Separate Spheres in Sexual Health: Women with HSDD Left Without Options

By Corinne Schwarz, Government Relations Intern

Antiquated, conflicting ideas continue to surround our conceptions of women’s sex drives. We’re either frigid ice queens who reject sex entirely—or submit passively, without regard to our own satisfaction—or we’re ravenous man-eaters with insatiable sexual appetites. Men, on the other hand, are depicted as virile, dominated by their desires and constantly craving sex. This binary thought permeates our society, impacting the pop culture we consume and the attitudes we hold about ourselves. Think about it—when was the last time you saw a commercial for Viagra or Cialis during daytime TV? Or watched a sitcom filled with punchlines surrounding some sex-crazed male character? There’s an entire industry based on maintaining and supporting male sexual desire, while women’s sexuality is routinely relegated to the sidelines, outside of mainstream discourse.  That probably explains why there are 26 FDA- approved treatments for erectile dysfunction and none for women.

These current conceptions of sexuality can be traced back to the Victorian era, when sex was simultaneously everywhere and nowhere. While sexology—the scientific study of human sexuality—began to gain traction in the early 1900s, social norms still viewed sex as something taboo, meant only as a step towards the ultimate goal of childbirth. Victorian society was based on a “separate spheres” ideology. Men were supposed to be the breadwinners in the public sphere, while women remained in the private sphere of housekeeping and childrearing. This separation directly impacted how Victorian scholars researched gender and sexuality. For example, evolutionary theorist Herbert Spencer thought that because men had to spend so much time and energy in the public sector of labor and industry, their sex drives were clearly more direct, focused only on fertilization. Women’s bodies were more complicated, as they had to expound more energy during childbirth and menstruation. These exhausting processes clearly left them with no time for involvement in the public sphere—or enjoyment of sex.

While we’ve got a century of distance from the Victorians, our social norms have not advanced as much as we’d like to believe. We still see sex, especially female sexuality, as something taboo at best and nonexistent at worst. Arcane laws are still on the books in Georgia and Alabama preventing women from purchasing sex toys under the guise of anti-obscenity legislation. Women who have little or no sex drive have a name for their clinically low libidos—Hypoactive Sexual Desire Disorder (HSDD) or Female Sexual Arousal Disorder (FSAD)—but they have few options, especially when compared to the 26 options men diagnosed with sexual dysfunction can currently access.

The American Psychiatric Association defines HSDD/FSAD as an absence or lack of sexual drive. Most importantly, HSDD is a unique diagnosis that exists separate from other factors that might diminish a woman’s libido, like depression, certain medications, work-life stressors, and menopause. Up to 1 in 10 U.S. women self-report a low level of desire and arousal (or none). This condition combined with a significant level of distress about the lack of desire means that these women are candidates for an effective medication. Given this huge market of 16 million women, it is somewhat surprising to find that treatments for HSDD have been extremely limited.

Two new drugs, flibanserin and bremelanotide, potentially offer new solutions for women who are not served through psychotherapy or OTC options. Flibanserin is a non-hormonal pill taken once daily, targeting certain sectors of the brain that regulate dopamine and serotonin (the chemicals that excite us and inhibit us, respectively). Bremelanotide is a hormonal, injectable drug that activates the pathways of sexual desire in our central nervous system. Interestingly, bremelanotide apparently can be used for both male erectile dysfunction and female HSDD.

However, we aren’t close to getting prescriptions for flibanserin or seeing commercials for bremelanotide, as the FDA has raised concerns about the efficacy and safety of both products, preventing their abilities to move into the marketing stage. Though over 11,000 women have participated in flibanserin trials, with self-described personal gains in sexual desire, the FDA has deemed these successes as “modest” gains, per their standards.  But this treatment is being given another chance by the FDA with requested tests regarding sleepiness and driving on the following day.

While I agree that our current medicalized system involves some of Big Pharma-constructed illnesses and disorders — and that we should rightfully question what health conditions are marketed to us as valid for medical intervention — I also think we need to take a second look at our gender and sexuality norms. Our current, Victorian-inspired conceptions of male and female sexual desires are clearly impacting the medical treatment we can access. Considering the gains of the reproductive rights movement, we can all see that a crucial component of sexual health is sexual pleasure, which remains inaccessible for women suffering from HSDD.  Pleasurable sexual experiences are a key factor in most successful intimate relationships. If we want to advocate for healthy — and pleasurable — sexual experiences for all women at here, we need to honor their lived experiences not as taboo or nonexistent but as relevant and worthy of public and medical consideration.

3 responses to “Separate Spheres in Sexual Health: Women with HSDD Left Without Options

  1. losr of sex drive can be a real blessing, You get to enjoy the rest of human behavior WOW there is a lot of great things to think about JK ( not)

  2. I have no sex drive because I have it suppressed. It’s my go-to response to trauma. I have to do what I can to unsuppress it because I need to be whole. Drugs would not be the answer cause this is a fundamentally emotional/spiritual problem.

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