Studies have never defined a 鈥渘ormal鈥 level of sexual desire. Despite that, there鈥檚 a website and an online quiz to help you decide if you鈥檝e got a problem. Called 鈥淩ight to Desire,鈥 it brands libido as a feminist 鈥渞ight,鈥 and its home page offers the defiant, in-your-face prompt: 鈥淵es, I want my desire back.鈥
Click a few boxes and you鈥檙e instantly directed to a remedy (and an online doctor to prescribe it): a pill called Addyi from Sprout Pharmaceuticals.
鈥淭his particular product should not have been approved by FDA, but it was, and it is not a product that adds value to women鈥檚 lives,鈥 said Susan Wood, assistant commissioner for women鈥檚 health at the Food and Drug Administration from 2000 to 2005.
She added: 鈥淭here isn鈥檛 an actual market.鈥
The effort, called a 鈥渄isease awareness鈥 campaign, troubles critics because it attempts to define low sexual desire as a widespread disease that is treatable with a pill. Although doctors recognize that there is (perhaps) a condition called Hypoactive Sexual Desire Disorder, many of the studies defining HSDD were sponsored by the drugmaker. Almost all doctors on were consultants or on Sprout鈥檚 advisory board.
To further complicate matters, in the studies that led to Addyi鈥檚 approval, results were not terribly impressive. And, for those who would simply like a little more sex in their lives, is it worth a $400-a-month pill?
Enter the latest sales pitch, which encourages women to stand up for their rights. The new campaign taps into emotional issues that have long been staples of women鈥檚 equality movements, like the right to equal access to health care, the idea that women鈥檚 issues should be taken as seriously as men鈥檚, including women in conversations about their health and valuing women as sexual beings.
鈥淭o hear our language co-opted鈥 is upsetting, Cindy Pearson, the executive director of the National Women鈥檚 Health Network, said in an interview. 鈥淚t鈥檚 really bittersweet to see it co-opted to sell, and sell a product that isn鈥檛 that good.鈥
Addyi 鈥 also known as flibanserin 鈥 first gained FDA approval in 2015 after a long and contentious fight. It鈥檚 often called the 鈥渇emale Viagra鈥 because it鈥檚 related to sex, but Addyi and erectile dysfunction meds are quite different.
While impotence medications work by directing blood to the genitals and are taken before sex, Addyi is taken nightly and works in the brain to increase desire.
In fact, it was originally developed to be an antidepressant, but its clinical-trial performance fell short. Along the way, researchers noticed that subjects reported having some increase in sexual desire.
鈥淎ddyi is believed to work on the part of the brain involved in sexual motivation and response, though its exact mechanism of action is not fully understood,鈥 the official website reads.
Even during drug trials, Addyi鈥檚 effectiveness was questioned. On average, women who took it reported one increased sexually gratifying experience every other month, and that was only after the subjects began recording their experiences monthly instead of daily.
There are also concerns about side effects like dangerously low blood pressure, fainting, severe drowsiness and insomnia.
The FDA rejected Addyi twice before it went before a public advisory council, where patients, doctors and women鈥檚 groups (some by the manufacturer, according to industry researchers) testified in favor of the drug.
In the old days, drugmakers developed drugs for known diseases. Now drugs come looking for a market.
It鈥檚 difficult to pinpoint the number of women who report a persistent lack of sexual desire. Even the findings of studies sponsored by the drugmaker . Such complaints also tend to be more common among post-menopausal women 鈥 a group for whom the drug is not approved.
Experts say it鈥檚 difficult to get an accurate picture of the problem medically known as low libido because it has so many possible causes 鈥 depression, poor body image, fatigue, stress, pregnancy and menopause. Even in the Sprout-sponsored study, many women who were distressed about their low sexual desire ascribed it to 鈥渞elationship issues.鈥
鈥淵ou take something that can occur from a wide range of reasons, some of which have nothing to do with physiological or medical problems, and you turn it into a medical problem, you give it a name and you sell a product to get rid of it,鈥 said Diana Zuckerman, the president of the National Center for Health Research.
