Saturday, August 22, 2015

Flibanserin/Addyi: Potential problems for asexuals

The FDA recently approved Flibanserin/Addyi as a medication to treat low sexual desire in women.  Let's talk about what that means for asexuals.


I apologize for repeating some background, but it's necessary because of the many misconceptions about Addyi.

Addyi is the very first drug approved for low sexual desire.  No, Viagra was never a treatment for low sexual desire.  Furthermore, Addyi is taken daily, while Viagra is taken as needed.  Addyi also has serious side effects.  Most significantly, it absolutely does not mix with alcohol.  It's also considered too dangerous to take in the daytime.

Additionally, the effects of Addyi are extremely marginal.  In a trial, women with sexual desire disorders started with a baseline of ~2.7 "sexually satisfying events" per month.  Placebo increased this number by once a month, and Addyi increased it by less than twice a month.  So we're talking about an increase of about 20%, which for all I know could be achieved by Addyi's sedative side effects.

Hypothetically, a drug like Addyi could do some good for some people, but let's talk about the drug we actually have.  And regardless of the good that it might hypothetically do, we also need to weigh that good against the bad.

Asexuals vs Desire Disorders.

The basic problem is that there may be some people with sexual desire disorders, but asexuals exist too, and not everyone can distinguish between them.  Asexuality as an orientation has only come to public awareness over the past decade or so, and it's extremely common for asexuals themselves to be unaware of it.  When confronted with asexuality, many doctors, asexuals, and people in general deny what is unfamiliar to them.

Even if we were to approach the problem from a clear-minded perspective, no simple rules can be used to make the distinction.  You can't use distress as a distinction because asexuals may be distressed about their orientation, and often are.  Even if the distress is due to society, the asexuals themselves may not make that connection until later.  You can't use a sudden change in sexual desire as a distinction, because sexuality can fluctuate.  Someone who was happy with higher sexual desire may also find happiness with low sexual desire.

Some people think that there are at least a few clear cases, such as women with low sexual desire due to other medical conditions, or as a side effect from other drugs.  But Addyi is explicitly not approved for such cases, because the risks haven't been assessed.

Predicted problems

These are my predictions for what problems will occur affecting people on the asexual spectrum.

Ad campaigns - There will likely be ads for Addyi which encourage people to view low sexual desire as a problem, even if they wouldn't otherwise.

Unaware asexuals - People who don't experience sexual attraction might be even less likely to learn about asexuality.

Disbelieving public - Partners, friends, relatives, and the general public are often already predisposed to disbelieve asexuality, and might be even more encouraged by Addyi and its marketing.

Pushy doctors - Doctors who do not recognize asexuality, or simply unaware, might encourage their patients to take Addyi without making them aware of the asexual spectrum.

Disbelieving doctors - Doctors who hare aware of Addyi may be less likely to believe patients who disclose their asexuality.

Pushy partners - People with partners with higher degree of sexual desire might be persuaded or even blackmailed into seeking Addyi.  It could be used as a tool for control in abusive relationships.

If you can think of any other predictions, I'd like to hear about them.

Proposed solutions

Since Addyi is already approved, nothing can be done about that for now.  But to counteract some of the negative consequences, I propose that:
  • Doctors certified to prescribe Addyi should be educated about asexuality.
  • Addyi marketing materials should be criticized and mocked.
  • There should be more mainstream articles thoughtfully addressing Addyi and sexual desire disorders in relation to asexuality.