episode 8. Flibanserin: Viagra’s less popular little sister

Chances are you’ve probably heard of the “ little blue pill” that gives men erections almost like magic. But have you ever heard of Flibanserin? This “female Viagra” is the topic of this week’s episode, where we talk a little science and biology but of course get into some history, learning about Erectile Dysfunction, Female Sexual Dysfunction and the gaps between how we understand each of them in historical context. Ranging from Mesopotamian spells that men used to cast on each other to ward off virility-stealers to the DSM-V and how its use and misuse affects women’s mental and sexual health. In our Feminist Corner, we discuss the concept of “normal”, especially in the context of sexual dysfunction, and what the “Charmed Circle” is as well as how it’s used to understand sex in larger circles of society. Flibanserin deserves more of a role in the spotlight, so that’s exactly what we’re giving her!

Feminist Corner

“Charmed Circle”: Dr. Gayle Rubin coined the “Charmed Circle” as a paradigm to understand the ways that sex are viewed in our society. The inner circle is the “Charmed Circle” where “good, normal, heterosexual, male-dominated, vanilla, monogamous coupled sex” exist and everything else is considered “bad” and in the outer limits.

gayle rubin - JungleKey.com Image #50

What is normal? And what effects do defining symptoms of sexual disorders as normal or abnormal even mean? Because we use these terms in medicine all the time like oh her cholesterol levels are normal or the growth rate of those cells is abnormal. But how does rethinking our understanding of “normal” have a particularly different impact when talking about sexual dysfunction? 

Historians, cultural scholars and scientists who worked on developing Viagra say that in the 20 years since its release, it has changed the way America talks about sex, making it more open and less puritanical. What are your thoughts on this?

Instead of directly just asking about how this relates to us as women in medicine and women in our lives, I wanted to do a little role play kind of scenario. Think about a moment or time if your life when you felt really self-conscious or honestly ashamed about talking about sexuality. What I want to know is, what are some things you would have wanted to hear that could have inched you one step closer to owning your sexuality?

Listen to the episode, discuss these questions with friends and family, let us know what you think!

Show Notes:

Disclaimer: Episode 8 discusses topics of sex, sexual organs and sexual health. If this makes you uncomfortable, perhaps this isn’t the episode for you.

Part 1: Sex Ed, Dysfunction Edition

  • What is Erectile Dysfunction (ED)?
    • Erectile Dysfunction, according to the NIH, is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. 
    • We also get into some of the causes of ED
  • What is “Female Sexual Interest/ Arousal Disorder” or “Female Sexual Disorder” (FSD)?
    • FSD is defined as persistent/recurring decrease in sexual desire or arousal, the difficulty/inability to achieve an orgasm, and/or the feeling of pain during sexual intercourse

Part 2: “dude…why can’t I get it up?!”

  • In this section, we discuss the history of ED from Mesopotamia all the way through the discovery of Viagra. 
    • In mesopotamian texts from 7th century BCE, special chants were shouted at men to prevent sorcerers from stealing their virility
    • In the eighth century, men of Ancient Rome and Greece wore talismans of rooster and goat genitalia, because they believed these talismans would act as aphrodisiacs and promote sexual function.
    • Romans would eat the genitalia of animals with high sex drives like rabbits
    • In 1991, Dr. Nicholas Terrett patented this heart medication as Viagra
    • In 1998, Viagra became the first FDA approved oral treatment for ED! And in the first few WEEKS that Viagra comes out, experts estimate that US Pharmacists dispensed more than 40,000 Viagra prescriptions. 

Part 3: So…where’s MY magic little blue pill? 

