Birth control – what you need to know

My friend’s Huff Post blog on cervical mucus has garnered 26,000 likes and 3,049 shares. Women have written from all over the world to thank her for this information.  Despite our best efforts as sex educators, although we have been teaching specifics about female fertility for decades, it still seems to remains a mystery – not only to those who want to plan a pregnancy – but also to those who are trying to use their knowledge of fertility as a method of contraception.  With the operative word being “trying”.

Yet, clearly Canadians are using some form of birth control, because the age of first pregnancy is continually rising.  According to a report by Statistics Canada “the switch happened in 2010 and widened in 2011, when there were 52.3 babies born per 1,000 women ages 35 to 39 and 45.7 per 1,000 women ages 20 to 24… birth rates for women in their early 40s now are nearly as high as for teens.”

Young adults are trying to figure out how to succeed at work and somehow “work in” a family to their lives.  The most popular methods used by young people today are male condoms, oral contraceptives and withdrawal.

But what is the best method?

There is no “one size fits all”; but there are some serious considerations – especially for women – before making a choice.

  • age
  • number of partners
  • current health and medical history
  • how effective the method needs to be

The last point may seem odd, but a woman needs to ask herself how she would feel about being pregnant if her birth control method didn’t work.  Some women would accept the pregnancy; others would not.  She needs to examine her feelings about abortion as well as its availability.

What works?

Methods that are 98% –99%+ effective:

  • sterilization
  • intra uterine system (Mirena IUS)
  • combined oral contraceptives (the Pill), the Patch or the vaginal ring
  • Depo Provera (depot medroxyprogesterone acetate)
  • IUD (copper intrauterine device)

Effectiveness is measured in two ways: perfect use and typical use.  For example,

“male condoms are an effective method.  However, a man must use a condom correctly from start to finish.  With perfect use, 2 women out of 100 would get pregnant (98%); but with typical use, 15 would get pregnant (85%)”. 

Withdrawal, the third most common method used by young people must also be used carefully.  An inexperienced man may find that its effectiveness drops as his desire to stay inside increases.

What my friend has written about fertile mucus comes in very handy when using withdrawal or condoms.  If a man does not pull out in time and his partner is at the most fertile time in her cycle, she needs to consider using emergency contraception.  The same advice holds true for a condom that breaks.

What influences the method you choose?

“Ask a woman if she is using birth control and she will likely tell you whether or not she is taking “the pill.” For most women, they are synonymous. Often, she’ll ask her doctor to ‘put’ her on the birth control pill, which conjures the image of a five-minute consultation, prescription pad at the ready. Do the words “informed consent” have any real meaning when it comes to birth control?”

Sadly, pharmaceutical companies skip through the loophole in Canadian laws prohibiting direct to consumer advertising in order to sell hormonal contraceptives, especially the pill.  But safety is an issue.  There is a difference between side effects and risks.  As I point out, some hormonal methods and formulations are riskier than others.

This leaves some people wondering about alternatives.

Unfortunately, there isn’t much that’s new on the contraceptive scene.  A few methods are in clinical trials, but nothing that really changes the birth control landscape.

As for men, how about a remote controlled implant or a “vasectomy switch”, the Bimek SLV?  Unfortunately, there doesn’t seem to be anything on the scene that seems workable.

But perhaps youngish women should not practise contraception too long if they want to have a baby “some day” given the decline in fertility after 35.  As a young friend said to me recently, “Just assume that all my friends who are rapidly approaching 40 are trying.”

 

 

Teaching sex ed – what’s love got to do with it?

Reading this article, I was reminded of an interview I had done on a national radio program last spring.  I guess it’s time to revisit this discussion.

The article above explains the dilemma for (heterosexual) boys:

“…while boys crave closeness, they are expected to act as if they are emotionally invulnerable. Among the American boys I interviewed, I observed a conflict between their desires and the prevailing masculinity norms – if they admit to valuing romantic love, they risk being viewed as ‘unmasculine’.”

