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Sexual interest disorder

The Sunday Times

Love sickness

While Basson makes tea, I study her office, which faces downtown Vancouver and the Burrard Inlet. Often when I have interviewed doctors and scientists, their walls have been spattered with certificates and awards - and occasionally a Nobel prize. But her space is spartan. Her priority has been patients. She's a late bloomer in the pharmaceutical garden. Pride of place goes to a poster of a Eugene Smith photo and a group portrait of the King's College London Medical Society when she was a student there in 1967.

So why front a campaign with a working clinician? Why not wheel out some established big cheese? As we talk in her office, that mystery fades: if she didn't exist, they might need to invent her. Of course, they need a women to medicalise female sexuality - and the key players in urology are all men. They need a medical doctor - and the field of sexology is overrun by PhDs. To pluck a leader from Canada is a political masterstroke: it plays well in both the US and Europe.

But the married mother-of-two argues that medicalising sexuality is the opposite of what she intends. Her model, she says, is "bio-psycho-social", requiring doctors to elicit a rounded picture. "All of us aren't like little robots," she tells me. "Because the pharmaceutical industry is now interested, and maybe now there are drugs for various aspects of the physiology that can go wrong, it doesn't mean it's all a medical entity."

Some of her research, she says, points to Viagra's limitations, and she argues that the impact of defining sexual interest disorder may actually reduce drug prescribing. "The data to date suggests that most women who go ahead and have sex with their long-term sexual partners do it for reasons of emotional closeness," she says. "There's not going to be a drug to increase emotional closeness."

Well, I think she's wrong. Ecstasy does that now, admittedly with quite some downside. Testosterone, meanwhile, is used to raise women's libido, and oestrogen to create "wellbeing". Drug companies are doing nicely with products for inattentiveness (Ritalin), shyness (Paxil or Seroxat) and life's futility (Prozac). And last month American researchers reported that the selective serotonin reuptake inhibitor citalopram was effective in "compulsive shopping disorder".

In my view, I told her, her ideas could be used to sell Viagra to women today. Although research looks thin on its role for female problems, mysterious new conditions, such as "vaginal engorgement insufficiency" and "clitoral erectile insufficiency", are emerging, for which her model may be invoked to address. If, as she says, (a) different stages in the sexual response cycle reinforce each other, and (b) physical arousal precedes feelings of desire, she may be opening the door for prescribing drugs for arousal when the patient has ticked "lack of interest" in the quiz.

But more important is the direction of scientific research, for which her model may map new routes. For hospital ethics committees to approve new-product trials, they must first have a disease for the product to treat. No disease, no treatment. End of story. But if the campaign Basson launched to change definitions succeeds, "sexual interest disorder" becomes a bona-fide problem to which remedies may be properly addressed.

There will be no quick fix and, as research goes on, her announcement in Paris may be forgotten. But, no question, from the lectern she proposed a new paradigm that chimed well with the spirit of big pharma. Just as television audiences have fractured in the face of cable and satellite, so markets for medicines are threatening to shatter as gene-based personalised therapies loom larger. As generic manufacturers gnaw at patent rights, the research-based industry lusts for new blockbusters for us all to swallow daily for life.

As Rosen's colleague and Paris attendee Leiblum hints at the priorities in the introduction to her book, Getting the Sex You Want: "While the search is on for a miracle potion or fail-proof device that will transform sex and make it magical, it is my belief that ultimately, women hold the tools necessary to get the sex they want. It is their willingness to do what needs to be done - whether it means taking hormones, starting therapy, or believing that they are entitled to sexual pleasure." [My italics]

By an astounding coincidence, Leiblum was in Vancouver and hijacked my first session with Basson. But back to one-on-one, we return to my worry that the British doctor may be pathologising untroubled, healthy women, bringing medicine where it doesn't belong. It seems to me that if a person isn't interested in sex and doesn't want to train a partner to change that, they might take up tennis, read Anna Karenina, or in some other way get on with their life. I also found it troubling to see a model implying that women merely responded to men.

"I could argue it from either side," she says. "I could argue it from a feminist side, saying, 'Look, if you don't care about a disorder, even though you're totally different from everyone else on the planet, who cares? It's not a diagnosis. It's not a disorder.' Then you could argue it from the other side and say, 'Look, if your appendix is inflamed and it's pus-y, it's going to burst,' and you reply, 'I don't care. I don't mind the pain. I do not have appendicitis.' Well, of course you have appendicitis. Whether you care about it or not, in the medical world, is irrelevant."

"But that doesn't happen," I say. "Except in weird religious groups. If you're in a situation when you have no interest in sex - even an 'abnormal' lack of interest in sex - but it doesn't bother you, and you've not presented yourself to physicians saying you have a problem, your position is that their condition still exists."

"That's right," she says.

"Now that creates the opportunity for all your little questionnaires in the waiting room - tick, tick, tick, tick. 'Speak to the doctor about this', and the doctor will flog you a drug."

"But women who have no interest in sex and don't care are not going to take a drug," she hits back. "Why would they? They don't care."

"Because then you're into fashion, social pressures, cultural pressures."

"If you've got no interest, you've got no interest. By definition."

"But if you turn on your TV and it says, 'Are you feeling this?' and you start to think: 'Maybe...' Then it says: 'Are you bored?' And you think: 'Oh, well...' And maybe it ties in with depression. 'Maybe the reason you're depressed is because you're not getting enough sex.' And you say: 'Oh, I'm not interested in sex...' And they say: 'Well, we have a product for that'."

"We haven't got a product for women's sexual interest."

Well, no. She is right. Not yet.

The blue pill era has barely dawned. We've only five years of erection enhancement. There will be many more conferences, foreign trips and research papers before big business sells drugs to turn us on.


Read an investigation by Brian Deer into sexual medicine five years earlier in Pfizer's Viagra, or into the pharmaceutical industry at its weirdest in Bactrim - Septra - Septrin

Sexual interest disorder
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