Sex, lies and pharmaceuticals

How drug companies plan to profit from female fear of sexual dysfunction

by Ray Moynihan and Barbara Mintzes


At first I thought it was great but now I’m worried that…he might be getting reliant on it…and in some ways, you know, I don’t even like thinking about that, cause it’s like ‘God, does someone have to take a pill to have sex with me?’ – 33-year-old woman whose partner took Viagra.

During the last year or so, has there been a period of several months or more when you lacked interest in having sex? When you felt anxious about your sexual performance or were unable to achieve an orgasm? Was there an extended time when you had trouble getting aroused, experienced pain on intercourse or just didn’t find sex pleasurable? If you answered ‘yes’ to just one of these survey questions, and you’re a woman, you could easily be classified as suffering from a brand new medical condition called ‘female sexual dysfunction’, or FSD. First described in the textbooks only a few decades back, FSD is set to become the next blockbuster medical condition, coming soon to a doctor’s surgery near you. As the ups and downs of daily life are re-categorised as the symptoms of medical diseases, soon all of us will be sick.

One of the women who actually helped write the definitions of female sexual dysfunction puts it very clearly. ‘[W]hat once was considered normal,’ wrote American psychologist Sandra Leiblum, ‘has come to be considered dysfunctional.’ Nowadays, if a woman lacks the desire for sex, and is bothered by it, she could be diagnosed with a disorder of low libido. That’s just one of the four main disorders of female sexual dysfunction described in one of the leading manuals of diseases. The others include disorders of arousal, orgasm and pain. As the evidence plainly shows, forces are fast amassing to tell you, and your doctor, that close to one in every two women suffers from some form of this new medical condition.

The giant pharmaceutical industry – with worldwide sales now approaching a trillion dollars a year – is hungrier than ever for new markets. In order to maximise sales, the industry must ‘create the need’ for its newest and most expensive products. Sometimes that means selling sickness to the wealthy healthy, helping transform common ailments into widespread conditions that require treatment with the latest pills. Applauded for producing medicines that extend life and ameliorate suffering, drug companies no longer simply sell drugs; they increasingly sell the diseases that go with them.

Female sexual dysfunction is perhaps the perfect example of selling sickness, and the commercial firepower behind its forthcoming promotion is simply awe-inspiring. ‘With more than 50 million potential sufferers in the United States, FSD could offer a larger market than male sexual dysfunction,’ wrote a pair of enthusiastic market observers. ‘FSD could be the next boon for pharma companies . . .’ If a drug is approved to treat this condition in the United States, the tsunami of marketing that will be unleashed in the media and on the web will soon swamp the shores of nations everywhere. According to industry reports, one company on the verge of having its product approved for women had set aside $100 million for the drug’s advertising budget alone.

Three global corporations in particular have been at the forefront of the race to spread the word about this new medical condition and get their drugs approved to treat it. Pfizer, the biggest pharmaceutical company in the world and currently worth well in excess of $100 billion, has had high hopes that its wonder drug for men, Viagra, will also work for women. Procter & Gamble, with global annual sales of almost $80 billion, is famous for selling soap to housewives, but it also wanted to sell them testosterone patches as well. The third corporation featuring in this drama is the family-owned German outfit Boehringer, which boasts just over forty thousand employees and has affiliated companies in almost 50 countries. The German company’s pill targets the brain, with claims it can give women back their lost desire.

So what exactly is this condition called FSD? The answer depends a little on the solutions being sold at the time you ask the question. If Pfizer is promoting a drug that enhances blood flow to the genitals, then the condition might best be described as an ‘insufficiency’ of vaginal engorgement. If Procter & Gamble is pushing its testosterone patch as a cure for women, the sexual disorder is discussed as a ‘deficiency’ of hormones. And if Boehringer has a pill that affects the mind’s neurotransmitters, women with low libido may have a ‘chemical imbalance’ in their brains. In a strange way, the disease seems designed to fit the drug.

A forward-looking business intelligence report in 2003 named FSD drugs as an area of great future growth for the pharmaceutical industry, part of the burgeoning ‘lifestyle’ market including medicines for baldness, smoking cessation and obesity. The report was prepared for industry insiders and, with a hefty price tag, was never intended for public consumption. However, a leaked copy described how drug companies were ‘expanding the patient pool’ by using marketing campaigns to change public perceptions about things that used to be considered part of normal life. ‘The medicalisation of many natural processes,’ the report observed, ‘is creating markets for lifestyle drugs for those who want to optimise quality of life.’ It predicted that the market for FSD drugs could soon approach a billion dollars a year. The days when the treatment of sex problems was dominated by the idea that therapy could render sexual inadequacy obsolete were quickly forgotten, swept away in a collective enthusiasm for new panaceas to treat this new dysfunction, and the billions that might flow from it. But the enthusiasm was not universal.