The writer encourages sexual health educators to teach boys about emotional intimacy; but there is a distinct difference between emotional intimacy and love.  One can certainly have one without the other.  Let’s be frank.  Adults know full well that we don’t have to be “in love” or in a committed relationship to enjoy the pleasures of sexual intimacy.  And one can have emotional intimacy in a casual sexual relationship to which one would not necessarily apply the “love” label.

The Canadian Journal of Human Sexuality has published numerous articles on casual sexual relationships (CSRs). This article identifies four types of casual sexual relationships: One Nights Stands, Booty Calls, Fuck Buddies, and Friends with Benefits.    Despite the apparent crudeness of the terms, these are indeed intimate relationships, which hopefully include the basic requirements of good communication, honesty and respect.  Sex educators need to acknowledge the reality of CSRs rather than insist on a societal ideal.  In the early days of sexual health education, we used “love” as part of the discussion of heterosexual pairings leading to commitment and babies.  “When a man and a woman love each other…” etc.  For sex educators, in the same way that we have sought to be broadly inclusive in terms of gender and orientation, we need to avoid upholding a hierarchy of intimate relationships with marriage at the pinnacle.

Not so very long ago, lesson plans abounded with examples of the difference between infatuation and love.  No doubt these classes evolved from educators’ fear of talking about pleasure: we were afraid it might lead to early, risky experimentation.  But what would be the point of raising the question of “love” with children having their first crushes who are just discovering the pleasure of holding hands or enjoying that first kiss?  With older adolescents, at what point in the discussion of the sexualization of relationships would we then introduce the notion of love?

The article insists that we talk with young people about feelings.  And we do.  We want them to be able to evaluate whether they feel happy and satisfied in their relationships.  We encourage them to ask themselves: Do I look forward to seeing my partner?  How do I feel when we are together?  Does my partner treat me the same when we are alone as when we are in public?  On the whole, do I feel happier because I am in this relationship?

Not all feelings measure up to the standard set by romantic notions of love.

What we really need to teach young people are the bases of healthy relationships; viz., integrity, honesty, respect, fairness and good communication.  These are, after all, the values that we hope will inform their relationships.  Depending on the individuals, all of these qualities may be found in CSRs as well as long-term committed relationships.  Moreover, we can teach them the prerequisites of sexual activity – consent, safety and pleasure – which are also rooted in equitable, clear communication.

Let’s teach young people about emotional and sexual intimacy, so that when they are ready to engage in more sophisticated sexual activity, they are able to be present, find connection, take risks, experience erotic intimacy, communicate their desires, explore and be authentic.  After all, aside from asexual people who may only want to experience emotional intimacy, the rest of us also want our sexual desires to be fulfilled.

It is important to point out that many people in battered relationships are in love, albeit a love that is based in a power imbalance.  This tie is particularly hard to break.  Not only do women find it difficult for complex reasons to leave their male abusers but the dynamic also holds true for same gender partners.  We may think we can change the person or control the situation, but it is no exaggeration to say that the scenario may also escalate into murder.  As Maya Angelou says of jealousy,

“Jealousy in romance is like salt in food. A little can enhance the savor, but too much can spoil the pleasure and, under certain circumstances, can be life-threatening.”

So let’s teach young people about equitable relationships, and offer them the skills to seek happiness in their relationships, whether they consider themselves to be in love or not.

 

The sexual pleasures of aging

There are plenty of articles about sex and aging.  I have written a few myself (http://www.cwhn.ca/en/networkmagazine/olderwomenandsexuality).  For women, the advice seems to boil down to “use lube”; and for men, “consider Viagra”.  But erectile dysfunction is not inevitable; neither are dryness and vaginal atrophy.

According to this article on testosterone therapy for women (http://www.medscape.com/viewarticle/855874_1?nlid=95444_1842), “Although sexual problems generally increase with aging, distressing sexual problems peak in midlife women (aged 45-64 y) and are lowest in women aged 65 years or older.”  Lest one might think distress is lower in this age category because we have given up on sex, some of us who are 65 and older are having regular and satisfying sexual activity with no need for aids of any kind.

