After decades of neglect, drugmakers are closer than ever to finding a prescription for a malady in millions of women: lack of sexual desire.

For Jean Toth of Cleveland, going through menopause was bad enough, but the worst part came afterward: She lost all interest in sex. Her lack of desire–a problem afflicting millions of women and straining millions of marriages around the world–almost broke up her relationship with her boyfriend of 19 years. “It was like Ididn’t even want him to put his arm around me,” she says, “because then he’d want more–and I wasn’t about to go further.” Nothing worked for Toth, a 56-year-old tax analyst, not creams or herbal elixirs or sex toys, not even a romantic getaway to the Bahamas.



Then she heard a radio ad about a new drug trial for women with low libido and joined up in early 2003. Soon after placing a testosterone patch on her bare hip, she noticed a startling change. “I felt normal again,” she recalls. “Very much so,” says her beau, George Burrington, 65. They used to have sex maybe four times a year; now they do it as often as possible, sometimes daily.



The mystery of what turns women on has eluded husbands and boyfriends, even women themselves, for centuries. In medieval times men were said to push herbs, mushrooms and other purportedly aphrodisiacal potions on women. When Madame de Pompadour became Louis XV’s mistress in 1745, she drank hot chocolate to warm up her desire. In more recent times drug companies had other priorities, and women were left to fend for themselves.



But medical breakthroughs in treating female sexual dysfunction suddenly are imminent, thanks to a surge in research fueled by the Viagra revolution. A dozen drug firms, from Procter &Gamble to obscure biotech boutiques, now are in later-stage patient trials of a spate of treatments for both the body and the brain. “The bell has rung,” says Leland F. Wilson, chief executive at Vivus, in Mountain View, Calif.



Curiously, raising sexual desire in disinterested women may entail making them a bit more like men. Vivus now is in middle-stage trials of a metered-dose spray of testosterone, the “male” hormone. It also is signing up women for final-phase trials of Alista, which contains a blood vessel dilator that, oddly, is similar to a natural component of men’s semen. The main ingredient may also affect genital tissue while amplifying nerve sensations and sexual receptors in the brain.



Some advocates see a $3 billion-a-year market looming, while some sex therapists and other doubters question whether female sexual dysfunction is even a disease and whether it warrants the risk of side effects that new drugs pose. “There’s really no comprehensive research on the necessity of these drugs,” says Leonore Tiefer, a clinical psychologist at New York University medical school. Tiefer runs a Web site that debunks “myths” she says the drug industry has perpetuated about women and sex problems. Shere Hite, author of the seminal 1976 book The Hite Report, which found that thousands of women were sexually dissatisfied, says drugs can’t offset bad technique. “Drug companies will be disappointed in their long-term sales,” she says. “While their drugs may at first create desire, they will not create the satisfaction of that desire.”



The first treatment for female desire–Intrinsa, the P&G testosterone patch that reignited Jean Toth’s interest in sex–could win federal approval within months. In September the Food & Drug Administration granted P&G fast-track “priority review”; an advisory panel could rule on the patch in December. Developed jointly with Watson Pharmaceuticals, P&G’s patch is applied to the abdomen twice a week and releases 300 micrograms a day of testosterone into the bloodstream, matching the level produced by many women in their peak reproductive years. The testosterone is believed to stimulate cells in both the genitals and the brain, prompting a physical response as well as desire and sexual fantasies.One Phase III trial of 562 women found the patch led to a 74% increase in the frequency of “satisfying sexual activity.” (Then again, a placebo yielded a 33% increase.) In another trial of similar size the patch led to 51% more sex.



Initially P&G will aim Intrinsa at a narrow target: more than a million women in the U.S. who have had their ovaries removed and say they are distressed by the low sexual desire that followed. The ultimate market could be far bigger: Some 20 million women are believed to have lackluster libido; 10 million women have had their ovaries removed, reducing desire; 52 million have gone through natural menopause.



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