Addyi - "Female Viagra" (??) a cautionary comment

Since the approval by the FDA in America of Addyi (Flibanserin), there has been a frenzy. It's followed a rather predictable course - first came the tabloid-style shouty headlines, with their excited proclamations about the dawn of the "female Viagra".
Happily in the Twittersphere and elsewhere I've also seen a more balanced view; indeed a more informed view, regarding the use of such a drug in specific patient groups such as women whose menopause has severely affected their levels of desire.

I'm irritated that some people reading the headlines may be misled by the "Female Viagra" angle. Flibanserin is a drug that is entirely different from Viagra. We don't need more of this conflation. A further risk is the double-confusion that arises from the myth (STILL out there) that Viagra increases the male libido.

I also have a concern about the cultural implications of drugs like these, when they bring with them myths and misconceptions that aren't effectively corrected.
One evening at a drug-sponsored presentation, I asked a local urologist if he was at all concerned about the "recreational" use of Viagra; that is, the use of Viagra by men who had no clinical need for it, but chose to use it as a kind of supplement. Did he see any problems with this? No.
I spoke a little about the unhelpful effect this might have on the sexual psyche of 21st Century males (i.e. that 'performance' can only be good enough through enhancement) but it was met with a kindly (somewhat condescending) silence.
I am slightly concerned that with the "female Viagra", there might be a corresponding risk, of reinforcing a set of values around women's desire that is helpful for some but profoundly unhelpful for others. The idea of "normal" libido in women (which is already all-but-inseparable from the cultural demands of men) may slip to a point where enhancement is the only way to get by.

What I'd like, then, is for clear and responsible information to be given about BOTH these drugs. I'd like some cultural arrows pointing back to the acceptance of individual norms, rather than a reliance on "enhancements".
Who's going to offer these safeguards? Not the pharmaceutical companies, that's for sure - a wonderful new organ of revenue is starting to engorge.

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.A couple of things worth reading about the flip-side, for those interested... the Independent article about side effects and risks is short, digestible and responsibly written.

And here is the abstract from a very recent article in The Journal of Sex Research:

"There were numerous missed opportunities at the October 2014 U.S. Food and Drug Administration (FDA) meeting on female sexual dysfunction (FSD). They included opportunities to hear from a diverse range of patients and to engage in evidence-based discussions of unmet medical needs, diagnostic instruments, trial end points, and inclusion criteria for clinical trials. Contributions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) nomenclature, based on extensive research, were dismissed in favor of language favoring a seemingly clear but scientifically unsupportable distinction between women’s sexual desire and arousal. Numerous participants, including patients recruited by their physicians, acknowledged travel expenses paid for by interested pharmaceutical companies. Conflicts of interest were manifold. The meeting did not advance the FDA’s understanding of women’s sexual distress and represents a setback for our field."

Leonore Tiefer, Ellen Laan & Rosemary Basson (2015) Missed Opportunities in the Patient-Focused Drug Development Public Meeting and Scientific Workshop on Female Sexual Dysfunction Held at the FDA, October 2014, The Journal of Sex Research, 52:6, 601-603, DOI:10.1080/00224499.2014.1003362

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Another blue pill - straight men only??!!??

(I was the subject of a few strange looks when taking this photo in the toilets at Sainsbury's. But I am committed to bringing you updates on the unhelpful perpetuation of these aspects of sexual culture.) 

This one seems to be aimed at those who have a "she" partner. Will it not work otherwise? I was unable to find an explanation for this in my research.

See also "Normal Healthy Men Of The World - Your Penises Still Aren't Good Enough"
and "Men & Sexual Myths - Two Steps Forward, One Step Back"

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Normal healthy men of the world - you still need to be enhanced

These machines are all over the place. It's a fair assumption that every man in the UK will see a machine, selling a product like this, at some point (when they have to pee).

What I find especially disappointing about this example is that young men in particular are being given the messages:

Sex is about "performance"
You need to be "enhanced"

.... again, the inference is that normality just won't do. What you bring to your sexual encounters, i.e. "you", with the body you have, the sexuality you have developed, as an individual who can be good enough for a partner, is NOT good enough.

.... see also Menhancer and Sorry, Bernie

Nick Clegg's "boost" to mental heath services

I've come out of my blogging hibernation, to have a rant about deputy PM Nick Clegg's cash-injection into mental health services.
 
Clegg is promising that people with mental health issues will be seen more quickly. There will be a target waiting time of 18 weeks, he says, promising an extra £120 million of government funding.

The first thing that strikes me is that there is no mention of standards - no suggestion that the £120m will be spent on good quality psychotherapy. My guess is that much of the cash may be pumped into the already heavily-criticised IAPT programme. This thought saddens me deeply. I don't share the enthusiasm of (for instance) ReThink, who said “This is a watershed moment for everyone affected by mental illness and has the potential to improve the lives of millions.”. (... aren't ReThink one of the organizations who would stand to earn a chunk of the £120m??)

As other commentators such as Andrew Samuels have intimated, I think the £120m will largely be spent on expensive training for poorly-qualified practitioners, who will then deliver manualized psuedo-therapy.

One more thought... perhaps readers will remember what happened when Accident and Emergency waiting targets were introduced in the UK.  All kinds of amazingly creative tactics have been used to keep the figures down. In my town of Colchester, people are still waiting for hours in an ambulance outside the hospital - such is the need to massage the figures.
How can we expect anything different to happen in mental health services? I await with dread the horror stories to come, of patients who have been sidelined in ever-more demeaning ways, and their suffering made worse.

We need to do better.

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