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Am I bovvered…about not desiring sex?

February 22nd, 2010

Dr Petra

catherine tate

Last November you may remember drug company Boehringer Ingelheim reported at a conference on their trials of a drug called Flibanserin, aimed at treating hypoactive sexual desire disorder (HSDD) in women. In lay terms HSDD means a lack of sexual desire, sometimes also described as a lack of libido.

The trials did not indicate strong findings individually, but with combined data from different country sites it suggested a women who took the drug reported 0.7 more sexually satisfying sexual experience per month as compared with placebo. You can read a summary of the history of Flibanserin, information about the trials, details of how the drug company have tried to involve practitioners and appraisals of the drug and trials here.

While aspects of the drugs effectiveness and safety long term are still being investigated, and while approvals are being sought from the FDA and EMEA the drug company appear to be continuing efforts actively promote the concept of HSDD.

Late last week the company released findings from a survey of women with low desire and associated distress at a women’s sexual health conference. Dubbed the DESIRE study (Desire and its Effects on female Sexuality Including Relationships) it reported on 65,129 women ages 18-88 from five European countries. Participants completed a computerised Decreased Sexual Desire Screener (DSDS) a five-question diagnostic tool which is apparently designed to assist “non-expert clinicians in the clinical diagnosis of generalized, acquired Hypoactive Sexual Desire Disorder (HSDD)”. 7,542 (11.5% of original sample) answered “yes” to all four questions and 5,098 (8% original sample) women further chose to participate in the in-depth survey.

It’s not clear what participants were asked in the survey, nor whether these women were part of the wider Flibanserin trials. But we can see the DSDS screening tool, which asks five questions to which you should answer yes or no:

- In the past, was your level of sexual desire/interest good and satisfying to you?
- Has there been a decrease in your level of sexual desire/interest?
- Are you bothered by your decreased level of sexual desire/interest?
- Would you like your level of sexual desire/interest to increase?

In a fifth Yes or No question, women are asked to note any factors from the following list they feel may be contributing to a loss of sexual desire or interest.
- Medications, drugs or alcohol you are currently taking
- Pregnancy, recent childbirth, menopausal symptoms
- Other sexual issues you may be having (pain, decreased arousal or
orgasm)
- Your partner’s sexual problems
- Dissatisfaction with your relationship or partner
- Stress or fatigue

If you say ‘yes’ to questions 1 to 4 and ‘no’ to all the questions in number five you can be classified as having HSDD.

However, let’s go back and look at this study again. Firstly the title of it – DESIRE. It’s unclear if this is how it was introduced to participants, but it is worth noting that using potentially coercive titles in study acronyms is ethically frowned upon in research. Regardless of whether participants were told this was the name of the study, the branding of the research as ‘DESIRE’ is certainly making a point and one might add is part of an overall marketing strategy.

Moving on to look at questions 1-4 again. They don’t contain clear parameters so ‘in the past’ could mean anything from ever in your life to the last few weeks or months.

They’re also vague ‘has there been a decrease in your level of sexual desire/interest?’ A decrease compared to what? How I’ve felt over the course of my life? How I feel now as compared to when I met my partner? How I feel with my current partner compared to how I felt with a previous lover?

See also ‘are you bothered’. Well, maybe I’m bothered because my partner bugs me I don’t seem to want sex enough. Or maybe my partner’s great and never pressurises me but I still feel inadequate. Perhaps I feel bothered about a lack of desire not because I don’t feel any, but because I’m not in a relationship currently. Or maybe I’ve lost desire for reasons I understand, it does bother me, but I also know that the situation may change or I can do something to solve the issue. Being ‘bothered’ can mean very different things to different people at different times in their relationship.

The questions are also leading. ‘Would you like your level of desire/interest to increase?’ Well most of us would probably say yes. But even if we did say this, does it really tell us much. If I say I don’t want my levels of desire to increase it may not also tell you that I would like the opportunities to explore pleasure to be more forthcoming. Or perhaps I’d like more opportunities to have the time to spend on intimacy.

If you’re setting up a diagnostic you need to be really clear about what it is you’re asking people to measure their experiences/behaviour against. Otherwise it becomes all too easy for people who’re probably not that troubled by something to be classed as someone who is in difficulty.

Let’s not lose sight of what are the main causes of desire problems in women – see how many of these you consider to be a ‘medical’ condition:
* Concerns over body image
* A lack of sex education or knowledge how your body works
* Not knowing what turns you on, or the inability to share what does turn you on with a partner
* Psychological or physical health problems (including sexually transmitted infections)
* Past or present sexual abuse or domestic violence
* A partner who has a sexual problem
* A partner who does not know how to turn you on effectively
* Relationship difficulties including arguments or jealousy
* Being overworked and lacking support from family and/or partner
* Having a young family (particularly if there’s little support provided to care for them)
* Concerns over fertility, problems with contraception use
* Lack of privacy to relax enough for sex
* Poverty and related issues of limited access to healthcare
* Focusing on vaginal sex instead of wider sexual activities, particularly clitoral stimulation

Aside from the DESIRE study a ‘patient registry’ will now be collating data on women classified as having HSDD who will be followed up long term. This will be supported by an ‘unlimited grant from Boehringer Ingelheim’ (see press release above).

What’s interesting about the reports on the DESIRE study and launch of the patient registry is there is no mention on the press release about Boehringer Ingelheim’s development of medication specifically to treat HSDD. This is important if you need to put both their investment in this study and the registry in context.

Sadly the media covered this story uncritically and without asking key questions about it. Not least about the funding of the research, registry and additional studies being conducted on medications to ‘treat’ female desire disorders.

Instead we heard coverage that women with a lack of desire suffer from emotional distress, in reports that indicated this was a widespread crisis that needed immediate attention.

Now many women do report dissatisfaction with sex, but that does not mean they are dysfunctional, nor does it mean they are always distressed. Problems around desire affect women and men, gay and straight, partnered or single. And they can be due to a variety of often interrelated factors – physical, psychological and social.

What we are currently seeing is a shift towards setting up a lack of desire as a widespread, distressing, clinical condition that requires drug treatment as a first port of call.

There are questions to be asked about why a drug company would invest in surveys and patient registers to indicate there is a disorder, while at the same time creating medication to treat this condition.

[Non UK readers may be wondering what the 'am I bovvered?' phrase in this title refers to. It's a catchphrase of a character, surly teenager Lauren Cooper, in UK comedy programme The Catherine Tate show, shown in the picture at start of this blog]

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