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Complex picture of female sexuality hinders magic pill

When sex researchers want to make a point about the difference between the genders, they sometimes flash two comical slides:

One shows a simple radio with a single toggle switch. That represents male sexuality.

The other shows a complex radio crammed with switches and dials and lights and bells. That represents female sexuality.

The contrast, researchers say, captures the main reason why, five years after Viagra came out and with two rival male impotence pills about to hit the market, there is still no counterpart for women. And, some are even saying, there may never be.

"There's not going to be a magic pill," said Dr. Sandra Leiblum, director of the Center for Sexual and Relationship Health at the Robert Wood Johnson Medical School in New Jersey. The causes of sexual problems in women are so complicated, including biological, psychological, and relationship factors, that "I think it's unlikely we're going to find a single drug, or a drug all by itself, that's going to help all of the women for whom sex is a problem."

Others predict that a powerful pill may indeed be found, but caution that it will take years. Biomedical research on women's sexual problems is still in its infancy -- buffeted by stormy and sometimes politicized debates, relatively poor in resources, and challenged by female complexity.

But the population who needs help is potentially enormous -- perhaps as many as 40 million American women have some form of sexual dysfunction. And more than half of British women had experienced sexual problems lasting at least a month, according to a study in last week's British Medical Journal.

The most common complaints among women are lack of desire and trouble getting aroused or reaching orgasm. Pain during intercourse is also widespread.

Specialists say that though they lack a panacea, much more can be done in a piecemeal way, from correcting hormone imbalances that can affect desire to improving communication between partners.

In addition, Viagra appears able to help some women by improving blood flow as it does for men -- testing is still underway. Hormone gels and creams, too, seem promising, among other treatments under development, researchers say.

What makes women so much trickier to treat than men? Their hormones and anatomy are more complex and sex has a stronger psychological component for women. New research even suggests that women's sexual orientation is more nuanced than men's.

A study by researchers at Northwestern University in Chicago found that heterosexual women were as aroused by watching films of lesbian sex as by films of sex between a man and a woman. By contrast, heterosexual men were much less aroused by watching films of gay men.

"The relationship between genital arousal and sexual arousal in women is much weaker than it is in men," said Northwestern researcher Meredith Chivers. "A lot of the research is pointing to more cognitive factors being important, things like having a positive emotional reaction to a sexual stimulus."

Indeed, some specialists in female sexuality emphasize that desire has such a strong emotional component that even if a Viagra-like drug worked for most women, it might well not solve their sexual problems.

Exhaustion from taking care of family members, marital strife, body image issues, or traumatic memories of abuse cannot be solved with a pill, they say.

On the physical side, the problem is not just complexity. Even at the level of basic anatomy, much remains unknown about female sexuality, said Dr. Irwin Goldstein, director of Boston University's Institute of Sexual Medicine.

"It's extremely difficult to conceive of a pharmaceutical development when the basic understanding of the physiology of sexual response is not appreciated. You need to understand the mechanism," he said.

However, researchers have begun to study chemical signals that affect the nerves and blood flow in the female genitalia, said Noel Kim, assistant director of the Laboratory for Sexual Medicine Research at Boston University. They are also working on the role that hormones -- androgens and estrogens -- play in female sexual function, he said.

In addition, BU researchers are mapping the nerves in the genital region, said Dr. Abdul Traish, research director of the institute. But in general, he said, "We're just beginning to understand how hormones affect nerves, how nerves affect the vascular system."

Despite all the unknowns, a handful of medications for women are already making their way through batteries of tests and toward the market. Clinical trials of Viagra in women are in their third and final phase, and "it seems to work in selected women but it's more limited than in men," said Pfizer spokesman Daniel Watts.

Studies indicate that Viagra works best in women who have a normal hormone balance, said Andre T. Guay, director of The Center for Sexual Function at the Lahey Clinic North Shore in Peabody. Likewise, the hormonal creams and gels in the works seem to have similar limitations.

Meanwhile, researchers are riven by a battle royale over whether the search for a female Viagra amounts to the "medicalization" of arguably normal aspects of female sexuality: the waning of desire that can come with aging, for example, or after a child is born. The battle tends to pit psychologists against medical doctors, and women against men.

That battle seems irrelevant, however, to patients like 35-year-old Patty Apkarian of Methuen, who had enjoyed a great sex life for years and then suddenly found her desire flagging two years ago, not long after starting a new anti-depressant. Sex became painful, too.

"All of a sudden, a switch went off in my head, and oops, I'm not interested," she said.

Ultimately, Dr. Goldstein prescribed new topical hormone treatments, and though she is not quite as active with her husband as in the old days, "the desire's back," she said. "I'm chasing him."

Carey Goldberg can be reached at

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