Missed Opportunities in the Patient-Focused Drug Development Public Meeting and Scientific Workshop on Female Sexual Dysfunction Held at the FDA, October 2014

Navigating Women's Low Desire: Sexual Growth and Destiny Beliefs and Couples' Well-Being

People's beliefs about how to maintain sexual satisfaction have been associated with how they navigate sexual differences, but research has yet to explore the consequences of these beliefs for couples facing a distressing sexual issue. The current research extends past work on sexual growth beliefs (i.e., the view that sexual satisfaction requires continuous effort to maintain) and sexual destiny beliefs (i.e., the view that sexual satisfaction is the result of natural sexual compatibility with a partner) to couples for whom these beliefs might be especially consequential - those coping with sexual dysfunction. In a dyadic longitudinal study of 97 couples coping with women's clinically significant low desire and arousal, we tested how sexual growth and destiny beliefs are associated with sexual, relationship, and personal well-being. We found that endorsing greater sexual growth beliefs was associated with higher sexual desire for both partners, whereas, with some exceptions, endorsing greater sexual destiny beliefs was linked to lower sexual desire and relationship satisfaction, more conflict, and more depressive and anxious symptoms. However, these effects did not persist one year later. Our findings highlight the implications of sexual growth and destiny beliefs for both couple members when navigating a chronic sexual difficulty.

Bremelanotide and flibanserin for low sexual desire in women: the fallacy of regulatory precedent

The US Food and Drug Administration (FDA) has approved two drugs for 'hypoactive sexual desire disorder' in women, flibanserin (Addyi) in 2015 and bremelanotide (Vyleesi) in 2019. In this paper we examine the outcome measures and clinical trial data upon which regulatory approval was based. In clinical trials, flibanserin led to an average of only one additional enjoyable sexual experience every two months, bremelanotide to none. Trials for both drugs feature shifts in primary outcomes and a contested indication. A politicised industry-sponsored advocacy campaign and conflicted patient and expert testimony likely influenced flibanserin's approval at its third attempt. Bremelanotide, with even weaker efficacy, capitalised on the regulatory precedent set by the approval of flibanserin. Reconsideration of regulatory decisions to approve these drugs is in order, as well as a broader examination of how future regulatory decisions can better address conflicts of interest and clinically meaningful benefit.

Patient-Centered Outcomes and Treatment Preferences Regarding Sexual Problems: A Qualitative Study Among Midlife Women

BACKGROUND

Sexual dysfunction is common in midlife women and can have a significant negative impact on quality of life. Although treatments exist, there is little research on which sexual function outcomes and treatments midlife women prefer.

AIM

To better understand the sexual function outcomes that were most important to sexually active women 45 to 60 years old and the types of treatments they would prefer from individual interviews and focus groups.

METHODS

Twenty individual interviews and three focus groups (N = 39) were led by a trained facilitator, audio recorded, and transcribed. Two investigators developed a codebook, and the primary investigator coded all data. A second investigator coded five randomly selected interviews to ensure intercoder reliability. Codes relating to outcomes and treatment preferences were examined to identify central themes.

RESULTS

The mean age was 52.8 years (range = 45-59). When asked what they would want a sexual dysfunction treatment to do, women sought solutions to specific sexual problems: low desire, vaginal pain and dryness, and decreased arousal or ability to achieve orgasm. However, when asked about the most important aspect of their sex life, most women indicated emotional outcomes, such as enhanced intimacy with their partner, were most important to them. Most women preferred behavioral over pharmaceutical treatments, citing concerns about side effects. These women felt that behavioral treatments might be better equipped to address physical and psychological aspects of sexual problems.

CLINICAL IMPLICATIONS

This study highlights the importance of considering not only physical but also emotional outcomes when evaluating and treating sexual dysfunction in midlife women. It also emphasizes the importance of developing behavioral treatments in addition to pharmaceutical treatments.

STRENGTHS AND LIMITATIONS

By using a qualitative approach, this study allowed women the time and space to speak their own words about their experiences with sexuality at midlife. In addition, different racial and ethnic groups and menopausal statuses were represented. Limitations include limited generalizability, as is true for most qualitative research. In addition, although most women did endorse sexual problems, we did not exclude women with no sexual complaints.

CONCLUSIONS

Midlife women value physical and emotional outcomes with regard to sexual function. Many midlife women in this sample expressed a preference for behavioral approaches over pharmaceutical approaches for the treatment of sexual dysfunction. Thomas HN, Hamm M, Hess R, et al. Patient-Centered Outcomes and Treatment Preferences Regarding Sexual Problems: A Qualitative Study Among Midlife Women. J Sex Med 2017;14:1011-1017.

Apples and Oranges: "Sexual Medicine" and the Effort to Deny That Counting and Classifying Are Political Acts

Criticisms and controversies about scientific method are rarely just about science. As or more often, they are sociological exercises in boundary patrol, helping determine which work is in and which is out. The recent back-and-forth on the question of whether psychological treatments for sexual desire complaints are sufficiently "rigorous" is part of the effort to define the field of sexual medicine. Limiting good sexual science to quantitative clinical trial style is a rhetorical maneuver which must be challenged.

Women’s Sexual Desire

Abstract. Recent changes in the classification of female sexual dysfunction in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the US Food and Drug Administration’s (FDA) approval of the first drug to treat low sexual desire in women (flibanserin) have highlighted the intense focus on sexual desire problems in women. We first discuss the rationale for the DSM changes and outline the DSM-5 criteria for Female Sexual Interest/Arousal Disorder. We provide an overview of some of the key events leading up to the approval of flibanserin for the treatment of hypoactive sexual desire disorder in women, including the role of the “Even the Score” advocacy campaign, that accused the FDA of gender bias in not giving women with sexual desire problems access to treatment options. Incorporating narratives from testimonials of female patients attending the 2014 FDA Patient-Focused Drug Development Public Meeting, we examine some of the prevalent beliefs around sexual “normalcy” and the immutability of sexual desire. We critique how the media and pharmaceutical companies depict sexual norms and female sexual desire and how pharmaceutical trials often narrowly define and assess sexual desire and “sex.” We end with some recommendations for how researchers, clinicians, and journalists can better acknowledge that sex and desire have multiple meanings and interpretations with a view to women being offered a truly informed choice when seeking help for sexual problems.

Female sexual dysfunction: a call to arms for collaboration to understand the sexological elephant

Female sexual dysfunction (FSD) is a controversial condition, which has prompted much debate regarding its aetiology, components, and even its existence. Our inability to work together as clinicians, psychologists, patients, and advocates hinders our understanding of FSD, and we will only improve matters with increased funding and collaboration.