female pleasure. If women are having unfulfilling sex, it’s unsurprising that they wouldn’t desire sex. Beyond the ignorance of the actual causes of HSDD, Sprout Pharmaceuticals assumed that a lack of sexual desire is negative. This stems from the mistaken idea that women owe sex to their partners. Instead of being able to own their desire, women are being told that a lack of desire is something that needs to be fixed. This can cause the distress that defines HSDD. This distress and the causes that underlie it should be addressed, but should not be treated by pharmaceuticals.

After Addyi was rejected twice by the FDA, Sprout Pharmaceutical decided to manipulate women’s anger about medical injustices. Sprout Pharmaceuticals built a marketing campaign around the feminism of “female Viagra” called “Even the Score,” which demanded that the FDA approve medication for female sexual dysfunctions. “Even the Score” never acknowledged the fundamental differences between Viagra, which lets men act on their desires, and Addyi, which increases desire. Pretending that HSDD was a new and purely physical disorder also allowed Sprout Pharmaceuticals to conceal the biased history of HSDD from members of Even the Score. Many groups, including Jewish Women International, The American College of Nurse Midwives, The National Association of Nurse Practitioners in Women’s Health, and The Black Women’s Health Imperative joined “Even the Score.” When the advisory committee for Addyi met, the room was packed with activists, doctors and women with HSDD all showing their support for Addyi. The crowd would cheer and clap when supporters took the stage. Several speakers tried to raise concerns about the efficacy of Addyi and its side effects but the crowd hissed and booed. On Aug. 18, 2015, the FDA approved Addyi.

After the approval, backlash began when people realized that Addyi was designed to regulate female desire, not treat a physical inability. This was exacerbated by the increasing awareness that Sprout Pharmaceuticals had started “Even the Score.” Pharmaceutical companies had seen the anger of women who had been systematically ignored, misunderstood and dismissed for generations. Instead of addressing their concerns or the historical biases in medicine, Sprout Pharmaceuticals manipulated this anger to force a drug through the FDA that perpetuates misconceptions about female sexuality.