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The Sexual Pharmacy

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A Genealogy of Appetite in the Sexual Sciences

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Abstract

This chapter examines the pharmaceutical tablet as a technique for the management of sexual appetite in the twenty-first century. It explores the emergence of Addyi (flibanserin) as a case study of how this technique produces a particular subject of pharmaceutical knowledge. The chapter considers the significance of the act of pharmaceutical ingestion on the embodied subjectivity of the consumer and the chemical constitution of the human body. The use of Addyi to manage sexual imbalance in combination with the tools of the diagnostic manual, discussed in Chap. 5, converges in the emergence of a socio-technical and knowledge-gathering subject. This subject is armed with techniques to monitor the self and gather knowledge of her sexual imbalance, a process that affirms intimacy. Indeed, the subject who swallows the pill is a fundamentally social one, that is to say, one who desires intimate contact with others.

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Notes

  1. 1.

    As demonstrated in Angus McLaren, Impotence: A Cultural History (Chicago and London: University of Chicago Press, 2007).

  2. 2.

    See, for example, Jack Hitt, “The Second Sexual Revolution,” The New York Times, February 20, 2000, accessed January 19, 2019. http://www.nytimes.com/2000/02/20/magazine/the-second-sexual-revolution.html?pagewanted=all, and Steven Lamm, and Gerald Secor Couzens, The Virility Solution: Everything You Need to Know about Viagra, the Potency Pill that Can Restore and Enhance Male Sexuality (New York: Fireside Books, 1998). It is worth noting that drugs for the management of male sexual appetite developed rapidly after Viagra. They include Cialis, Staxyn, Stendra, Edex and Levitra, though there are differences between how they work.

  3. 3.

    A couple of days later, Valeant Pharmaceuticals International announced that it had acquired Sprout for $1 billion. Another drug Vyleesi (bremelanotide) was approved by the FDA in 2019. Much like Addyi, Vyleesi claims to target neurological pathways by increasing levels of dopamine in the brain. While there are differences between how the two drugs work—Vyleesi, for example, is used through subcutaneous injection 45 minutes before sexual activity—the way they produce understandings of sexual appetite in women is similar: it can be addressed through “working on” the brain. See Food and Drug Administration. “Drug Trials Snapshot: Vyleesi.” 2019, accessed July 19, 2019. https://www.fda.gov/drugs/drug-safety-and-availability/drug-trials-snapshots-vyleesi.

  4. 4.

    Elizabeth A. Wilson, Gut Feminism (Durham & London: Duke University Press, 2015), 100.

  5. 5.

    Nikolas Rose, The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century (Princeton: Princeton University Press, 2007), 209.

  6. 6.

    Ibid., 212. See also Nikolas Rose, “Neurochemical Selves,” Society 41, no. 1 (2003): 46–59.

  7. 7.

    Beatriz (Paul) Preciado, Testo Junkie: Sex, Drugs, and Biopolitics in the Pharmacopornographic Era, trans. Bruce Benderson (New York: The Feminist Press, 2013), 198.

  8. 8.

    Rose, The Politics of Life Itself, 223.

  9. 9.

    Ibid., 70 (emphasis original).

  10. 10.

    Nikolas Rose, “Beyond Medicalisation,” The Lancet 369 (2007): 702.

  11. 11.

    Examples include depression, myalgic encephalomyelitis (Chronic Fatigue Syndrome), persistent genital arousal disorder, sexual pain and bipolar disorder.

  12. 12.

    Roy Moynihan, “The Making of a Disease: Female Sexual Dysfunction,” British Medical Journal 326, no. 7379 (2003): 45.

  13. 13.

    Rose, “Beyond Medicalisation,” 702.

  14. 14.

    See Kane Race, Pleasure Consuming Medicine: The Queer Politics of Drugs (Durham and London: Duke University Press, 2009).

  15. 15.

    Donna J. Haraway, Simians, Cyborgs, and Women: The Reinvention of Nature (New York: Routledge, 1991), 272.

  16. 16.

    Ibid., 325–327.

  17. 17.

    Preciado, Testo Junkie, 33–34.

  18. 18.

    Ibid., 76.

  19. 19.

    Donna J. Drucker, The Machines of Sex Research: The Machines of Sex: Research Technology and the Politics of Identity, 1945–1985 (Dordrecht: Springer, 2014).

  20. 20.

    Preciado, Testo Junkie, 114.

  21. 21.

