What Do Women Want?: Adventures in the Science of Female Desire (16 page)

Yet there was the Australian study: on desire, new relationships trumped menopause, easily. And Goldstein spoke about how readily dryness and atrophy could be treated with estrogen supplements, with low and safe doses. Lubrication was restored, tissues regained health, but libido didn’t revive reliably. Stubbornly, the effects of hormones evaded logic. Sometimes desire seemed to hide itself from science.

He returned to talking about testosterone. He was among the thousands of doctors who provided it off-label, flouting the spirit if not the letter of the law. He didn’t hesitate to discuss this. He felt he had to do what he could for his patients. Women came to him after being dismissed by their family physicians, by other gynecologists. “If I had a nickel for every time a patient has said that her doctor told her, Just have a glass of wine.” He gave the hormone to women of all ages, though not indiscriminately—he used his own criteria, his own intuition, to try to figure out who it might benefit. He looked for low blood readings of testosterone, poorly predictive though he knew these to be. He weighed the histories he heard during his interviews, listened for the disappearance of erotic dreams. This, in his mind, was a telling sign: the evanescing of sex from the life of the unconscious. He dwelled on the clues he gathered, followed his hunches. He guessed that by proceeding in this way, he helped more than half the women he provided with the hormone. But that left a lot of his patients inexplicably unreached and a lot who didn’t qualify, by his calculus, for this treatment. And it left him reading dreams, practicing medicine by a system that was barely systematic.

This muddle, this imprecision, this inability to predict, lay within testosterone’s latest struggles with the FDA. In trials with a thousand women, a pharmaceutical company had collected data to back its product, Libigel. The product did seem to work—somewhat. On average, it made desire rise—undramatically. And yet in the trials, a fake gel, a placebo, had aided libido as much as the medicine. Self-persuasion seemed as potent as the drug.

A
round the fire pit or after the school bus, the chatter about Flibanserin was light, filigreed with a joke or two, the way Wendy liked talk to be. Yet with her friends gone, after wine or coffee, she felt something insidious, a helplessness, a foreboding, a sense that she would be unable to protect—to protect what? Not her marriage, not quite that. She trusted that she and her husband would remain together. It was, she said, love that needed saving. It was—she used the simplest of words—“happiness.” She wrestled to prevent desire’s further and further withdrawal.

After college, she’d met her husband at a sports bar, laughed with him over a foosball table, laughed more later that night as he clowned, concocting his own dances. This was in New York, where she lived for a few years, intending to return home to the Midwest, to marry there, to build a life close to her family. But she found herself unguarded with him, without need of hiding, which was new. She admired “the way he could make fun without making anyone feel bad.” And there were moments almost too inconsequential to be described. They had gone to a video store one evening, stood in a crowd waiting for the clerk to set out a batch of movies—and when the film she wanted appeared, she paused before reaching, to let someone else take it. He said that he liked what she’d done, and so many years afterward she still recalled his plain and half-shy praise, the pleasure he’d taken in her gesture. Gradually, as they dated, she had grown entranced by him, thinking, when they were out with other couples, I just want to get home with him, I just want to get home with him. And then they had created a home together, inside the three-bedroom brick colonial, a life she had never regretted. It was only that she was scared.

Years ago in their house, she had seized his hand and hurried him up the stairs. Now she waited, somewhat like prey though the predator was tender, though he was cherished. “He’ll move closer to me in bed, or put his arm around me, or rub my back.” Once a week he tried to reach through the invisible barriers she built; once a week she tried not to refuse him. And like an indestructible machine, she climaxed regularly when they did make love, as she always had. But the next night she returned to being the person she’d become, the woman who willed herself to sleep or focused intently on her book as he climbed the stairs. It was impossible to understand, how those stairs had changed.

U
nlike Libigel, Flibanserin tinkered directly with neurotransmitters, but its tinkering was too delicate. In trials, it didn’t do enough good to get past the FDA. Wendy and her friends had been accurate barometers. Other medications had other troubles. A few years before Wendy’s group got involved in such studies, a drug had arisen through happenstance. A team of University of Arizona researchers had been exploring a chemical as a sunless tanner, a compound that would fuel a set of pigmentation-producing cells in the skin called melanocytes. But when the scientists ran tests on a small number of men, they heard back from almost all with an unexpected response: sudden and stunningly rigid erections. And unlike the effects of Viagra, which were all about the hydraulics of the blood, the bronzer tilted the mind, left it reeling with lust. Viagra bestowed hardness where there was drive; the tanner, the researchers found, bestowed both.

