Future Sex: Nasal Spray for Lady Boners

While the development of Viagra was met with praise and profits, drug development for women’s sexual and orgasmic difficulties has been more contentious, with opponents accusing pharmaceutical companies of framing normal female sexuality within a disease model to drive profits. But a new drug that's currently in testing might change that.

A second-stage research study for a new drug treatment for Female Orgasmic Disorder (FOD) — sometimes referred to as a component of Female Sexual Dysfunction (FSD) — is currently recruiting study participants in the U.S., Canada, and Australia. The drug, Tefina, was developed by Canadian drug company Trimel Pharmaceuticals with backing research performed in the United States at Case Western Reserve University and at Australia’s Monash University. Tefina, like other drugs that have been developed for FOD and FSD, is testosterone-based, but is delivered in the form of a nose-spray.

Notably, Trimel is also in the third phase of trials for its drug CompleoTRT, another testosterone-based nose-spray, this one for the treatment of “Low T” (male hypogonadism). Low T, a condition of decreased male testosterone, has also encountered skepticism from critics who believe that its actual incidence is far less than what drug makers would lead consumers to believe, and that oftentimes the condition isn’t a disease condition per se, but is the result of normal aging.

Other drugs have been developed and used for the treatment of FSD. Procter & Gamble’s Intrinsa, a testosterone patch, was approved in the EU for treatment of FSD in post-menopausal women. The FDA, citing insufficient data on its efficacy and worries over prospective widespread off-label prescription and use, did not approve the patch. A testosterone cream is also available for women in Europe and Australia, and testosterone implants are available as well. Tefina claims to function differently, as it can be used on an as-needed basis. If a woman wants to be sexual one day, she can use the drug, and its effects will be felt in a few hours. Patches and implants simply maintain the testosterone at higher levels.

The blockbuster performance of Viagra and subsequent drug treatments for erectile dysfunction in the late 1990s and early 2000s incentivized drug companies to find parallel drugs for women. Dr. Fiona Jane of Melbourne’s Monash University, where Tefina is being researched, brought up an oft-cited statistic in her defense of drug development for FSD, saying "Female sexual dysfunction is a real thing and we think up to 43% of women suffer some form of sexual dysfunction."

The 43 percent statistic – one that’s made the rounds on the talk show circuit countless times — comes from a sociological study published in 1999, Sexual Dysfunction in the United States Prevalence and Predictors. Researchers analyzed data from a National Health and Social Life Survey conducted in 1992 by the National Opinion Research Center at the University of Chicago. The original study asked individuals several questions pertaining to their recent sexual experiences. Examples include: Have you experienced a lack of sexual desire? Pain during intercourse? Anxiety about sexual performance? Notably, the original study participants had not been asked if these experiences had troubled them or were problematic.

Anyone who had experienced any one of these “symptoms” in the preceding year was deemed to experience sexual dysfunction. But many of these experiences are entirely normal; it’s easy to see how a man or woman could have anxiety around their sexual performance – perhaps a first encounter with a new partner – without that anxiety being pathological. And I wonder if the researchers realized that sex for a woman often consists of something penetrating her. That can hurt a little sometimes.

So why would sociological researchers delve into a seven-year-old study, then use vague and far-reaching criteria to define sexual dysfunction, thus producing likely inflated statistics around FSD? Viagra made its U.S. debut on April 10, 1998. In the first three months the drug was available, 2.7 million prescriptions were filled and $411 million in sales were recorded. The University of Chicago study was released on February 10, 1999. It’s possible that researchers were simply focusing on human sexuality and dysfunction in an effort to provide more analyzed data to a booming field. It’s certainly true that drug developers then and now have seized on this statistic to support an “epidemic” that likely does not exist.

Currently in the U.S., the only FDA treatment approved for FSD or FOD is Eros therapy, a small pump that can be placed over the clitoris. It is available by prescription only and costs around $200 (plus the cost of doctor’s visit). A trip to your local sex shop would be more fun and likely cheaper.

Hormone replacement for post-menopausal women and surgically post-menopausal women is often necessary to restore their quality of life, both sexually and emotionally. It is hormone treatment for pre-menopausal women suffering from FSD that is especially contentious. For instance, in the above-mentioned study, researchers found that sexual problems in women 18-59 tended to decrease with increasing age.

Since testosterone levels in women peak at around age 20 then decline, if a physiological testosterone deficiency was responsible for FSD, one that could be corrected by testosterone therapy in pre-menopausal women, then the results should show the opposite trend. Instead, it’s likely that social and emotional factors are important in understanding the data. Younger women might have more anxiety over sexual encounters and may be less vocal in asking for what they desire sexually, leading to reduced sexual satisfaction and problems with orgasm.

The solution to this issue seems distinctly not to be broad testosterone drug intervention, as testosterone increases breast cancer incidence in women. We might do better to address women’s youthful, socialized anxiety around their sexuality, a trend that is changing, and perhaps has even changed a great deal in the 20 years since the original study was conducted.

Tefina and its “use as required” option is actually more positive development in the realm of drugs for FSD. There are women who legitimately suffer from reduced sex drive, inability to orgasm, and other sexual dysfunction, sometimes because of hormonal imbalance. They would be able to use Tefina to increase testosterone and reduce their dysfunction. There are other women who would probably like to have the option to increase their libido and sexual satisfaction at certain times, whether they possess a true testosterone deficit or not. There is nothing inherently wrong with developing drugs to enhance women’s sexual experiences; ideally, women will be able to weigh the risk versus benefit of these treatment options and make informed decisions.

Spraying a little extra testosterone up your nose every once in a while to increase a reasonably healthy libido doesn’t sound so bad. But, like any drug enhancement, there’s some risk. The issue with drug development for FSD is that we’re being sold a reductive solution, one that over-simplifies women’s sexual experiences and relies on biological intervention where psychological intervention and sexual education might be more useful and less invasive.

If you tell people they’re diseased enough times, if you present enough statistics and doctors and sexual specialists droning on about the high incidence of women’s sexual pathology, people start to believe it. But just because you were nervous that one time about having sex with a guy doesn’t make you sick. Just because, as a woman, you experienced pain or didn’t have an orgasm doesn’t mean you have a disease. Fine, investigate a weird nose-spray that might make sex better, but don’t tell me nearly half of women are dysfunctional.

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