Flibanserin, the FDA, and the longing for spontaneous sexual desire

The FDA Advisory Committee voted 18-6 to recommend approval of Flibanserin, the twice-failed antidepressant being marketed as “pink Viagra.” Quick summary: the drug increases “sexually satisfying events” by one per month over placebo, and roughly 13% of women who take it experience side effects like somnolence, dizziness, and nausea.


I watched as much as I could of the live webcast, particularly during the open comment section, when women who’ve struggled with low desire described their longing for something, anything to help them. It was very moving, and I believe that it was for those women that the committee members voted yes, even with “serious, serious safety concerns” and not being persuaded that the effectiveness of the drug is more than “marginal.”

Indeed, Sprout CEO Cindy Whitehead attributed the success this time to “putting the patient voice at the center of it.”

(Patient voice, as opposed to… say… just for example… the science.)

Doctors also spoke – about their feeling of helplessness when their patients asked them for help with low desire. And we heard from heads of important sexual health organizations like the American Sexual Health Association (ASHA) and the American Reproductive Health Professionals (ARHP), who spoke for their organizations, recommending that the drug be approved.


These last were actually the most difficult for me to hear, but they were an important reality check:

ASHA, ARPH, and even the FDA itself have not recognized what the American Psychiatric Association has: that responsive desire is a normal, healthy variation on the experience of desire, and that spontaneous desire – fun as it is – is not necessary for normal, healthy sexual functioning. They are, it seems, tied to an understanding of sexual functioning that puts desire, “wanting,” at the center, when the science and social justice would, I believe, put PLEASURE at the center of sexual wellbeing.

Those of you who’ve been reading the blog for a long time have been hearing about responsive desire from the very beginning. Quick summary: responsive desire begins in response to arousal, as contrasted with spontaneous desire, which begins in anticipation of arousal. (That’s not a technical description – technically all desire is responsive, it just feels spontaneous for some people, sometimes.)

Many of the women participating in the trials describe their pre-drug sexual desire as responsive – which is a normal, healthy way of experiencing desire  – except they hated their responsive desire. They believed that their lack of spontaneous desire meant they were broken. They felt profoundly inadequate, and their partners agree with that assessment.

If their doctors had known about responsive desire, those patients might have had a chance to let go of their desperate self-criticism.


The women are struggling – so much so that their relationships are at risk. They are sick, in the way that a person is sick if they’ve spent their whole lives breathing toxic air. That toxic air is the cultural narrative of spontaneous desire.

I wish, for the sake of their patients’ wellbeing, that those providers already knew about responsive desire, so that they could help to clean the air their patients breathe.


One of the things I’ve been saying as I’ve traveled across the continent talking about my book, is that I will spend the rest of my life attempting to deserve the opportunities I had at Kinsey. One of those opportunities was that early exploration of groundbreaking ideas like responsive desire. Responsive desire is science I was first exposed to during my clinical internship at Kinsey, under the brilliant Cynthia Graham.

The pro-Flibanserin support from ASHA and ARHP, and the FDA’s own befuddlement, remind me that what I consider baseline science is still far from mainstream knowledge. There is a lot of educating to do. There is a lot of catching people up on the science that has happened since they were in school. There is a lot of asking professionals to try on a whole new way of thinking about a thing they’re already sure they understand:

Put PLEASURE at the center of your definition of sexual wellbeing. Let desire emerge from pleasure.