Ah, that little blue pill. You know the one. It knocked the shame out of impotence. It boosted virility. It rattled the stock market. But, you may wonder, what has Viagra done for me?
Possibly a lot--even if you've never set eyes on the drug. It turns out that one of Viagra's most powerful side effects is being felt not in the bodies of men, but in homes and labs across the nation: it is sounding a wake-up call about sexual problems in women. Women's gynecological health is routinely monitored through Pap smears and pelvic exams, and yet the closest most doctors come to asking about sex is "What kind of birth control are you using?" Despite a plethora of ORGASM! headlines and sex-advice columns, scientists still have little more than a superficial understanding of how female arousal works, let alone how to fix it when something goes wrong. But sexual dysfunction--everything from lack of libido, arousal or orgasm to painful intercourse--affects millions of American women. Now women are making it known that they need help in the bedroom, too. Doctors are opening female sexual health clinics, and pharmaceutical companies are seeking their next fortune--be it female Viagra or other potions in the works. "It's been a long time coming that serious attention has been paid to women's sexual health," says Sandra Leiblum of the Center for Sexual and Marital Health at the Robert Wood Johnson Medical School in New Jersey. "We're entering a new era."
To many women, a healthy sex life does not come naturally. In the 1992 survey Sex in America, University of Chicago researchers found that one third of women--twice as many as men--sometimes lack interest in sex. One quarter can't always achieve orgasm, and one fifth say sex is sometimes not pleasurable. For some women, such feelings stem from abuse or unhappy relationships. Others fear getting pregnant or contracting a sexually transmitted disease. "A pill won't solve those problems," says Howard Ruppel Jr., head of the American Association of Sex Educators, Counselors and Therapists. But a pill--or patch, cream or suppository--might help with sexual dysfunction that stems from physical problems. Torn tissue sustained during delivery, for example, or nerves damaged during hysterectomy can reduce pelvic or vaginal sensation. Bonnie Myers had a hysterectomy at 27 to treat endometriosis, an overgrowth of uterine tissue. The procedure cured the condition but killed her sex life: she lost genital sensitivity and the ability to reach orgasm, and she suffered painful vaginal dryness. "I was so uncomfortable and sore," she says, "it just wasn't worth it after a while." But last year Myers, now 41, became one of the first women to try Viagra, in a study at the University of Maryland. The pill leaves her red in the face--a common side effect--but Myers says it dramatically increases sexual pleasure: "My body functions are practically the way they used to be. It's fantastic."
Few doctors are prescribing Viagra for women, because its long-term side effects and even effectiveness are unknown. Pfizer, the drug's manufacturer, is conducting its own clinical trials on women in Europe. In a small (15-woman) trial of Viagra, Maryland's Dr. Toby Chai is finding that it can increase blood flow to the pelvic region by 50 to 100 percent. Still, it's too early to tell whether that will translate to better sexual feeling.
Viagra isn't the only drug in trial. Texas-based Zonagen announced in December that it has recruited 60 women to test a suppository called Vasofem. The drug is a female equivalent of the company's Vasomax, which enhances blood flow to the penis and is now being considered for approval by the Food and Drug Administration. Harvard Scientific Corp., in Florida, has developed a gel form of prostaglandin E1, which has been shown to increase blood flow by almost 50 percent in female rabbits. And TAP Pharmaceuticals, in Illinois, is testing apomorphine, a central-nervous-system drug, for erectile dysfunction. It is considering testing the compound in women, too.
And what could be more logical than treating sex problems with sex hormones? A woman's testosterone production, like her estrogen levels, plummets with age, but giving women more of it to maintain libido is highly controversial. Side effects range from increased facial hair and a deeper voice to liver damage. But researchers are taking a closer look at the hormone. Louann Brizendine, director of the Hormone Assessment Clinic at the University of California, San Francisco, is studying whether testosterone taken several hours before sex increases libido. If so, taking a pill only as needed (or wanted) would bring fewer side effects than keeping levels of testosterone high all the time.
Whether any of these drugs--which are several years from the market--will help women is far from clear. There is no doubt that, for men, good blood flow is key to erection. The clitoris contains erectile tissue, too, and, with the vagina, becomes engorged with blood during arousal. So drugs that enhance blood flow might improve sensation. But there's plenty to learn. Drs. Irwin Goldstein and Jennifer Berman of the Women's Sexual Health Clinic at Boston University Medical Center plan to do anatomical studies mapping out the nerves and arteries of the vagina and clitoris. And Cindy Meston of the University of Texas is finding that male and female arousal is not controlled by the same branch of the nervous system, as many assumed. When specialists gathered last fall, "the biggest take-home message was that women seem to be more complicated than men," says Meston. "The male erection is understood." The female system is just getting there.