  • In this section, we discuss the history of ED from Mesopotamia all the way through the discovery of Viagra. 
    • In the 1st millennium BC across the world, we basically moved away from the mythic, cosmic, and collective consciousness we had with women in the center, and moved towards a male dominated, rational, analytical, individualistic consciousness. 
    • As early as the 16th century, it wasn’t a LACK of sexual desire that was seen as a female sexual disorder, it was nymphomania that was seen as more worth writing about. 
    • Freud was the person who basically created the concept of “frigidity” to describe failure of vaginal orgasm.
    • FSD got added to the DSM as a separate category in the fifth edition
    • Treating FSD has had no super significant findings because most of the experiments are unreliable or poorly conducted
      • But Flibanserin is a drug available, and yet no one knows about it

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Angel K. (2010). The history of ‘Female Sexual Dysfunction’ as a mental disorder in the 20th century. Current opinion in psychiatry, 23(6), 536–541. https://doi.org/10.1097/YCO.0b013e32833db7a1

Baid, R., & Agarwal, R. (2018). Flibanserin: A controversial drug for female hypoactive sexual desire disorder. Industrial psychiatry journal, 27(1), 154–157. https://doi.org/10.4103/ipj.ipj_20_16

Basson, R. Women’s sexual function and dysfunction: current uncertainties, future directions. Int J Impot Res 20, 466–478 (2008). https://doi.org/10.1038/ijir.2008.23

https://doi.org/10.1215/9780822394068-006

Brown DA, Kyle JA, Ferrill MJ. Assessing the clinical efficacy of sildenafil for the treatment of female sexual dysfunction. Ann Pharmacother. 2009;43(7):1275-1285. doi:10.1345/aph.1L691

Chakraborty, K., & Thakurata, R. G. (2013). Indian concepts on sexuality. Indian journal of psychiatry, 55(Suppl 2), S250–S255. https://doi.org/10.4103/0019-5545.105546

Chen, A. (2019, July 25). Why Did the “Female Viagra” Fail? Retrieved September 7, 2020, from https://daily.jstor.org/why-did-female-viagra-fail/

Female Sexual Dysfunction. (2007, January 1). Retrieved September 7, 2020, from https://www.webmd.com/women/guide/sexual-dysfunction-women#1-2

Ferguson, S. (2019, May 29). Everything You Need to Know About Female Arousal. Retrieved September 7, 2020, from https://www.healthline.com/health/healthy-sex/female-arousal#stages

Gurtner, K., Saltzman, A., Hebert, K., & Laborde, E. (2017). Erectile Dysfunction: A Review of Historical Treatments With a Focus on the Development of the Inflatable Penile Prosthesis. American journal of men’s health, 11(3), 479–486. https://doi.org/10.1177/1557988315596566

Gulland, S. (2018, May 26). “Spanish Fly”—a deadly Viagra of the past. Retrieved September 7, 2020, from http://www.sandragulland.com/spanish-fly-a-deadly-viagra-of-the-past/

McLaren, A. (2007). Impotence: A Cultural History (Annotated-Illustrated ed.). Retrieved from https://books.google.com/books?id=nQOz-jpeg4YC&pg=PR11&lpg=PR11&dq=%E2%80%9Cprotective+spells%E2%80%9D+that+went+like+this:+%E2%80%9CGet+excited!+Get+excited!+Get+an+erection!%E2%80%9D&source=bl&ots=caVlq3wAd2&sig=ACfU3U2WCzaSh4QmOyIk_LGChyuDrhqIWQ&hl=en&sa=X&ved=2ahUKEwjZ8rTWk-TqAhXMVc0KHfG_A7sQ6AEwBnoECAkQAQ#v=onepage&q=%E2%80%9Cprotective%20spells%E2%80%9D%20that%20went%20like%20this%3A%20%E2%80%9CGet%20excited!%20Get%20excited!%20Get%20an%20erection!%E2%80%9D&f=false

Mollenhauer, W. F. (2011). Female Sexual Dysfunction: History, Critiques, and New Directions. UCLA: Center for the Study of Women. Retrieved from https://escholarship.org/uc/item/8jh824nc

Nymphomania | Origin and meaning of nymphomania by Online Etymology Dictionary. (n.d.). Retrieved September 7, 2020, from https://www.etymonline.com/word/nymphomania

Rao, T. S., & Nagaraj, A. K. (2015). Female sexuality. Indian journal of psychiatry, 57(Suppl 2), S296–S302. https://doi.org/10.4103/0019-5545.161496Rubin, G. (2012). Thinking Sex. Deviations, 137–181. https://doi.org/10.1215/9780822394068-006

Like the episode? Send us your thoughts and questions!

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