Granted, older people may be ambivalent about aging and sexuality.  Slyly, or perhaps subconsciously, some of us seek compliments by making constant reference to our age.  Some struggle mightily to maintain health through diet and exercise; and sexiness through cosmetic surgery, fast cars, high heels and hip replacements.  Some (women) work really well with their aging beauty; for others, it’s a fight to the death.

Still others cultivate the sexlessness of old age.

Distaste about sex and aging are fuelled by stereotypes.  Robin Williams’ brilliant bit on Viagra (https://www.youtube.com/watch?v=aFM11SmoxfI) is funny but also disparaging: the comic juxtaposition of sex and age.  The Cat in the Hat on Aging is not much better (https://medicalhumour.wordpress.com/2012/09/15/the-cat-in-the-hat-on-aging/).

In his book of poetry, The First Little Bastard to Call me Gramps, CBC broadcaster Bill Richardson bemoans aging in the same vein (http://www.westender.com/news-issues/vancouver-shakedown/bill-richardson-west-end-bard-1.2122654).  Mr. Richardson and his interviewer laughed heartily over “pizza dough” skin and the horror of imagining older people having sex. (http://www.cbc.ca/radio/thenextchapter/farzana-doctor-on-the-dark-side-of-vacationing-and-bill-richardson-on-the-funny-side-of-aging-1.3383121/bill-richardson-on-late-middle-age-1.3383129).  I was not amused.

Because we do.  Have sex.   

Granted, everyone’s definition of “having sex” is different.  LGBTQ people do not have the monopoly on opening up the language.  As long as we have skin and nerve endings, we can delight each other with languorous kisses, caresses, genital and anal play – and call it what we like.

There may be challenges to some of our sexual activities: physical challenges like disabilities; specific conditions like diabetes, stroke or high blood pressure and changing hormones; there may be pain, limited mobility, incontinence, difficulty with erections/lubrication.  There may be societal challenges, like body image, lack of privacy, societal disapproval or expectations.

But there are also some real advantages.

  • If pregnancy was once an issue, it is no longer.
  • If you don’t conform to the societal version of beauty, neither does your partner.
  • We’ve learned to take our time.
  • By now, we have a pretty good idea of what pleases us.
  • Over time, we have developed more skills to please others.
  • We are learning to be more creative.

The newly single can put old routines aside

Many older people have lost their long-term partner to divorce or death.  With a bit of courage and a lot of luck, they can seek and find a new partner.  A new partner can really get the juices flowing no matter one’s age.  It’s exciting to explore a new body and see the delight in someone’s eyes as they explore yours.  Moreover, with a new partner, we have a chance to finally get it right, communicating about safer sex, for example; but above all – communicating about pleasure.  While the need for accommodation may require discussion, we can also talk about what’s on or off the menu.  We can try new out sexual positions, fantasies, role plays – that we may never have had the courage to mention in a previous relationship.  We can see the beauty in each other and feel free to say it out loud.  (I don’t know what their sex life will be like, but when Downton Abbey’s butler, Carson says he finds Mrs. Hughes beautiful, we see it too.)  We can savour long sessions of lovemaking in the privacy of our older adult cocoon.

What about orgasm?

Orgasm is lovely.  Multiple orgasm is lovelier.  The goal of “getting there” is controversial http://dodsonandross.com/blogs/eric-amaranth/2014/09/about-trip-or-about-orgasm.  The language itself is goal-oriented; viz., “achieving orgasm”.  I would argue that enjoying the moment – the long, lovely moment of a sexual session – is the goal rather than any particular sensation.  Watching your partner’s pleasure, or keeping your eyes closed to concentrate on those sensations, paying attention to each other’s ongoing pleasure, are in themselves a satisfying turn-on.

Like any two people making love, having sex, or whatever they choose to call it, older people seek to give and to take pleasure.  Our generation remembers Alex Comfort’s original “Joy of Sex” and we are now quietly (or not so quietly) contributing to the latest edition.

