post_libidopillIronically, it was the marketing of Viagra in 1998 that brought the issue of women’s sexual problems to the media forefront. Middle-aged men, suddenly gifted with the penile hydraulics of teenagers, were dismayed to find that their partners weren’t necessarily cheerleaders for their newfound prowess, and drug companies took note. Now, more than a dozen years later, female sexual concerns have earned their own spotlight, becoming far more than Viagra’s rib. Drug companies are spending billions on a variety of drugs—none of which have yet proven significantly effective or safe enough to warrant an FDA nod.

Placebo Power Punch

Even the two top drug contenders—the testosterone transdermal patch, Intrinsa, and the supposedly desire-enhancing Flibanserin—have failed to impress FDA advisory panels. In trials for Intrinsa, women’s sexual function did improve, but sexual activity also increased for those given a placebo patch. A similar result occurred among the subjects in the Flibanserin studies. These strong placebo responses are especially intriguing because all the drug trials are “double-blind.” This means that nobody knows who receives an actual drug or an inactive substance—neither subjects nor researchers— insuring against the subtle influence that such knowledge, even by a researcher, might exert on a participant.

Most recently, researchers at the University of Texas at Austin reported more evidence of this placebo punch in women’s drug trials. They analyzed data from the placebo arm of a study that used the erection enhancing drug Cialis* in treating women’s sexual problems. About a third of the women given placebo showed meaningful improvement in sexual desire over 12 weeks of treatment, usually within a month of starting the pseudo pharmaceutical. Many women even reported more stimulation during sexual activity during the trial, even though their partners were not given any special instructions. As mystifying as this might seem at first, there is an explanation.

When is a Placebo More Than a Placebo?

To understand the power of placebo, it’s important to note that in sexuality research, women aren’t just given a drug and told to go home and do nothing more than pop a pill or change a patch. Instead, in a variety of different ways, they are asked to focus on their sexuality; to give that side of their lives more attention than usual. Along with using the patch or drug, participants in these studies talk to therapists, fill out questionnaires, write in diaries, record sexual thoughts and feelings, keep a journal of sexual activity, and communicate with researchers and partners about sex more often and explicitly than before. The very fact of participation in a study about sex means that one’s life becomes centered on sex and intimacy, which in itself can be provocative. Though the placebo is inactive as a medication, it can still be a meaningful lens through which to direct one’s experience. One could say that the placebo’s power comes from giving women a fresh way of filtering sexual experience.

It’s important to consider that most women wouldn’t become involved in a sexuality study at all unless they at least imagined a satisfying result. That kind of hope—imbued with the psychological magic of belief and expectation—can play a potent role in a woman’s successful outcome. We can add to this another phenomenon: when sexual problems are related to emotional factors, or when a woman needs the validation of a doctor or therapist to open up sexually, a shift in behavior or perception is likely without the intervention of any active drug. The brain is such a powerful sex organ that it isn’t a stretch to view it as the single most potent arbiter of our sexual responses.

You might wonder why all of the women who receive placebos don’t experience improvement. I would suggest that the placebo effect—or, more accurately, the “experimental study effect”—is less potent in some circumstances, such as when deep relational problems undermine sexual interest or where a woman’s subconscious expectation of failure is greater than her hope for success.

Let’s remember that the “study effect” can also influence participants taking an active drug. Some drugs may help some women some of the time, just as the study effect may help some women, whether they’re taking an active drug or a placebo. But, for a drug to be found truly efficacious, these elements need to be parsed to a level of certainty in favor of the drug’s stand-alone superiority. So far, no drug has been able to pass that test. Consequently, the “pink pill” and all of its baby sisters are little more than gleams in the eyes of pharmaceutical giants. The complexity of female sexuality, the complicating nature of the mind-body connection, the effects of intimate relationships on sexual arousal and desire, and the confounding impact of cultural pressures on all of these means that a one-size-fits-all wonder drug for women is unlikely to appear anytime soon. Nevertheless, the concept remains a Big Pharma wet dream. It’s also a “Stepford Wives” nightmare among women’s activists who envision horny men secretly drugging their wives into states of lustful receptivity. While this might sound outrageous, the concept of a substance that induces desire where none existed before raises numerous moral and ethical questions. At the same time, the idea that such a remarkable drug formula is actually hidden somewhere within the private vaults of Big Pharma sounds equally fantastic—at least, to me.

What do you think?

* Note: Eli Lilly never sought federal approval to market Cialis to women, and studies of Viagra in women were disappointing.