No one was sure about everything the chemical did in the brain while it browned the body, but with each dose, the medial preoptic area of the hypothalamus, part of Pfaus’s “ground zero of desire,” sent extra dopamine coursing, for several hours, through gray matter. Not only did the appetite for sex shoot up, but the appetite for food was killed off. This fit with a known interconnection inside the subregions of the hypothalamus, with a relationship between the basic motivations: sex, food, sleep. If the desire for one gets overwhelming enough, the others stop mattering.

The company that bought the rights to the chemical believed it had something remarkable. It sculpted the compound, culling out what tanned and carving away what deadened the appeal of food, saving those effects for drugs to be developed later and concentrating first on sex. For a preliminary forecast of how well the medicine, christened Bremelanotide, might do, the company sent a box, via FedEx, to Pfaus, who sent the new molecule, via mini-skullcap, into his rats. The males sprouted erections at an extraordinary rate. This was good news for the company, given that Viagra and its chemical cousins don’t work for around one-third of impotent men. But what inspired corporate glee was the female reaction. The tallies of hops and darts, of head-pointings and prancings away, of climbing the hindside of a male and doing a demonstration hump—the utterances of
I crave you
in feminine rat parlance—soared.

Next the company turned to hundreds of women who lamented the state of their libidos. “I was one hundred percent into it.” They recorded their experiences in trials after absorbing Bremelanotide by way of a one-dose nasal inhaler. “I was tingling and throbbing.” “I was focused on sex; I wasn’t thinking about anything else.” “My climax was like it used to be.” “I was able to climax multiple times.” At the Maryland sex clinic where Wendy now got her EB pills, the psychologist in charge had also had high hopes for Bremelanotide. His center had taken part in those studies, and he remembered one woman inhaling the chemical, then sitting in the waiting room until she could have her vital signs checked for negative side effects. Overcome by metamorphosis in mind and genitals, she declared to everyone in earshot, “I’ve got to call my husband to make sure he’s home when I get there.”

The signs for Bremelanotide were spectacular. A major magazine put the drug on its cover with an illustrator’s vision of midtown Manhattan. Taxis had screeched to a halt. An orgy raged on hoods and windshields, on the roofs of buses, on the pavement of a traffic island.

But the snag, the Maryland psychologist recalled, was that some women weren’t celebrating in his waiting room; instead, a few were in his bathroom, vomiting in the stalls. Besides the bouts of nausea, blood pressure jumped in a small percentage of subjects. About halfway through the FDA process, with tens of millions still to spend on more trials, the company slunk away from its application, knowing it would never get approval for an aphrodisiac with those hazards. It had since moved on to studying an intravenous version, which didn’t seem to bring on queasiness or hypertension, though how many people would be willing to stab themselves with a needle for the sake of desire was a source of doubt.

And the company had always fretted about something else. In the initial phases with Bremelanotide, after seeing the randiness of the female rats, the euphoric reports pouring in from women, and the orgy on the magazine cover, company officials got frightened even as they were overjoyed. At meetings, Pfaus remembered, they anticipated that the drug might be too effective for the FDA, that the cover image of women splayed feverishly on cement, their legs hooked around strangers, would haunt the agency and scare it off. There was no telling whether the FDA would have raised the specter of sexual mayhem had the application reached a conclusive review, but the company huddled with researchers like Pfaus to ask if there were any data to suggest to the agency that the chemical’s impact would be “selective,” that Bremelanotide-sniffing wives and daughters wouldn’t “want to go off and do the football team.”

This resonated with what Goldstein recounted from his involvement with Flibanserin. In Flibanserin’s trials, he hadn’t taken his usual outsider’s role, interviewing women, dispensing medication. He’d been hired as an advisor by the corporation that owned the molecule; he’d been in on strategy sessions. “When you’re going to the FDA with this kind of drug, there’s the sense that you want your effects to be good but not too good,” he said. Too good hadn’t turned out to be Flibanserin’s problem, but, he explained, “There was a lot of discussion about it by the experts in the room, the need to show that you’re not turning women into nymphomaniacs. There’s a bias, a bias against—a fear of creating the sexually aggressive woman. There’s this idea of societal breakdown.”