 

 

 

A little breast rant

I used to pay for thermography (http://www.thermographyclinic.com/) as my breast screening tool.  It was expensive but non-invasive and relatively available in my city.  When my sister got breast cancer, I let my family doctor know.  She had previously been on board with my choice but was no longer, so I started having mammograms.

We know that mammography is not only an imperfect tool, but carries its own risks, most notably radiation and an increase in additional testing and unnecessary treatment (http://www.nejm.org/doi/full/10.1056/NEJMp1401875).

A few years ago, after my mammogram, the technician at the breast screening clinic asked me to wait for an additional ultrasound after their physician had reviewed the mammogram.  I sat in my open-back “gown” trying not to panic but feeling awfully vulnerable.  Following the ultrasound, a doctor came to repeat the test and pronounced the glitch they had seen on the screen to be “nothing”.  Relief.

This year, they did the mammogram then sent me home, saying they would call if there were any concerns.  A few days later, I got the call.  Not only did they want to do an ultrasound, but said it would be preceded by a second mammogram.  No additional information or explanation was available.  I felt I had no choice but to book the appointment.

Coincidentally, I had just posted the article above on my professional Facebook page, which concluded,

“It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors.  We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify. Providing clear, unbiased information, promoting appropriate care, and preventing overdiagnosis and overtreatment would be a better choice”.

I reasoned with myself that I was in the same situation as the last time, with the exception of having to wait a few days before being re-tested.  But reason rarely trumps anxiety.

I hardly slept the night before the appointment and assume the diarrhea was the result of too many kidney beans.  I packed my bag for a yoga class following the appointment, hoping that it would be a celebratory session.  I also printed out the article above to use as a talisman if there was any problem with the coping strategy I had worked out.

At the front desk, I told the clerk I wanted to speak with someone before any testing was done.  She saw this as a reasonable request.  I changed and read the local free paper, absorbed in the politics of the day, surrounded by other gowned women.  When my name was called, the technician had me sit in the examining room while she explained the reason for the re-test.  It was indeed exactly the same glitch as the last time, which gave me hope.

“I would like to do the ultrasound before the mammogram.  Is that all right?”  She said that if the ultrasound was definitive, they would not need to do the mammogram.  I told her about the article in my purse and she quickly agreed that mammography had its faults.

When she finished the test, she said the breast appeared normal, but she needed corroboration from a doctor.  The doctor who came in said that they were checking for a malignancy.

“Oh, you used the “m” word”.

“Well, we like to give our patients complete information.”

That sounded like overkill to me, because one cannot test for malignancy without a biopsy.  However, after performing the ultrasound again, he agreed that what they were looking at was just breast tissue.  He went to consult with a third doctor who agreed.  Free to go.

So here’s the rant:

First, it is unfortunate in the extreme that they could not do the follow-up ultrasound on the same day.  Second, I had to reason with the technician to avoid being exposed to radiation a second time.  I doubt that the majority of women would feel informed or assertive enough to do the same.  Third, the doctor used the “m” word unnecessarily, although I can’t imagine his motivation.

And fourth, Canadians are no longer having annual exams (http://www.ctvnews.ca/lifestyle/is-an-annual-physical-necessary-the-doctor-is-out-on-that-one-1.2017959).  The news report states:

“Three years later, what this panel of experts concluded was that the “routine annual physical exam should be discarded.” Instead of full annual exams, doctors should create “selective plans of health protection packages” appropriate to the health needs of the different stages of life.”

What that means for women is that it could be a few years between one clinical breast exam and another.  The breast screening clinic does not start with a clinical breast exam: they use their machines.  I had to ask my doctor to do a clinical breast exam.  Breast self-exam has long been controversial (http://www.berkeleywellness.com/self-care/preventive-care/article/re-examining-breast-self-exam).

Where does that leave us?

