Can a Pill Help Women Reach Orgasm?

You can't help but feel the anguish of Charletta, a charming 60-something Southerner who appears prominently in Liz Canner's new documentary, Orgasm Inc. Charletta is so distraught about her inability to achieve orgasm simultaneously with her husband during intercourse that she agrees to be a test subject for a bizarre invention called an "orgasmatron." But inserting this questionable device in her spine stimulates only her left leg, which shakes uncontrollably when she flips a switch. After the orgasmatron is removed, Charletta shares with Canner her distress at being such a freak. "Not only am I not normal, I'm diseased," she says. But under questioning by Canner, Charletta discloses that she can, in fact, achieve orgasm in other ways. When Canner tells her that makes her "normal," since 70 percent of women don't reach orgasm during coitus, Charletta is stunned. By the end of the film, she seems like a new woman. With a big smile on her face, she tells Canner, "I accept myself the way I am." If more women could make such a statement, Canner wouldn't have spent much of the last decade making Orgasm Inc. But the film, which has its New York premiere May 27 at the Film Society of Lincoln Center, is a desperately needed antidote to all the hype generated by pharmaceutical companies pursuing their holy grail: a female Viagra. Canner hit on the topic after years of doing documentaries on subjects like human-rights abuses, police brutality, and poverty. Looking for something more upbeat, she was researching female sexuality when she got a call from the pharmaceutical company Vivus, which wanted her to create erotic videos to use in their clinical study of an "orgasm cream" for women.

Vivus had had an initial success with a product for men called Muse, a pellet inserted into the urinary opening with a plastic applicator. The product launched more than a year before Viagra. When the much easier-to-use Viagra pill quickly overcame Muse as the market leader, Vivus started looked at ways to make a product for women's sexual problems. Canner was bewildered by the purported disease that the new Vivus product was intended to cure—something called "female sexual dysfunction." "They were telling me that 43 percent of women had this disorder, which I found amazing," Canner says. "How could that be true if I had never heard of it before?" That question set Canner off on a cross-country quest that included visits with scientists, experts in erotica, and individual women who often suffered profoundly because their sex lives didn't live up to the glowing imagery displayed in popular culture. She found that the often-cited 43 percent figure actually refers to a 1994 study of all kinds of sexual problems, including a lack of sexual desire, anxiety about performance, and pain during intercourse. Canner ultimately concluded that the catch-all female sexual dysfunction is essentially a phony disease made up by pharmaceutical companies."A lot of this is about marketing," she says. "They are trying to sell disorders." A spokesman for the Pharmaceutical Research and Manufacturers of America, an industry trade group, said she couldn't discuss Canner's charge since "as a trade association we can't really comment about issues that are specific to individual companies."

Viagra's phenomenal success inspired drug companies like Vivus to search for a product that could solve women's sexual issue with a similar quick fix. That search hasn't been particularly successful. Pfizer, the maker of Viagra, gave up on creating a similar product for women after eight years of research because, the company said, women's sexual problems were too complex to be fixed with a pill that targeted the genitals. Vivus also gave up on its attempt to create an orgasm cream for women. One highly touted product, Intrinsa, a testosterone patch from Procter & Gamble, was rejected by a U.S. Food and Drug Administration advisory panel in 2004 because of safety and efficacy concerns (it became available in Europe three years ago).

On June 18, the FDA will hold a hearing on the drug flibanserin, from the German manufacturer Boehringer Ingelheim, which was initially tested as an antidepressant. It didn't lift mood, but it did heighten sexual interest and reduce inhibitions—which led the company to test it on women who were suffering from a lack of sexual desire. The results, presented late last year at the Congress of the European Society for Sexual Medicine in Lyon, France, showed that women in the North American part of the trial who took flibanserin for about six months increased their number of "sexually satisfying events" (including orgasm) to an average of 4.5 from 2.8.

