Politics of pleasure

With the US Food and Drug Administration (FDA) giving the go ahead to flibanserin, a libido boosting medication aimed at women, pills as we know them are ready to change forever. Yet, what are the drug's benefits? What are the pitfalls? How can we weigh both before exploring it?

During last Thursday's finale (post a four-year-old debate among women's group, many of which saw the pill with skepticism), the FDA jury voted 18-6. Sufferers of hypoactive sexual desire disorder (HSDD) made a strong case for demand of this non-hormonal treatment. Sprout Pharmaceuticals, the drug's developers, produced stirring testimonials from women with low/diminished sexual desire who negotiate the risk of over-the-counter medication in the absence of a licensed treatment.

But even as FDA touched upon the 'unmet medical need' of these women, it described the drug's benefits as 'moderate' and 'marginal'. Flibanserin, originally developed as an anti-depressant, was shot down twice by the advisory committee before Thursday's turnaround, as possible side-effects of nausea, dizziness, fainting and low blood pressure were highlighted. While Viagra treats the specific condition of erectile dysfunction (ED), they noted, its effects on women may be vague.

Locating the discourse in the Indian context, Dr Duru Shah, Scientific Director, Gynaecworld, Mumbai, says: "In India, a variant of male Viagra, Sildenafil, is often used in infertility treatments. Used indiscriminately, it can cause palpitation or allergic reactions, especially in cardiac patients. While this drug triggers localised increase in the blood flow, flibanserin is likely to balance your neurotransmitters, elevating the brain's excitatory response. However, side effects, could be similar."

Taking a relevant detour, Shah adds: "In our country, a large number of women fail to enjoy sex. While HSDD is a reality, in most cases, partners don't learn how to sufficiently stimulate and prepare them for penetration.

Women's bodies are designed such that they take longer to be aroused. They have to be led to the throes of enjoyment, done easily with proper knowledge. It's this knowledge that we lack."

Reacting to the drug being dubbed as the new gender-equalisation tool, Shah observes: "Sex is essentially a bilateral activity; it's a woman's right to enjoy it as much as a man's. Unfortunately, society has never offered her that position. The Viagra may heighten certain sensations for women during sex, but it can be achieved with a little bit of work that, thankfully, comes free of side effects."

Shah insists that if female Viagra finds its way to the market, it should be accompanied by standard government-approved guidelines. Her fears are relatable–vague or faulty advertising by over-zealous pharmas may lead the youngsters to misuse the product to a dangerous effect, "like with emergency contraceptive pills".

Medha Uniyal, 21, working with NGO Pratham belongs to this younger demographic. She insists that while she doesn't see herself as a potential customer, "It is a patriarchal hoodwink, if a woman with low sexual drive finds herself with nothing to turn to in the 21st century, while men are offered the assurance of ED treatments. If this drug has harmful side-effects, they must find another. Not offering us an option is not an option."