We are very much at the mercy of a technology that is universal but imperfect; and a system that does not ensure the simple preliminary tool of clinical breast exam.  A glitch means subsequent testing –  possibly leading to even more testing – and down the rabbit hole we go.  There must be a better way.

Chickens coming home to roost

If you have a cervix, read this.

In 2013, I wrote a blog on new provincial and federal cervical screening guidelines (https://springtalkssex.wordpress.com/2015/01/08/confused-about-pap-tests-july-2-2013/) partly because women’s health advocates were worried that these updated policies were putting women at risk in order to save money.  There was no risk, in my opinion, in delaying the initial Pap or from the longer interlude between screening tests.  But there certainly was a risk: not informing women of the difference between cervical screening and Sexually Transmitted Infection (STI) testing.

Because most Human Papilloma Virus (HPV) infections resolve on their own, research indicated that earlier and annual testing did not decrease sickness or death from cervical cancer.  Even high-risk HPV infections that cause cellular changes on the cervix tend to resolve on their own without treatment.  Cervical cancer develops when there is persistent infection with a high-risk type of HPV in the presence of co-factors like a suppressed immune system.  Pap testing (and/or HPV testing) indicate when treatment is necessary to prevent its development.

When Cancer Care Ontario (CCO) published fact sheets to inform the public about the new guidelines, I contacted them to point out that they also needed to provide information about the importance of STI testing.  It was obvious to me at the time that there would be repercussions.

I had been selling the annual Pap as part of sexual health education classes for years.  Suddenly, young women (including trans men with a cervix) were being told they didn’t have to start till they were 21 (Ontario) or 25 (federally); and they didn’t need to have a Pap every year.  So, of course, many stopped having internal exams until they were told they had to.

Young women, in my experience, especially those whose annual Pap test coincided with – and in some cases were dependent on – their birth control pill renewal, had no idea what was going on during their internal exam.  Despite the efforts of sexual health educators in the classroom to distinguish between the Pap test (checking for abnormal cells on the cervix) and STI screening (swabbing the cervix and inside of the vagina) when they arrived at clinic for their exam, counsellors had to take the time to explain it again. It is not clear if Physical Education teachers and family physicians today consider it important to educate about this important difference.

So what’s the big deal?

The importance of the distinction becomes clear when we look at the statistics.  According to the lead researcher of a recently published article on this issue (see below), over the past 10 years, chlamydia and gonorrhea rates in Canadians rose by 72 and 53 per cent, respectively, especially for chlamydia.  The highest number of cases of chlamydia are diagnosed in young people between the ages of 15 – 24.  The increase in diagnoses was in part due to Public Health Units encouraging an increase in testing in the early 2000s.  The urine (NAAT) test (v-e-e-ry appealing to men) also brought in more young people for testing.  One of the suspected behavioural reasons for the increased number of cases was less condom use among older adolescents and young adults who made the switch from condoms to hormonal contraception without being tested first.

Untreated chlamydia, which is commonly asymptomatic, can do serious damage to the Fallopian tubes.  Moreover, untreated STIs which provoke an increase in white blood cells at the site of the infection, make it easier for HIV to enter the bloodstream.

Here come the chickens

St. Michael’s Hospital in Toronto raised the alarm about a decrease in testing in their recent study (http://www.sciencedaily.com/releases/2015/10/151015144701.htm).  The lead researcher said, “…we found that women weren’t visiting family physicians as often for Pap tests, causing a drop in STI screening as well.  Female patients were also less likely to be screened for syphilis, hepatitis C and HIV under the new guidelines…”

When I contacted Cancer Care Ontario to complain about the lack of information on the importance of ongoing STI testing, the woman I spoke to thought it would be confusing to try to explain the difference between the various types of testing.  Prior to writing this blog, I re-visited the CCO web-site looking for what I hoped would be updated literature.  There is still no mention at all of STI testing.

The takeaway for readers with a cervix is this: if you have had unprotected sexual activity, whether you have symptoms or not, see your health care provider even though it is not time for your Pap test.  They will look at your genitals; they will test you for chlamydia and gonorrhea and any blood-borne infections you may have been exposed to.

