Different for girls

Can women ever solve their sexual problems with drugs? Or, asks Clare Rudebeck, do they just need a little more understanding- and a nanny?

After she had her third child, Karen Speck's libido disappeared. "It wasn't like me at all," says the housewife from Enfield. "I'd always had quite a good sexual relationship with my husband." Although her partner was understanding, their relationship began to break down. "I blamed myself, and if there had been a drug on the market, I would've tried it. You'd be a fool not to," she says.

Five years ago, the anti-impotence drug Viagra burst on to the market-place. Since then, more than 20 million men worldwide have been prescribed the drug. However, there is currently no drug licensed for the various sexual problems reported by women – from pain during intercourse, to lack of desire, lack of arousal, and inability to achieve orgasm. Could the answer to their problems lie in a drug? Or is female sexuality altogether too complicated to be fixed by a pill?

Dozens of drug companies are striving to develop the drug that could do for women what Viagra did for men – including the makers of Viagra, Pfizer. Viagra works by increasing the blood flow to the penis during the erectile process. Research has shown that increased blood flow to the sexual organs is also vital to female arousal. So, Pfizer reasoned, wasn't it possible that Viagra would also work for women?

Trials started five years ago, but they were a flop. Only a small number of women responded to the drug. Pfizer had to think again. Further research showed that women's sexual problems were rather more complicated than men's. "Most research now recognises four main types of Female Sexual Dysfunction (FSD): disorders of desire, disorders of arousal, inability to achieve orgasm, and painful intercourse," says Dr Mitra Boolell, a senior director of clinical sciences at Pfizer.

The most common complaint is lack of desire. However, Pfizer now realises that Viagra can only help women who have problems with lack of arousal. Last year, a Pfizer-funded trial of 200 women who predominantly had difficulty becoming aroused showed that Viagra benefited those women. "The research is still at a very early stage, but we are very optimistic," says Dr Boolell. He says that up to 20 per cent of the female population could benefit from this drug. Several other drug companies also hope to help this fifth of the female population. They include the Californian company Vivus, which is currently testing Alista, a cream that aims to help women become aroused by aiding blood flow to the clitoris. Another US company, Palatin Technologies, is developing a nasal spray that they claim will propel women into a state of sexual arousal.

Others in the medical community are more sceptical. Dr Leonore Tiefer, associate professor of psychiatry at New York University, claims that not only will very few women be helped by these drugs, but that Female Sexual Dysfunction itself is an invention of drug companies eager to cash in on women's insecurities. "FSD implies that there's a normal sexual function, and I see no evidence for that," says Dr Tiefer. "My experience is that women's sexual styles are very different. Their goals and expectations are very varied. It's a cultural thing. It's an age thing. It's a relationship thing. Female Sexual Dysfunction was manufactured, really, out of nothing."

Her claims were backed up last month by the British Medical Journal (BMJ). A paper published in the journal called into question key research that established the existence of FSD. In 1999, the Journal of the American Medical Association (JAMA) published an article claiming that 43 per cent of women, aged 18 to 59, suffered from some sort of sexual dysfunction, including 20 per cent who had disorders of arousal, as quoted by Pfizer's Dr Mitra Boolell. But the BMJ said that there were serious questions over the validity of the research, pointing out that the JAMA article said that these figures were "not equivalent to clinical diagnosis".

"Yes, Viagra could have a role in helping women with their sexual problems," says Dr Tiefer. "But how many women will benefit? The sex life of a few women would improve if you distributed free soap around the country. A few would benefit if you distributed a small flask of gin. About the same number would probably benefit from drugs such as Viagra."

So, where does this leave women such as Karen Speck, who, like most women who report sexual problems, experienced a lack of desire? Was she suffering from a physical condition that could be treated with drugs? Or were the causes elsewhere? In fact, there has been very little research into female sexuality and thus what might cause women's sexual problems. Both Dr Tiefer and Pfizer's Dr Boolell say that research in this area is decades behind that into male sexuality.

Dr Ellen Laan, associate professor of clinical psychology at the University of Amsterdam, is one of the pioneers. In one study, she showed women two different porn films while monitoring the blood flow to their vaginas. One film was made by a man. The other by a woman. In the man-made film, the focus was on the man's pleasure and orgasm. In the woman's, the female orgasm was the focus. What she found was that although both films resulted in increased blood flow to, and therefore arousal of, the genitals, the women reported feeling far more aroused when watching the woman-made porn film.

In other words, blood flow to the vagina has little effect on a woman's desire for sex and feelings of arousal. As a result, Dr Laan believes that the drug companies have been looking in the wrong place: the key to treating women's sexual problems lies not in the genitals but in the brain. "In medically healthy women, causes [of sexual problems] are almost never physical. There's no proof," she says. "When given adequate sexual stimulation, there's nothing wrong with their blood flow. I think there are a host of non-physical factors that ultimately result in a lack of adequate stimulation."

So, if the problem is predominantly psychological, what is the solution? Counselling? A new partner? Getting a nanny? Dr Laan says that the quality of a woman's relationship with her partner is most important. "Women report that sexual activity is more rewarding when there's closeness and intimacy. In that sense, men and women seem to differ," she says. And while Karen Speck's sex life with her ex-husband had deteriorated, her libido returned to normal after meeting her new partner. "The old sparkle is back," she says.

But blaming the man, or the quality of the relationship, is also too simplistic an explanation. Dr Tiefer says that women's sexual problems stem from a host of pressures facing the modern woman. "A loss of desire is often related to fatigue – to long hours, worries about money, childcare and care for elderly parents," she says. "Sex responds to that kind of pressure. Women don't need drugs, they need childminders."

She says that women should be more proactive in educating themselves about sex: "People say, 'Go to your doctor with sexual problems'. I think you should go to your bookstore. Sex education in Britain and America is pathetic, especially in comparison to Scandinavian countries. People are vulnerable to these drug companies because they don't know much about their biology, or about the relationship between their feelings and experiences."

But what if there was a drug that worked on women's brains instead of their sexual organs? Ian Russell, a nurse working at Dumfries and Galloway Royal Infirmary, believes that he may have found just such a drug. He has worked with people suffering from sexual problems for 12 years. In 2000, a new drug was licensed for erectile dysfunction in men, Uprima. The drug works by stimulating men's sexual-response centre in the brain, and Russell noticed that with some men it improved their sexual interest as well as function.

"It made me think," he says. "Function isn't really at issue for women, it's the libido. The sexual organ is not the issue, it's the brain." Perhaps, he reasoned, this drug could work for women, too. Last year, he completed a trial of 10 women, aged 38 to 60, all of whom reported a reduced libido. The results, he says, were "uncanny", with eight of the 10 women showing improvements in desire, arousal, ability to achieve orgasm and painful intercourse. This positive response across the spectrum of female sexual problems prompts him to believe that Uprima could be as revolutionary for women as Viagra was for men.

This remains to be seen. Russell's study was so small that the result could easily be a freak. In March, he hopes to start a much larger study. Meanwhile, the mystery of female sexuality remains, with Boollel, Tiefer, Laan and Russell all saying that there will never be a single solution to women's sexual problems.

'Horizon – Sexual Chemistry' is on BBC2 tomorrow at 9pm