    Annie Potts, “Cyborg Masculinity in the Viagra Era,” Sexualities, Evolution and Gender 7, no. 1 (2005): 3–16.

  22. 22.

    Ibid., 4.

  23. 23.

    Under “Indication” on Addyi’s website: “Addyi is not … to improve sexual performance,” accessed January 19, 2019. https://www.addyi.com/. This narrative is common to Vyleesi, whose label also states that it is not indicated to enhance sexual performance. See Food and Drug Administration. “Vyleesi Label.” 2019, accessed July 19, 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/210557s000lbl.pdf.

  24. 24.

    Thea Cacchioni, Big Pharma, Women, and the Labour of Love (Toronto: University of Toronto Press, 2015), 38–43.

  25. 25.

    See Leonore Tiefer, Sex Is Not a Natural Act and Other Essays (New York: Westview Press, 2004); “Arriving at a ‘New View’ of Women’s Sexual Problems: Background, Theory and Activism,” Women & Therapy 24, no. 1–2 (2002): 63–98; and “The Viagra Phenomenon,” Sexualities 9, no, 3 (2006): 273–294.

  26. 26.

    Barbara L. Marshall, “‘Hard Science’: Gendered Constructions of Sexual Dysfunction in the ‘Viagra Age,’” Sexualities 5, no. 2 (2002): 141 (emphasis original).

  27. 27.

    Ibid., 141.

  28. 28.

    A.H. Clayton, L. Dennerstein, R. Pyke, and M. Sand, “Flibanserin: A Potential Treatment for Hypoactive Sexual Desire Disorder in Premenopausal Women,” Women’s Health 6, no. 5 (2010): 639–653.

  29. 29.

    Wilson, Gut Feminism, 35.

  30. 30.

    Helene Gelez, Pierre Clement, Sandrine Compagnie, Diane Gorny, Miguel Laurin, Kelly Allers, Bernd Sommer, and Francois Giuliano, “Brain Neuronal Activation Induced by Flibanserin Treatment in Female Rats,” Psychopharmacology 230 (2013): 639–652.

  31. 31.

    While “interest” is not positioned as an issue for men in the DSM, the DSM-5 introduced in 2013 the category of Male Hypoactive Desire Disorder. See American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th edition (Washington, DC: American Psychiatric Association, 2013), 440–443.

  32. 32.

    “Interest” has also been employed to suggest that women are more likely to experience desire in response to an initiating partner/image. See Anthony F. Bogaert and Lori A. Brotto, “Object of Desire Self-Consciousness Theory,” Journal of Sex and Marital Therapy 40, no. 4 (2014): 323–338.

  33. 33.

    Jayne Lucke, “A Sexually Satisfying Event for Women, or Just a New Identity for an Old Antidepressant,” The Conversation, June 6, 2015, accessed January 19, 2019. https://theconversation.com/a-sexually-satisfying-event-for-women-or-just-a-new-identity-for-an-old-antidepressant-42734. Addyi, under the name BIMT 17, was originally trialled as a potential antidepressant. See F Borsini, E Giraldo, E Monferini, G Antonini, M Parenti, G Bietti, and A Donnetti, “BIMT 17, a 5-HT2A receptor antagonist and 5-HT1A receptor full agonist in rat cerebral cortex,” Naunyn Schmiedebergs Arch. Pharmacol 352, no. 3 (1995): 276–282.

  34. 34.

    Wilson, Gut Feminism, 102.

  35. 35.

    Ibid.

  36. 36.

    Sprout Pharmaceuticals, Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women NDA 022526, Advisory Briefing Document, 2015, 15.

  37. 37.

    See Rose, The Politics of Life Itself, 143.

  38. 38.

    Wilson, Gut Feminism, 66.

  39. 39.

    Michel Foucault, Society Must Be Defended: Lectures at the Collège de France, 1975–76, trans. David Macey (London: Penguin Books, 2003), 247.

  40. 40.

    Ibid., 252.

  41. 41.

    Preciado, Testo Junkie, 207.

  42. 42.

    Ibid., 208.

  43. 43.

    Nikolas Rose and Joelle M. Abi-Rached, Neuro: The New Brain Sciences and the Management of the Mind (Princeton and New York: Princeton University Press, 2013), 9.

  44. 44.

    Ibid., 143.

  45. 45.