As for me, I guess it’s time to contact CCO medical directors encouraging them to read the St. Michael’s study.  I wonder if they still think it’s too much for women’s brains to handle.

Read more here:

Cancer Care Ontario information on screening: https://www.cancercare.on.ca/cms/One.aspx?portalId=1377&pageId=9550

“Set the tatas free”

A friend posted a photo with a caption on my Facebook page.  It depicted a slim woman, nude except for panties, arms raised over her head, flying her (matching) black bra overhead.  The caption: “Support breast cancer.  Set the tatas free.  Oct. 13 no bra day”.  My friend “loved” it.

It came via 9gag.com, which is a clear descriptor of the site.

I don’t love it and here is why.

Starting with a minor quibble, I believe they meant to say “support the prevention of breast cancer” rather than supporting breast cancer.  The word, “support” itself is a favorite term used by bra manufacturers.  But supportive underwire in particular has also been touted as a risk for breast cancer in the popular press, for which there is no scientific evidence.   (http://cebp.aacrjournals.org/content/early/2014/08/27/1055-9965.EPI-14-0414.full.pdf+html?sid=201973b9-7f7e-45f9-876f-3fd40263a00b).  So taking off your bra is hardly a prevention strategy.

Turning to tatas…

Boobs.  Boobies.  The girls.  Tits.  Titties.  Headlights…I could go on.  When I was in university, a male friend would yell, “Boobs!” (his nickname for me) as soon as I walked into the common room.  Hilarious, right, especially after years of harassment from the time I was 12 by older men working construction.  Many years later, I remember telling my daughter that they were called breasts.  She said I could call them breasts if I wanted to but she was going to call them boobies.  As a sex educator, I have a thing about language.  With a friend or a lover, we can call our body parts whatever we want.  But I do not want my breasts referred to as anything but breasts when talking about breast cancer.  Of course, some breast cancer survivors may feel OK about slang or affectionate terms; and if so, I’d like to hear from you.

In 1968, when I came to the women’s movement, there were lots of anecdotes about bra burning, most of which were the stuff of urban legend; but certainly many of us went braless at times either for comfort or as a political statement.  There were consequences.  It was less Slutwalk than trash talk.  I suffered some pretty difficult moments because it was so noticeable that I wasn’t wearing one.  Going braless is, of course, a choice; but like the Slutwalk movement says, it does not give anyone the right to harass us. Clearly sexual harassment will continue until we have made a sea change in our sexist society. Advocating a “no bra day” on a gag site is more than suspect.

Finally we get to the issue of real breast cancer prevention.  The Canadian Women’s Health Network (CWHN) has long supported health advocates who are critical of Pink Ribbon campaigns and “pinkwashing” in general.  In a film on the subject, http://www.nfb.ca/film/pink_ribbons_inc/trailer/pink_ribbons_inc_trailer/ the filmmakers examine the power behind the money and also follow the money.  The CWHN and Breast Cancer Action prefer to look at chronically underfunded primary prevention research rather than funnelling most funding into “a cure”.  They would like to see monies dedicated to examining environmental issues like toxic work environments.

In ground-breaking work done regarding exposure to carcinogenic materials, James Brophy, Margaret Keith et al. concluded:

“These observations support hypotheses linking breast cancer risk and exposures likely to include carcinogens and endocrine disruptors, and demonstrate the value of detailed work histories in environmental and occupational epidemiology.” http://www.ehjournal.net/content/11/1/87?utm_campaign=06_11_13_EnvironHealth_APHA_Award_Mailing_3rdP&utm_content=7387543941&utm_medium=BMCemail&utm_source=Emailvision

This October, if you know someone who has been dealing with breast cancer or are remembering someone who did not survive, instead of running, supporting a run, donating money to everything pink, think first about its destination.  And if you choose to go braless, please don’t do it because some gag web-site is egging you on.

