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April 4, 1998
New Drug for Impotence Raises Hope for Its Use by Women, Too
Related ArticlesFDA Approves Pill to Overcome Impotence (March 28) Frequent Orgasms May Lengthen Lives of Men, British Study Finds (Dec. 23, 1997) Theorists See Survival Value in Menopause (Sept. 16, 1997) The New York Times: Women's Health
By GINA KOLATA
he buzz over the new impotence drug, Viagra, has prompted many women and researchers to wonder whether it could improve the sex lives of women if they took it as well. And, in the process, it is generating new interest in sex research in general and women's sexual problems in particular.
For decades, the field of sex research has been a scientific backwater, researchers acknowledge. The federal government kept away from sex research and serious investigators considered it career suicide to go into an area that lacked federal financing and evoked snickers from other researchers.
Even Viagra was discovered by accident. Pfizer, its maker, was looking for a drug to relieve the chest pain of heart disease. The compound, sildenafil citrate in pill form, did not work as intended, but it had an unexpected side effect: some men taking Viagra found that it resulted in prolonged or enhanced erections.
When Pfizer scientists decided to investigate its usefulness as an impotence remedy, they had to learn about the biochemistry and neurobiology of erections. They also had to pay for developing a survey to determine whether erections, sexual performance and sexual desire improved and, if so, by how much.
Now many doctors want to know whether Viagra works on women, since the clitoris is the female version of the penis and thus becomes engorged with blood during sexual arousal. But how, they ask, should they measure arousal in women, especially since relatively little is known about sexual function and dysfunction among women?
Until researchers solve that problem, Pfizer's plans to test the effects of Viagra on women cannot begin. In the meantime, researchers say, women have been calling them and asking about the pill.
But even asking about whether Viagra works for women has meant starting the sort of sex research that has been stymied, experts said. Viagra "has opened the door to the study of sexual function," said Dr. Raymond Rosen, a sex researcher and professor of psychiatry at the Robert Wood Johnson Medical School in New Brunswick, N.J.
While some welcome the change, others ask how money and attention from drug companies will alter a field that has focused as much on feelings and relationships as it has on physiology and mechanics.
With drug company money, "the studies have been so mechanical -- is it hard? how wide is it? how big is it? how many seconds does it last?" said Dr. Leonore Tiefer, a sex researcher and clinical professor of psychiatry at New York Medical Center.
But "I think of an erection as a means to an end," Tiefer said, "something suitable to a couple rather than something you measure in the guy in the lab."
Some researchers wonder whether it will be good or bad for relationships if a new generation of drugs enhances sexual functioning for people who have been getting along fine with less-than-peak performance.
"Think of this like winning the sexual lottery," said Dr. Pepper Schwartz, a sociology professor at the University of Washington. "You might think in a lottery that if a little money is good, a lot must be great. But that is not always true."
Yet some say that the anticipated renaissance for sex research is long overdue, particularly for women.
"We can argue that as a society sexual functioning shouldn't have the image it has," said Rosen. But sexual dysfunction "for the people involved, it can be devastating," he said.
If anything, he added, sexual problems are more common in women than in men and, as in men, they are more common as people get older. For women, a major issue is lack of desire. Yet Rosen said much remained unknown:
"What is the relationship between lack of desire and measures of sexual performance -- lubrication and arousal? Is it that women lose desire and then develop arousal difficulties or is it the other way around?"
Women may complain of a lack of desire because it is more acceptable for them to say that than to say they have difficulty becoming aroused, Dr. Rosen said.
A 55-year-old nurse at the University of Maryland said she could not decide whether her problem was lack of desire or lack of an ability to become aroused.
"When you're younger, you could look at someone and all those bells and whistles would go off," the nurse said, speaking on the condition of anonymity. But "when you are with your partner for a long time," she added, "a certain boredom sets in." So maybe Viagra "could be the answer to that," she said.
The nurse said she, and virtually every woman she knew, would like to try Viagra.
"I think everyone wonders if it could be better," she said.
At least one researcher, Dr. Irwin Goldstein, a professor of urology at the Boston University School of Medicine, said his research indicated that the problem for middle-aged women was the same as it was for middle-aged men: a paucity of blood flowing to the sex organs. And if Goldstein is correct, it makes at least theoretical sense that Viagra be helpful for women.
It was Goldstein whose survey of Massachusetts men indicated that about half of all men aged 40 to 70 had difficulties obtaining or maintaining erections. He also discovered that the problem was most common among men with conditions that can lead to vascular problems that can lead to diminished flow in blood vessels, like diabetes. Now Goldstein and his colleagues are extending their research to women.
To get an idea of how common sexual problems are in women, Goldstein surveyed 300 women whose partners had consulted him about impotency.
Defining sexual dysfunction as discomfort during sexual intercourse, dryness, increased time for arousal, diminished ability to reach orgasm, or diminished clitoral sensation, Goldstein found that 58 percent of the women were affected. And, as like men, the women were more likely to have sexual difficulties if they were older and if they had medical conditions relating to vascular problems.
Goldstein and Dr. Jennifer Berman, a urologist at the University of Maryland in Baltimore, also examined the blood vessels that supplied the clitorises of cadavers and those of women undergoing X-ray examinations of the arteries for vascular disease. They found that just as disease and aging cause blood vessels to narrow in other parts of the body, the sexual organs were similarly affected, Goldstein said.
"The whole field changes now," he said.
Sexual dysfunction, Goldstein said, is no longer mostly a psychosomatic complaint, it is not something to be resolved only through years of therapy, and it is not a problem for a urologist alone.
Instead, he said, sexual dysfunction "is in essence a vascular disease." It is, he said, "a heart attack of the vagina, a heart attack of the clitoris, a heart attack of the penis."
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