    See, for example, J.R. Georgiadis and M.L. Kringelbach, “The Human Sexual Response Cycle: Brain Imaging Evidence Linking Sex to Other Pleasures,” Progress in Neurobiology 98 (2012): 49–81, Serge Stoléru, Véronique Fonteille, Christel Cornélis, Christian Joyal, and Virginie Moulier, “Functional Neuroimaging Studies of Sexual Arousal and Orgasm in Healthy Men and Women: A Review and Meta-Analysis,” Neuroscience and Biobehavioral Reviews 36 (2012): 1481–1509, and David L. Rowland and Ion G. Motofei, “The Mind and Sexuality: Introduction to a Psychophysiological Perspective,” Journal of Mind and Medical Sciences 2, no. 1 (2015): 1–8.

  46. 46.

    Rose and Abi-Rached, Neuro, 163.

  47. 47.

    Addyi, “Addyi (flibanserin),” 2019, accessed January 19, 2019. https://addyi.com/.

  48. 48.

    Meika Loe, The Rise of Viagra: How the Little Blue Pill Changed Sex in America (New York and London: New York University Press, 2004), 57.

  49. 49.

    Tests were conducted with women who had been in their current relationships for over ten years on average and had experienced HSDD symptoms for nearly half that time. See Sprout, Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women NDA 022526, xv.

  50. 50.

    Ben Harder, “Potent Medicine: Can Viagra and Other Lifestyle Drug Save Lives?” Society for Science & the Public 168, no. 8 (2005): 124–125.

  51. 51.

    Rod Flower, “Lifestyle Drugs: Pharmacology and the Social Agenda,” TRENDS in Pharmacological Sciences 25, no. 4 (2004): 182.

  52. 52.

    See McLaren, Impotence, 149–180.

  53. 53.

    Race, Pleasure Consuming Medicine, 6.

  54. 54.

    Ibid.

  55. 55.

    Ibid., 7.

  56. 56.

    “Even the Score” is a coalition of twenty-six organisations including Sprout Pharmaceuticals and women’s health NGOs. For an analysis of this campaign, see Jacinthe Flore, “Intimate Tablets: Digital Advocacy and Post-Feminist Pharmaceuticals,” Feminist Media Studies 19, no. 1 (2019): 3–18, and Judy Z Segal, “Sex, Drugs, and Rhetoric: The Case of Flibanserin for ‘Female Sexual Dysfunction’.” Social Studies of Science 48, no. 4 (2018): 459–482.

  57. 57.

    See, for example, Judy Z. Segal, “The Rhetoric of Female Sexual Dysfunction: Faux Feminism and the FDA,” CMAJ 187, no. 12 (2015): 915–916, and Ellen Laan and Leonore Tiefer, “‘Pink Viagra’: The Sham Drug Idea of the Year,” LA Times, November 13, 2014, accessed January 19, 2019. http://www.latimes.com/opinion/op-ed/la-oe-laan-tiefer-pink-viagra-20141114-story.html.

  58. 58.

    Emily Martin, “The Pharmaceutical Person,” Biosocieties 1, no. 3 (2006): 276.

  59. 59.

    Lauren Berlant and Michael Warner, “Sex in Public,” Critical Inquiry 24, no. 2 (1998): 555.

  60. 60.

    Rose and Abi-Rached, Neuro, 163.

  61. 61.

    Marshall, “Sexual Medicine, Sexual Bodies, and the ‘Pharmaceutical Imagination,’” 135.

  62. 62.

    Judith (Jack) Halberstam, In a Queer Time and Place: Transgender Bodies, Subcultural Lives (New York: New York University Press, 2005), 2.

  63. 63.

    Ibid., 4.

  64. 64.

    Lee Edelman, No Future: Queer Theory and the Death Drive (Durham and London: Duke University Press, 2004), 1–31.

  65. 65.

    Ibid., 3.

  66. 66.

    Rose, The Politics of Life Itself, 20.

  67. 67.

    Viagra. “Learning: How Does Viagra Work?” 2019, accessed January 19, 2019. https://www.viagra.com/learning/how-does-viagra-work.

  68. 68.

    Ibid.

  69. 69.

    Ibid.

  70. 70.

    Michael Johnson Jr., “‘Just Getting Off’: The Inseparability of Ejaculation and Hegemonic Masculinity,” The Journal of Men’s Studies 18, no. 3 (2010): 238–248.

  71. 71.

    See Sprout, Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women NDA 022526, i–xvi.

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  1. Royal Melbourne Institute of Technology, Melbourne, VIC, Australia

    Jacinthe Flore

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Flore, J. (2020). The Sexual Pharmacy. In: A Genealogy of Appetite in the Sexual Sciences. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-39423-3_6

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