Rather than turn to a costly, silver-bullet medication approach, complaints like sexual dysfunction and low desire often need to be addressed by mental health professionals, sexual health professionals or people with more time and training than general practitioners, Zuckerman said.
Anyway, Addyi鈥檚 labeling expressly notes it is not approved for use by women whose low libido is caused by problems in their relationship, menopause, childbirth, medical issues, other medications they are taking or mental illness.
While Wood said she thought Sprout would like to market Addyi to 鈥渁lmost all women,鈥 there鈥檚 a 鈥渢iny subset of women who suffer from HSDD.鈥
鈥淎nd there鈥檚 not a big a market of people who actually suffer from this diagnosable condition that could benefit from a medical treatment,鈥 Wood added.
鈥淩ight to Desire鈥 brands itself as a movement for women who are struggling with HSDD. The campaign is heavy on social media, with a strong Facebook presence that includes Funny or Die videos, date night 鈥渉acks鈥 and testimonials from patients and doctors. There was a #RightToDesire 鈥済irls鈥 night out鈥 Twitter party featuring several mommy bloggers and giveaways.
It鈥檚 not the first time feminism has been used to sell a product, but it鈥檚 still frustrating for women鈥檚 health activists who have been working for years to get their issues taken seriously.
At the time, a coalition of groups 鈥 some venerated women鈥檚 rights groups and some that were formed and funded by the pharmaceutical industry 鈥 known as 鈥淓ven the Score鈥 pushed for the drug鈥檚 approval and found traction. The rallying cry was the idea that 26 drugs had been approved for male sexual dysfunction and none for women.
鈥淚 believe [the FDA] found it hard to keep the product off the market when they were being accused of being sexist,鈥 Wood said.
鈥淭hey got, in my view, sort of bamboozled by that argument,鈥 she added.
Forty-eight hours after Addyi was approved, Sprout sold it to Valeant, now under the umbrella of Companies, for around $1 billion.
And it flopped. According to Wood, that鈥檚 because the drug didn鈥檛 work, came with safety concerns and wasn鈥檛 covered by many insurance plans. Addyi cost around $800 a month for a daily pill, which may account for why at its peak in March 2016 only were written for it.
In 2017, Valeant gave up on Addyi, , which is now trying again to make the drug a sensation. As part of the , according to press reports, Sprout did not have to pay an upfront fee and, among other parts of the deal, agreed to pay Valeant, now Bausch, royalties on sales of the drug, though early indications say it still isn鈥檛 successful.
鈥淲e will receive royalties once they make a milestone,鈥 Arthur Shannon, senior vice president and head of investor relations and communications for Bausch, wrote in an email. 鈥淲e have not received any royalties thus far.鈥
The deal paved the way for a lower price tag 鈥 cut in half 鈥 and this trendy pop-feminist ad campaign.
Sprout did not make its CEO available for an interview.
Originally, the drug鈥檚 labeling included a prohibition on drinking alcohol while on the medication. This caution, though, resulted from a study whose participants were mostly men.
This spring, Sprout funded two new studies to show Addyi was safe to consume with alcohol, but the FDA kept the 鈥渂lack box鈥 warning in place with one change 鈥 the alcohol prohibition is restricted to two hours before and at least eight hours after taking it.
鈥淣ow is the time to lend your voice and demand gender equality when it comes to sexual health,鈥 the Facebook page declares as it directs visitors to a Change.org petition to get benefits managers to cover the drug. It also asserts that it鈥檚 鈥渢ime to address women鈥檚 sexual health beyond reproduction alone.鈥 It even quotes Eleanor Roosevelt.
鈥淸Sprout is] definitely appropriating all that language, making it seem like a feminist issue,鈥 said Dr. Steven Woloshin, a professor at the Dartmouth Institute. 鈥淭his is an issue that involves women, but that doesn鈥檛 mean that taking this drug is something you should do because you鈥檙e a feminist.鈥
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