Key to Female Viagra Seems a Brain Teaser
By MARLENE CIMONS, Times Staff Writer
Sunday, March 21, 1999
W ASHINGTON--Elizabeth Belt
remembers holding the two pale-blue,
diamond-shaped pills in the palm of her hand
before swallowing them and thinking: "Please
God, let this work."
The 35-year-old Richmond, Ind., woman has been desperately
unhappy for years over the sexual problems she has suffered since
undergoing routine gynecological surgery when she was 19.
Belt now pins her hopes on Viagra, the hot-selling impotence pill
for men. Although the first published study of Viagra in women
proved less dramatic than anticipated, the sizzling market it created
among men has sent researchers and drug companies racing to find
its female equivalent.
"The world is finally coming around for women," said Dr.
Jennifer Berman, a urologist who runs the Women's Sexual Health
Clinic at Boston University with her sister, Laura Berman, a
psychotherapist.
But the search for a female Viagra has led researchers to an
important conclusion: The key to improving sexual function in
women may lie in stimulating the libido. For women, scientists are
finding, the most important organ for sexual function may be the
brain.
"Viagra is really, literally, a functionally acting drug--it does
something mechanically," said Roland Gerritsen van der Hoop, vice
president of clinical operations for Solvay Pharmaceuticals in
Atlanta, one of the companies testing a libido-enhancing drug for
women. "It won't work if desire isn't there."
Dr. Steven A. Kaplan, a urologist at New York Presbyterian
Hospital who conducted the first published study of Viagra in
women, agreed that enhancing desire could be more important for
women than increasing blood flow to the primary sex organs.
"Many women define sexual pleasure as
arousal without orgasm and some disassociate
desire and arousal from the act of intercourse," Kaplan said.
The winning drug could produce an enormous windfall. Viagra,
which Pfizer Pharmaceuticals put on the market last spring, enjoyed
$788 million in sales last year. The market for women may be even
more promising. A recently released study found that four of every
10 American women are having problems in the bedroom.
One libido-enhancing drug currently being tested in clinical trials
among women is a chemical called apomorphine, which stimulates
the brain.
It is a pill that will be sold under the name Uprima and it has
already been studied--and judged effective--for increasing men's
sexual desire. The company plans to seek Food and Drug
Administration approval for men later this year. It could take several
additional years before it is approved for women.
Another drug that could win the race for a female Viagra has
been on the market for 35 years.
The hormonal combination known as Estratest, made by Solvay
Pharmaceuticals, is a mixture of estrogen and male androgens used
to treat symptoms of menopause. Women taking it have reported a
most pleasurable side effect: an increase in sexual desire.
Kaplan's Viagra study, which was conducted on 30
post-menopausal women, showed that only about a quarter of the
women experienced significant changes. The results were
disappointing to some, but Kaplan noted that larger studies on other
groups of women are needed before any conclusions about Viagra
in women can be made. In the meantime, he said, improvement was
"certainly significant in those women."
Pfizer has launched a study of the drug in
several hundred European women.
And some clinics are giving Viagra to women already. The
Bermans have been treating sexually dysfunctional women in their
Boston clinic with a combination of approaches, including Viagra.
They have found that Viagra seems to work best in certain women
and not at all in others.
"The women who benefit most are women who were able to
become aroused before," Laura Berman said. "If they have never
been able to become aroused or have an orgasm, Viagra is not
extremely useful. It's not a libido pill. It's not something that
enhances desire."
For Elizabeth Belt, who is engaged to be married, the trouble
started 16 years ago after a routine dilation and curettage, a
procedure involving scraping the walls of the uterus, after a
miscarriage.
But the surgery apparently caused nerve damage within her
vagina, causing her to lose all sensation there. In recent years, she
began to experience a similar numbness in other genital areas. She
was evaluated at the Bermans' Boston clinic in February. After
taking Viagra, she said, sensation has started to return.
"I'm hopeful now," she said. "Before, I didn't have any hope at
all. I just thought, 'I'm going to be like this forever.' "
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