That may sound impressive, but consider this: women in the placebo group increased their average to 3.7. Is the difference between 4.5 and 3.7 significant enough to justify approval and overcome any potential health risk? That's what the FDA will have to decide. There may be cheaper and faster ways to reduce inhibition—like a glass of wine and a more attentive partner. And the European women didn't experience the same benefit as their North American sisters, perhaps because they already are less inhibited.

One of the heroines of Canner's film is Leonore Tiefer, a clinical associate professor of psychiatry at the New York University School of Medicine. Tiefer calls herself a "sexologist": she has been studying human sexuality for four decades. She led a campaign against Instrinsa's approval and hopes that Orgasm Inc. will inspire people to "come down to Washington to raise a little hell" during the flibanserin hearing. Tiefer argues that no single drug could possibly cure all of women's sexual problems because there are so many potential causes for a woman's inability to enjoy sex. Male impotence is essentially a mechanical problem that can be cured by a medication that enables erection. But women may turn away from sex for many reasons: physical, emotional, psychological.

Tiefer says sites like sponsored by Boehringer Ingelheim "get the idea in women's minds that there is a safe and simple solution to their problems so they don't have to talk to their doctors, they don't have to talk to their husbands, they don't have to talk to anybody about this." Neuroscience about how the brain works to influence sexual desire is still primitive, Tiefer says. "The idea that you have to rebalance your brain? That's just ludicrous."

The people who created the site say they are helping women learn more about sexual problems. "All women experience sexual dysfunction at some point in their lives," said Linda Jo Parrish, vice president for institutional advancement at the Society for Women's Health Research. The cause could be the birth of a baby, menopause, or stress, she says. "To say this is a 'made-up' condition does a disservice to women—their health and their relationships—and prevents women from talking about their concerns with health-care providers and partners."

But women's health advocates agree with Tiefer. "There is more to good sex than a pill," says Cynthia Pearson of the National Women's Health Network. "We can't let someone's business model that requires a patentable solution get in the way of a broader inquiry." Flibanserin's potential benefit—slightly less than one more sexually satisfying event a month—doesn't impress her. "Women need to know what's behind the development of this and other drugs, and just how flimsy the evidence for FSD really is," she says. "We'll take advantage of the hearing to make the statement, once again, that we are concerned about drug companies that stress the advantages and play down the risks," Pearson said. "I don't think we have as high-level worries about this one as we did about Intrinsa because this one is not a hormone. But I still think there are a lot of warning flags waving on this one and we need to take it seriously."

Orgasm Inc. also highlights the increased use of cosmetic vaginal procedures that claim to produce "designer vaginas" with such highly questionable practices as trimming vaginal lips, tightening vaginas, and injecting collagen. The American College of Obstetricians and Gynecologists has warned against these procedures, pointing out that there is great variety in the appearance of the vaginal area and most of those differences are normal. In the film, Harvard Medical School professor Susan Bennett calls any unnecessary surgery to the vaginal area "a form of genital mutilation." "We shouldn't allow it," Bennett says.

Canner hopes the film will help women be more skeptical about drug-company claims. (A national theatrical release of the film in the U.S. is in the works and the DVD of the movie is currently available at "A lot of this happens because in the U.S., drug companies have the right to advertise to consumers," she says, "so they can directly market this stuff to women or they can market this stuff to women's partners. I think there is a great danger that many healthy women could end up taking drugs that could harm them to fix a disease they don't have." What does make a woman more receptive to sex? That's still something of a mystery. Emory University psychologist Kim Wallen, who is interviewed in the film, has been studying the interaction of hormones and social influences on sexual behavior for many years. Much of his work consists of observing monkeys at the Yerkes National Primate Research Center in Atlanta. He has what could be the film's best line. As Wallen and Canner watch monkeys engaged in an elaborate sexual dance, she asks him what he has learned about sex by studying primates. Wallen thinks for a moment and then says, "Pay more attention to females." That's better than a pill any day.