Health Check: 'Who benefits from female sexual dysfunction?'

Medicine is full of ironies and last week provided a choice example. The British Medical Journal published an article by the Washington-based journalist Ray Moynihan that accused the drug industry of creating a new disease – female sexual dysfunction – so that it could profit from drugs to treat it.

It was a nicely crafted piece that made its case with some force and it was picked up by TV, radio and most national newspapers, including this one. The gist of the argument was that drug companies have created such a buzz about the condition by sponsoring meetings and research that more people have come to believe in it. The more people that believe in it the bigger the potential market when these same companies launch products to treat it. This, in other words, is medicine driven by markets rather than the welfare of patients.

If this is true, those grasping drug-company executives must be rubbing their hands with glee. Thousands of words and hours of broadcast time have been devoted to the subject in the last few days. Thanks to Moynihan's efforts, millions more people know about the "non-existent" disease of female sexual dysfunction today than did a week ago.

So what is the fuss about? Moynihan's first complaint is that all the running in this debate has been made by the drug companies. Call me an old cynic, but I thought most conferences – indeed, most research – was sponsored by drug companies. They may not behave well – many go to the limit of what is acceptable (and beyond) to defend or extend their markets – but the fact is that without profit-driven drug companies there would be fewer drugs. State-run drug industries just don't cut the mustard.

There is a downside, of course. The need to generate profit means that there is a bias toward finding nostrums for the ailments of the rich developed world – the so-called lifestyle drugs like Viagra – rather than the killer diseases of the poor developing world. But on balance, I believe, the drug industry has improved a good many more lives than it has harmed.

Moynihan's next complaint is that female sexual dysfunction is being defined for the convenience of drug-company executives as a mechanical failure on a par with the impotence seen in men rather than the complex physical, emotional and psychological complaint that women know it to be.

He cites a paper published in the Journal of the American Medical Association in 1999 suggesting a remarkable 43 per cent of women over 18 were sufferers. This was based on a questionnaire study of 1,500 women that asked if they had experienced any of seven symptoms for more than two months in the previous year – including lack of desire, anxiety about performance or difficulties with lubrication.

The authors helpfully pointed out that this was "not a clinical diagnosis" – and the result probably does tell us more about the widespread feelings of inadequacy that our sex-focused culture generates than about disease. But the experts that Moynihan lines up to support his argument do seem oddly po-faced. John Bancroft, the director of the Kinsey Institute at Indiana University, complains that focusing on drug treatments is a mistake when attention should be paid to other aspects of a woman's life. Leonore Tiefer, professor of psychiatry at New York University, says genital function is being promoted as the centrepiece of sexuality and everything else is being ignored.

Couldn't the same criticism be made of drugs for high blood pressure, or heart disease, or diabetes or myriad other conditions caused, in part, by the stresses and pressures of modern life? There is much that can be done about these conditions by the sufferers themselves – eat a better diet, take more exercise – but it would be a negligent GP who refused to hand out the pills as well.

Some women commentators, including Dorothy Rowe in The Times and Cristina Odone in The Observer, see a conspiracy here by men interested in stoking the desire of their women, as they have tried to do for centuries with aphrodisiacs and potions, rather than address the real reason for their lack of desire – that they felt unloved, ignored and unsupported. But an equal case can be made for an entirely different conspiracy – to deny to women the same benefits that drugs for impotence have brought to men. Viagra has transformed the sex lives of millions of men. Consultant urologists say that for the first time they are sending their patients away happy.

Early results from trials of Viagra in women show benefits almost as startling as those in men. Ask any specialist who runs a menopause clinic and they will tell of the legions of women who come in desperate for something to rekindle their interest in sex. Of course drugs will never compensate for the failings of a troubled relationship. Even at the purely physical level, female sexual dysfunction may be a more complex disorder than male impotence. But why should women not be offered whatever pharmaceutical help is available?

If Viagra is licensed for women, I suspect the demand for it will be huge. And it will be from women interested in sex for themselves as much as for their men.