A New York university academic, Dr Leonore Tiefer, was by now pointing out in her writings that the post-sixties opportunities for the sexual emancipation of women were sadly being squandered in the medical takeover of sex. Rather than attaining further freedom, the fear was that women were being subtly encouraged to feel inadequate, or even dysfunctional, if they failed to live up to a new unrealistic norm of a constant desire for sex. Right on cue, the new blue pill bounced straight from the doctor’s surgery to the centre of popular culture. Viagra famously made a cameo appearance in the television series Sex and the City when Samantha took the drug and apparently enhanced her already considerable sexual enthusiasm. Apart from her broader social critique, Tiefer was also busy documenting drug company sponsorship of all the important meetings where the new disorders were being developed. The resulting evidence offered a rare insight into the extraordinary extent of pharmaceutical involvement with an emerging field of medicine.

Marketing to men as a glimpse into the future of marketing to women

When Viagra was first launched, older couples were used as models in advertising, and the United States ex-presidential candidate Bob Dole appeared in Pfizer’s commercials, speaking about his experiences using the drug after he’d had surgery for prostate cancer. Messages like this have rightly been credited with helping to de-stigmatise erection problems and allowing men to speak about what was a source of hidden personal shame. But as those who’ve tracked the advertising have observed, within a few short years the marketing strategy was shifting from a focus on older men and men with medical problems to a much broader and younger age group. In the United States, one of the few places in the world where it is legal to promote prescription pills direct to the public, there have been some classic advertisements helping to broaden the drug’s reach.

One magazine ad featured a close-up photo of a ruggedly handsome man around the age of 40 with the bold headline: ‘Viagra. It works for older guys. Younger guys. Even skeptical guys.’ Then, in the small print, the ad asked its readers: ‘Think you’re too young for Viagra? Do you figure, “It only happens once in a while so I’ll live with it”? Then nothing’s going to change, especially your sex life.’ The message was clear: even the most occasional erection problems could benefit from being treated with a drug. It wasn’t long, though, before the marketing seemed to be reaching out to an even wider group – men like the anonymous Canadian man interviewed elsewhere in this book who weren’t impotent at all, but simply wanted to enhance their sex lives. For North American readers, a lot of this advertising will be all too familiar, but for people living elsewhere the audacity of some of the claims will be simply fascinating.

One high-profile television commercial featured a man and a woman walking down the street, shopping. They first look at high-heeled shoes and the man then admires a mannequin in sexy black underwear, as the voice-over says: ‘Remember that guy who used to be called “Wild Thing?” The guy who wanted to spend the entire honeymoon indoors? Remember the one who couldn’t resist a little mischief ? Yeah, that guy.’ At this point, Viagra-blue horns sprout from behind the man’s head to a blast of trumpet. ‘He’s back,’ says the ad triumphantly, as the horns then become the V for Viagra.

And pretty soon Pfizer wasn’t the only company doing it, as the industry brought us Levitra and then later Cialis, with their rounds of promotion helping to further expand the market. Amid images of a woman’s flashbacks to romantic moments, a television commercial’s voice-over asked: ‘In the mood for something different? How about Levitra? Ask your doctor if Levitra is right for you. It’s the best way to experience that difference.’ The approach must have worked. For this class of medicines, the drug companies were soon spending far more on these advertisements than they were spending on sending sales representatives to visit doctors. Normally, it’s the other way round.

This focus on advertising to the public as a key promotional tool is very closely linked to how the condition of erectile dysfunction, or ED, has been expanded far beyond earlier definitions of male impotence. Inflated estimates of how many men suffer from the condition have subtly been mixed with suggestions that any degree of inability to have an erection, at any time, is too much. The implied message from so much of the advertising is that a younger man’s sexuality is the norm against which all men, at any age, should measure themselves. And that means the changes in sexuality that happen as we age can become portrayed as medical problems to be treated. That a man may have grown in experience and sensitivity as he’s aged, and may have become a better lover as a result, is simply not part of the picture. This construction of new norms is certainly something for which to watch out as the campaign to promote female sex drugs intensifies.

From the book Sex, Lies and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction. © 2010, by Ray Moynihan and Barbara Mintzes. Published by Greystone Books, an imprint of D&M Publishers Inc.. Reprinted with permission of the publisher.

Ray Moynihan has been investigating the business of health care as a journalist for over a decade. He is the author and co-author of three previous books, including Selling Sickness, which has been translated into a dozen languages. He lives in Byron Bay, Australia.

Dr. Barbara Mintzes investigates the link between clinical trials and pharmacosurveillance evidence on drug safety and effectiveness. She is an assistant professor in the Department of Pharmacology & Therapeutics at the University of British Columbia.