W
ith her yellow and orange scarf wrapped under her chin, Wendy told the coordinator—who was keeping information up to date after checking about the missing entries in Wendy’s EB diary—that she seldom fantasized about other men. Even passing images were rare. “I’m very attracted to my husband,” she said to me, a steely undertone just scarcely audible in her chipper voice. It was the kind of answer I’d heard from some, though far from all, of the women I’d spoken with, as if their feelings for their partners needed safeguarding, were better left unbetrayed, even in their minds. They seemed to adhere, consciously or reflexively, to timeless rules about the way women should and shouldn’t be. Did this take its toll on the sexual circuits of neurotransmitters, which, like all our circuitry, can be reinforced and augmented, or allowed to whither, throughout life? Did the narrowness of erotic thoughts attenuate the channels on which these thoughts travel within the brain, thin the ranks of neurotransmitters that flash along these paths, lead, in turn, to more constriction of thinking? Did the lessons delivered to girls about what is and isn’t natural, normal, leave these circuits less sturdy from early on? And broaden opposing tracks, channels of serotonin that rush to quell unacceptable impulse?

“I
surreptitiously gaze at him from beneath my lashes as he stands in line waiting to be served. I could watch him all day. He’s tall, broad shouldered, and slim, and the way those pants hang from his hips.”

Wendy had just read
Fifty Shades of Grey
, the first book in the trilogy of erotica that was approaching, in America, twenty million copies sold, that was breaking records for weekly sales rates, that Wendy and so many others labeled and laughed about as “mommy porn.” It wasn’t her usual reading. She took in scenes like this as Anastasia, the heroine, recounts the beginnings of her sadomasochistic affair with Christian, his manner reticent and self-possessed, his fingers “graceful,” all of him “heart-stoppingly beautiful.”

“ ‘Does this mean you’re going to make love to me tonight, Christian?’ ”

“ ‘No, Anastasia, it doesn’t. First, I don’t make love. I fuck . . . hard.’ ”

And, soon, like this:

“I come instantly, again and again, falling apart beneath him as he continues to slam deliciously into me.”

And, later, like this, with Christian commanding her, “ ‘Hold out your hands in front as if you’re praying.’ . . . He takes a cable tie and fastens it around my wrists, tightening the plastic. ‘Hold onto the post,’ he says. . . . He stands behind me and grasps my hips. . . . He smacks me across my behind with his hand. . . . ‘Part your legs.’ . . . He reaches over me and grabs my braid near the end and winds it around his wrist to my nape, holding my head in place. Very slowly he eases into me, pulling my hair at the same time. . . . His other hand grabs my hip, holding tight, and then he slams into me, jolting me forward. . . . I grip the post harder. . . . He continues his merciless onslaught. . . . My scalp is getting sore from his tugging my hair. . . . I fear my orgasm. . . . If I come I’ll collapse. . . . His breathing harsh . . . slamming really deep . . . my name on his lips. . . . I become all body and spiraling sensation and sweet, sweet release, and then completely and utterly mindless.”

While Wendy read on her iPad, a storm knocked out power on her block for a week; this jumbled her family’s routines and left them sleeping at a neighbor’s house, so there was no telling, she said, whether the book would have accomplished what Flibanserin and her first set of EB pills didn’t, whether some of the quickening it caused would have seeped into her feelings for her husband. That week, her life was too much of a mess. She guessed that
Fifty Shades
would have accomplished something, if the circumstances had been different—maybe not all she hoped for from the drugs, but something.

Meana—as Christian’s self-possession gave way to “groaning,” “slamming,” and as Anastasia, bound, bent, became purely object—lay close. But I was thinking of Pfaus’s perspective. “Dopamine, dopamine, dopamine,” he said about the book’s impact. “
Fifty Shades
is activating the whole neurochemical soup of wanting.” For Wendy, it was like a series of injections, lasting hours, into a mind that habitually kept fantasy and its neural effects at bay.