Read more here:

http://www.bcaction.org/

http://www.cwhn.ca/en/search/node/breast%20cancer

http://www.cwhn.ca/en/resources/womenplasticsandbreastcancer

“Pink Viagra” approved in US: Big Win for Big Pharma

Is Addyi coming to a drugstore near you?

With the Canadian purchase of Sprout, the company that convinced the US Food and Drug Administration to approve flibanserin (now marketed as Addyi), Canadian approval may not be far behind.  Does this medication really “even the score” with men by increasing women’s sexual desire?

The New View Campaign (http://www.newviewcampaign.org/) has been arguing for years that female sexual dysfunction was manufactured to pave the way for a medication to treat it.  The Journal of Medical Ethics agreed in their commentary, “Hypoactive sexual desire disorder: inventing a disease to sell low libido” (http://jme.bmj.com/content/early/2015/06/28/medethics-2014-102596.short).

But female sexuality and desire are complex.  Back in 2004, a CME (continuing medical education) guide was written to help doctors integrate the “New View” approach.  They included a section on the medicalization of male sexual problems and a similar history for women, including an account of the search for a female medication akin to Viagra, which had already begun by the late 1990s.  The CME detailed a step by step response to this medicalization.  They began by explaining that women’s sexual problems may be due to:

  • sociological, political or economic factors
  • problems relating to their partner and relationship
  • psychological factors
  • medical factors

Clearly, no medication is going to address all of these issues.

The big sell for a female equivalent to Viagra began with faulty research, which soon became medical gospel.  The New View Campaign repeatedly criticized the oft quoted 43% figure, which was said to represent the total prevalence of sexual dysfunction for women 18 – 59.  Where did this figure come from?  The researchers, including two authors paid by Pfizer, asked 1500 women to answer “yes” or “no”, if they had experienced any of seven problems – for example, lack of desire or difficulty with lubrication – two months or more in the past year.  If they answered “yes” to even one of these questions, they were popped into the sexual dysfunction category.

There is no clear biological indicator for abnormally low desire because desire is entirely subjective.  In order to be diagnosed with female sexual interest/arousal disorder, one must report “significant distress” which is also highly subjective.  Given the above list, what woman has not had life experiences that tamp down her desire or ability to lubricate?  Just had a baby?  Don’t touch me.  In a loveless relationship?  You don’t need lube or a pill.

There were already two failed attempts to get the FDA to approve flibanserin despite their widely publicizing the (manufactured) need for it.  The FDA cited lack of effectiveness (4.4 satisfying sexual experiences vs. 3.7 for women taking a placebo: a whopping difference of 0.8%).  There was also concern about side effects (e.g., dizziness, nausea, fatigue, insomnia).  In fact, many women discontinued participation in the clinical trials because of these side effects.  And for women who like a glass of wine before sex, forget about it.  Flibanserin’s concentration – and accompanying side effects – increases with alcohol.  There is a similar increase if she is using oral contraceptives or other common medications.  Moreover, a woman would have to take a daily pill without expecting any change for weeks, as is the case with anti-depressants.

The International Business Times agrees “it is more like an antidepressant and works by changing brain chemistry over time, in a similar way to serotonin and dopamine. While male Viagra is taken before engaging in sexual activity to increase blood flow to areas of the body to help treat erectile dysfunction, Flibanserin is to be taken daily to improve sexual desire over time.” (http://www.ibtimes.co.uk/female-viagra-addyi-approved-us-what-flibanserin-how-does-it-work-1516090)

What’s a drug company to do?

The third attempt was preceded by the creation of Even the Score (http://eventhescore.org/the-problem/), backed by pharmaceutical companies – a brilliant marketing ploy.  They argued that medical sexism was withholding medication from women whose sexual desire was perceived as less important than men’s.  Co-opting feminism is an old game, but one which, in this case, was very effective.  They won the American round.

It remains to be seen if Canadian women will fall for the same ploy.

Don’t believe the hype.

Read more:

Drug Facts Box: http://www.informulary.com/informulary-drug-fact-boxes/addyi-for-women-distressed-by-decreased-sex-drive