‘ Hypoactive sexual desire disorder’, I pause. Now, it is a disorder, not clear where it is written as such, for a woman not to want to have sex, at the same time that DSM-5 is floating the possibility of a hypersexuality disorder https://shirahvollmermd.wordpress.com/2010/02/15/hypersexuality-another-are-you-kidding-dsm-5/ . Is there some meter for sexual desire? Is sexual desire directly linked to the chemicals of our brain? What ever happened to the connection between a satisfying interpersonal relationship leading to sexual desire and the converse also true? Perhaps the disorder is not in the woman, but in the relationship. Duh.
Now, let us suppose that a woman, no matter what relationship she is in complains of a low libido. One could argue that chemical assistance might be in order. Boehringer Ingelheim, a German pharmaceutical company, has a medication (flibanserin) which although originally designed as an antidepressant, is now geared to elevate sexual desire in premenopausal women who are distressed by diminished libidos. http://www.nytimes.com/2010/06/19/business/19sexpill.html?scp=1&sq=boehringer%20fda&st=cse
I would happily prescribe a drug to a woman who could experience more sexual pleasure, given that the benefits outweigh the risks. I salute any pharmaceutical company that is focused on improving women’s mental and physical health. I support their efforts and I look forward to the FDA approval. My issue is not with the medication or with the drug company, but with the diagnosis. If the medication enhances the quality of life for a woman, why do we, as a society, need to link a drug to a diagnosis? Maybe the drug, like caffeine, helps people by altering the chemicals in their brain; the fact that the drug helps does not necessarily mean there is a disorder.
Insurance companies require a diagnosis for reimbursement. Is this the problem? Perhaps, but not the only problem. Doctors tend to want to treat disease. As a group they are not comfortable with promoting wellness, either through education or through pharmaceuticals. The culture of medicine needs to change. Baldness is not a disease, and yet doctors prescribe medications to help. Treatment must have a broader meaning beyond treating disease. As physicians, we need to treat discomfort; we need to openly accept that we want to help people enjoy more pleasure from their lives. A woman who has a low libido is not ill, but with some help, she could have a lot more fun.
Shirah Vollmer MD 