When screening candidates to test a new pill, MetroHealth nurse Paula Malbon asks the Tom Cruise question. She is looking for women who have lost interest in sex -- not women who have lost interest in slobby husbands. So she asks them if making love with the handsome movie star sounds just as unappealing as a toss with the man snoring beside her every night. "They have to say it's with anybody," Malbon says.
The ideal candidate says she's in a great relationship. She is healthy and not under unusual stress. But for some reason, sex has become objectionable. "Some of them say they would prefer to do anything but," Malbon says.
The condition has a name: female sexual dysfunction. According to one widely reported statistic, 43 percent of women are afflicted.
Until a few years ago, a lack of sexual interest might have gone by another name: frigidity. But having mastered the erection, pharmaceutical companies are in a race to find Viagra's female equivalent.
MetroHealth is testing a German drug to treat depression. The drug failed as an antidepressant, though by chance it appeared to increase sexual desire among women. University Hospitals and the Cleveland Clinic have contracts to evaluate testosterone patches. "There's a huge amount of money being invested by the pharmaceutical companies," says Dr. Robert Segraves, chairman of MetroHealth's psychiatry department. "It's only a matter of time before one hits."
The rewards could be enormous. Viagra had sales of $1.7 billion last year. Today, the only treatment for women with FDA clearance is battery-operated: a soft-tipped vacuum pump that increases blood flow to the clitoris.
Judging by the response to MetroHealth's call for subjects, women are looking for something beyond the hand-held. About 800 have applied. Most are married and have children under 10. They tell Malbon they thought their sexual appetite, lost after childbirth, would return. Five years later, it hadn't. By the time couples get to MetroHealth, sex has "completely become the biggest issue in the relationship," Malbon says.
But is female sexual dysfunction to blame? If the term sounds hatched, it sort of was. The Sexual Health Council of the American Foundation for Urologic Disease set guidelines for the disorder in 1998. But the council convened six months after Viagra was introduced, and 18 of the 19 panelists had relationships with drug companies. It looked suspiciously as if Big Pharm had a drug in mind and placed an order for an official affliction to cure.
The notion that sexual dysfunction attends 43 percent of women is equally dubious. Sociologists arrived at the figure after reexamining data from a 10-year-old survey about sexually transmitted diseases. The survey asked women if they had experienced persistent problems, such as performance anxiety or difficulty reaching orgasm. These would seem to be rather normal trials and tribulations of intimacy, just as easily ascribable to a lull in self-confidence or a lackluster partner. Yet if a woman answered "yes" to any of seven questions -- and 43 percent did -- she was labeled "dysfunctional."
The authors of the study neglected to disclose their having worked as paid consultants to Pfizer, the maker of Viagra.
Nonetheless, the 43 percent statistic is treated as cold fact. MetroHealth and UH both cite the number in their calls for test subjects. "It's almost like the Bible," says Dr. Sheryl Kingsberg, a UH psychologist. Dr. Julie Elder, a women's specialist at the Cleveland Clinic, notes that the study didn't include women 60 and over: "I think [43 percent] might be low."
Still, female sexual dysfunction's sudden ubiquity has created a backlash. Psychologist Leonore Tiefer of New York University has published a manifesto criticizing what she calls "the new medical myth." Tiefer says that any condition that supposedly afflicts almost half a gender is probably not a condition at all. The 43 percent statistic "became instant gospel around the world," she says, "because Pfizer and other pharmaceutical companies are trying to market a new product."
Tiefer isn't suggesting that women don't have sexual problems. Her manifesto, in fact, lists a few dozen grounds, such as depression, poor body image, and distress in the relationship. Rather, she resents what she sees as attempts to reduce sexuality to functioning or malfunctioning parts. In the post-Viagra world, Tiefer says, sex has become "performance-based." She prefers to think of sex as more of a dance than a feat.
Trisha Posner, the author of This Is Not Your Mother's Menopause, is also bothered that a woman might be called ill when her bedmate really needs a lesson in tenderness. "We're label freaks," she says. "We just can't kind of work through these things."
Yet Dr. Stephen Levine of the Center for Marital and Sexual Health in Beachwood says recent attention to women's sexual health is more than a ploy to push prescriptions. "Sexual dysfunction has existed in the population since before pharmaceutical companies existed," he says.
Drug makers are making up for lost time, formulating all manner of pills, gels, patches, even nasal sprays. Among the products being developed:
Viagra-style pills and creams that improve blood flow, thus enhancing physical pleasure.
Pills, sprays, and injections that open the gates of sexual desire via the central nervous system.
Hormone treatments, such as the testosterone patch, for post-menopausal women who've experienced a decline in libido.
The FDA might approve a treatment as early as a year from now. (Cleveland stands to gain nothing from a successful trial. The hospitals are paid a flat fee.) Whatever nostrums reach the market, a blockbuster on the level of Viagra is unexpected. Male sexuality, after all, is a fairly simple proposition. "Women are different creatures," Levine says.