Can pink pills cure her lack of sexual desire?

My dog Emma is in heat these days. She dreams about puppies and prepares a nest for them in her basket. Male dogs come galloping up to our house, tails high, owners behind them, short of breath and carrying an empty leash. Emma will mate at once, given the chance. She wants to, and she doesn’t care who the partner is, as long as he’s male. When she is not in heat, she sneers at any dog getting too curious of her behind. She does not want to mate. It’s simple.

Marianne and Svend are a couple a little over 50. Marianne’s desire for sex has disappeared completely. She never thinks of sex, has no sexual fantasies, no sudden nice feelings of warmth and heaviness in her pelvis. She and Svend have tried so many things: They have talked about what she likes and what usually turns her on, they have gone on a lover’s weekend, bought toys, watched porn. Nothing has helped. Svend doesn’t try to get close to her so much anymore and the good talks they used to have a getting more rare. Marianne is worried and sad. It’s not simple at all.

People have expectations about desire. They especially expect it to be there, ready to supply experiences, relaxation, wellness, intimacy, and happiness… Lust and a good sex life are seen as necessary ingredients in a good life.

Desire comes from many things

Words, pictures, touch, smell, thoughts and imaginations. What turns us on and how quickly and easily it happens has in part to do with where we are in life. Stress and busyness, disease, breast feeding, oral contraceptives, a partner who’s not as new and exciting as s/he used to be, pain – these are all desire killers. During puberty, when the libido hormone testosterone is high, the sex drive is intense and powerful. During old age spontaneous lust may have disappeared and can only be enticed forward by stimulation and fantasies.

Lack of desire is a widespread problem, with a negative impact on the lives of women and couples all over the world. Hence a great deal of money is at stake for a company who can bring a desire boosting pill on the market. The U.S. Food and Drug Administration has now approved Addyi (flibanserin), the first product ever to get an official stamp as a preparation strengthening sexual desire. It’s so far only tested on women prior to menopause. It’s been called “Pink Viagra” or Viagra for women, which is misleading. Viagra (for men) only works if the man already wants to have sex. Addyi is for those who have no desire for sex.

Small effect, many side effects

Dosage is one pill every day, and if you don’t have any noticeable effect after 8 weeks, you should stop the treatment. The pill can have side effects. It can make you dizzy, sleepy and nauseated. The risk is greatest if you drink alcohol, so during treatment with Addyi, you should not drink alcohol at all. A new kind of Antabus, actually. And the effect is not something that will make you see stars and fireworks. The women in treatment get a handful more sexual thoughts and fantasies, but only 10% of the women think their sex lives get better. On average, they have satisfying sex once or twice more every second month. If that makes it worth the trouble (and the side effects) taking Addyi probably depends on how often you have sex in the first place. And so far, Addyi is only approved for women who have not yet gone through menopause.

So Addyi is no miracle. Maybe it’s not at all better for Marianne than other ways of improving desire. I will come back to that later.

He still desires her. But her desire is gone.

The 60-year-old woman came to my office with her husband. She wanted to have a gynecological checkup. It had been very unpleasant last time she saw a gynecologist – her vagina was very dry and tender.

I asked if that was a problem for their sex life. Yes, it was, she answered. Actually, they did not have sex at all. It was impossible, even if they used a lubricant. She looked straight at me and answered in a matter-of-fact, direct way. She didn’t look at her husband, but he looked at her, concerned, mumbling that it had worked out well earlier, also after her menopause. She didn’t comment on that.

When I examined her it was obvious that her vagina was very dry and irritated. But that was not all. She squeezed her pelvic muscles so hard that it was impossible to do a gynecological examination and visualize the vaginal mucosa, the lining of the vaginal walls. There was just too little space. If she squeezed around her vagina like that when they were trying to have intercourse, it certainly wasn’t possible for him to enter her. And I think the reason with her seeing me was to tell the husband that they could not have sex.

Her sex life was over, but what about his?

When I told her what I had found, she actually seemed content. As I had just given her an alibi to finally drop all ideas about having sex. She clearly didn’t want that anymore. But he did. He asked a bit timidly if there wasn’t anything to do, lubricants, medicine? And yes, there was, so I gave her a prescription of vaginal estradiol tablets, the best remedy against postmenopausal vaginal dryness. But I don’t think she will pick them up at the pharmacy. She has decided that her sex life is over.

Then what about her marriage? I don’t know anything about that. Maybe they had lots of other ways of being intimate than sex. But it was clear that her husband was unhappy with the situation. What about his desire? Will he satisfy himself by masturbating in front of the computer late at night, or will he find another woman, a mistress? That is a dangerous solution. Has she thought that through?

Of course you should not have sex if you don’t want to. And it certainly can be a problem, when the parts in a relation differ a lot with regard to desire. But marriage is about willingness to compromise, more often than not. And desire can be turned on, if you allow it. How – that’s something you must talk about.