A common clinical problem

In this issue (p 138), Ray Moynihan argues that female sexual dysfunction is essentially an invention of big pharmaceutical companies. He accuses Procter and Gamble of aggressively marketing awareness of a type of sexual dysfunction—female hypoactive desire disorder—to create a need for its new drug, transdermal testosterone (Intrinsa), which recently failed to gain FDA approval. Moynihan further calls for less influence of marketing on decisions about this condition and its treatment. Clearly, we are well served as physicians and patients by maintaining our objectivity and seeking unbiased sources of health information. But I disagree with Moynihan about the diagnosis of female sexual dysfunction.

The most widely cited prevalence rate of 43% for female sexual dysfunction was actually derived through indirect means.1 Laumann et al applied a statistical technique (latent class analysis) to data from a survey of 1749 women and 1410 men. Far from being a big pharma initiative, this study was funded by the National Institutes of Health (NIH) and the Ford Foundation. The proportion of women who described lack of interest in sex was 27-32%, depending on their age group.1 A …