Ethical issues surrounding Flibanserin/Addyi

Flibanserin, or Addyi, was recently approved by the FDA after being rejected twice for low effectiveness with a high risk of severe side effects. It was approved with warnings on the label, and will be handled by specially-trained professionals, but that on its own won’t be enough to stop the ways that it could be misused to further pathologize asexuality, low sexual desire, or not wanting sex.

If the existence of the drug itself isn’t the problem, since it could be useful for a specific group of people (women who lost their sexual desire, want it back for their own sake, and are distressed over the loss) who may find it worth the risks, then it’s how it could be marketed, when much of mainstream society isn’t aware that low sexual desire in general, and asexuality aren’t diseases. If it isn’t going to be accurately marketed towards the one group that may want it, then it could reinforce the stigmas that low sexual desire and asexuality already face, and further stigmatize women who don’t want sex with their partners for any reason. I haven’t seen any of the ads for it yet, but if anyone has, how accurate are they? Do they avoid stigmatizing asexuality or low sexual desire in general?

Rotten Zucchinis wrote an elaborate list that dispels the myths surrounding Flibanserin/Addyi, detailing the various risks, and the how the possibility to misuse the drug is wide open, even when it is prescribed on-label. They note that when prescribed on-label, it would be used for treating women who are distressed over their loss of sexual desire, and want it back, but since some asexual women have been misdiagnosed with either Female Sexual Arousal/Interest Disorder (FSAID) or Hypoactive Sexual Desire Disorder (HSDD), they could also be subject to this drug when they don’t want, and don’t need it.

The distinction made between low sexual desire and asexuality versus a diagnosis of what is now called Hypoactive Sexual Desire Disorder for men, and Female Sexual Arousal/Interest Disorder (FSAID) for women, is that HSDD or FSAID causes “clinically significant distress” and “interpersonal difficulties”. Those qualifiers are also listed in the criteria for HSDD in the DSM-IV, and Addyi is marketed specifically for treating HSDD in women, which is a diagnosis in the DSM-IV, but not DSM-5. I’m confused as to why Addyi is being marketed to treat an obsolete diagnosis.

At face value, the “clinically significant distress” and “interpersonal difficulties” qualifiers seem reasonable. However, as I’ve written here on FORTRESS about being pathologized for not wanting sex, and recently added a section about Addyi to it, those qualifiers don’t account for the cause of distress or interpersonal difficulties. There are ways that wording can be interpreted, and misused to justify coercing someone into unneeded and unwanted treatments, including pushing them into taking Addyi when they don’t need to, or don’t want to. Or if not coerced into it by a partner, they may still feel like they have to take Addyi to “fix” themselves.

A couple where one partner desires sex, and the other doesn’t (or does a lot less than their partner), could be considered to have “interpersonal difficulties”, and the person who doesn’t desire sex, could be considered distressed, because sexual desire is causing the difficulties between them and their partner. Because of the expectations that committed relationships are to be sexual, the partner who doesn’t desire sex is generally seen as the one who needs to change for their partner. They are seen this way by societal norms, and possibly also their peers, or even their partner, who has social leverage over them. It’s almost never the partner who wants sex more that’s expected to change, or expected to even try to understand their partner’s point of view.

If not coerced by their partners to “changing” for them, there are still the societal expectations that can make someone feel guilty over not desiring or not wanting sex when their partner wants it.

Asexual women and women who have low sexual desire, and aren’t distressed over it, and are either single or have supportive partners, aren’t those who are at risk of having Addyi pushed on them. It’s those who aren’t aware that asexuality and low sexual desire aren’t problems, regardless of whether they themselves are causing distress or not.

From my time spent in the asexual community, I’ve seen so many report that before they found the asexual community, they felt “broken”, and tried to force themselves to desire sex, and force themselves to try to enjoy it. Some went to therapy to try to “fix” themselves. Addyi may be another way that these individuals may try to, when what these individuals need is self-acceptance, and understanding from others.

I was disappointed that the FDA approved it this time around, but it’s not surprising that it passed. Since 1992, a law was passed requiring pharmaceutical companies to pay the FDA directly to have their drug reviewed. The FDA receives a lot of funding this way, due to a shortage of funding of their own, so there is a financial incentive to approve it.

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One thought on “Ethical issues surrounding Flibanserin/Addyi

  1. Pingback: Linkspam: September 4th, 2015 | The Asexual Agenda

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