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But not every feminist and women's health organization has joined the fight. In fact, a significant number of sexuality researchers aren't convinced that we need a female sex drug at all. "The pharmaceutical industry wants people to think that sexual problems are simple medical matters, and it offers drugs as expensive magic fixes," argues Leonore Tiefer, Ph.D., a clinical professor of psychiatry at NYU School of Medicine. Tiefer is skeptical of Even The Score, which she considers more PR stunt than grassroots activism. She's spent the past 14 years running the New View Campaign, a coalition of 10 major women's and health groups, including Planned Parenthood of New York City, along with more than 100 doctors and social scientists. Its mission is to challenge what she calls "the medicalization of sex" for both men and women. The campaign's researchers have testified against the approval of female sex drugs at both FDA hearings to date. Tiefer thinks we should be fighting to change our culture—which, she argues, perpetuates negative messages and unrealistic expectations about women and sex via porn, music, and other media—instead of big pharma.

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So is the FDA really discriminating against women? Or is female sexuality too complicated to be treated by a pill?

One thing bothsides agree on: Finding an effective female sex drug isn't as easy as putting Viagra in a pink bottle. To understand why, it helps to distinguish between "desire"—your mental state of feeling turned on—and "arousal," in which your body signals that it wants to get it on (vaginal wetness, hardened nipples, and so on). Some women experience spontaneous-seeming arousal frequently (often at certain points in the menstrual cycle), and just noticing those physical signs will get them in the mood. But other women, especially those diagnosed with SIAD, are less aware of the physical signs of arousal. And triggering desire without physical cues is a complicated mental process. "You can't wait for desire to simply rise up, spontaneously," explains Tiefer. "It's like getting in the mood to watch a movie. You have to think about what you like and what circumstances are conducive to that."

Arousal and desire are more consistently linked for men because their main physical cue is so, well, obvious. "Men know if they have an erection, so that tends to trigger the mental desire," says Lori Brotto, Ph.D., director of the Sexual Health Laboratory at the University of British Columbia in Vancouver, who defined the criteria for female sexual dysfunction disorders for the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 2013. Viagra and other erectile-dysfunction drugs focus solely on the mechanics of physical arousal by increasing blood flow to the genitalia, so erections are easier to obtain and sustain. But when Viagra was tested on women, most felt confused. The increased blood flow made them more aware of vaginal wetness, but "they still weren't experiencing a mental state of desire," explains Brotto, "so the physical effect only magnified that disconnect."

Pharmaceutical companies realized that they needed a drug that would connect women's brains and bodies, so they turned to hormones and brain chemistry. Originally studied as a potential antidepressant, Sprout Pharmaceuticals' flibanserin targets neurotransmitters in the brain, increasing dopamine and norepinephrine (which play a role in sexual excitement) and decreasing serotonin (thought to be responsible for sexual inhibition). Another contender is bremelanotide, a drug made by Palatin Technologies, which, at press time, was awaiting the final stage of the FDA's three-phase testing process. Bremelanotide activates brain receptors that send sexual receptivity and readiness signals; patients inject themselves with the drug a few hours before sex to jump-start their desire. Meanwhile, a pair of drugs still in Phase 2 trials, called Lybrido and Lybridos, made by the Dutch company Emotional Brain, claim to pack a one-two punch by first priming the brain with testosterone to make women more sexually responsive and then increasing blood flow to genitalia, Viagra-style.

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Madison, a perky 37-year-old from Ohio, who also asked to have her name changed, thought a shot sounded "a little scary" when she first heard a bremelanotide recruitment commercial. But she was feeling desperate to recapture the sex drive that 10 years of marriage and parenting seemed to have erased. "When we first got together, I'd come home after work and a two-hour commute and still be like, 'Yeah, let's go!'" she recalls. "Now, I just don't ever want to have sex, ever. Maybe I'll snuggle with him and think about it for a second, but then it's like, I'd rather sleep." With bremelanotide, Madison could time the shots for when she and her husband had a window in their schedules for sex. The couple went from having sex once every three weeks to twice a week.

Both Cara and Madison—who were introduced to me by publicists for their respective drug manufacturers—posted unusually good results for their drug trials; on average, flibanserin users had sex once more per month, while bremelanotide patients reported having sex 0.8 times more per month. But: "Women in these trials are usually in long-term relationships and having some sex already, so counting how often they have sex isn't the best measure of the drug's efficacy," explains Sheryl Kingsberg, Ph.D., a professor in reproductive biology and psychiatry at Case Western Reserve University, who worked as a clinical researcher on both drugs. "What they're missing is that hunger for sex, which is much more subjective." Before trying bremelanotide, Madison often made deals with herself: "It would be like, 'OK, Sunday is the day! If we haven't done it by Sunday, I'll do it then, no excuses!'" she says. "It felt more like I was trying to think positive before a big test than doing something fun." Now that her flibanserin supply has ended, Cara can relate: "We do it every Saturday and Sunday morning, right after we brush our teeth," she says. To enjoy it, Cara wakes up early and remembers those hot sexcapades during her flibanserin trial, or anything else that might turn her on. "I know how important sex is for our marriage," she explains. "I miss really wanting to have sex. I hate having to 'wind myself up' to do it. It makes me feel broken. It takes a really dedicated effort for me to be there physically and mentally."


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