Intended for healthcare professionals

Education And Debate

The marketing of a disease: female sexual dysfunction

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7484.192 (Published 20 January 2005) Cite this as: BMJ 2005;330:192

It is not only Big Pharma that says that female sexual dysfunction exists

Sir,

In the article by Moynihan on whether female sexual dysfunction is a
product of a pharmaceutical executives’ fevered imagination or not, he
makes the statement that there have been no published peer reviewed
articles on testosterone replacement in women. This incorrect, Jan
Shifren, who is quoted later in the article, herself had a Proctor and
Gamble sponsored trial published in the New England Journal of Medicine
(1).

Several independent authors have reported the prevalence of some form
of sexual dysfunction in women between 18 and 75 years of age in the
region of 40 to 45% (2-5). It is difficult to imagine that these authors
have all been ‘bought’ by Big Pharma. These studies show, amongst other
things, that those who suffer most, are those who have lower androgen
levels than those in whom sexual function is reported as ‘normal’

There is, however, broad agreement that there has previously been
inherent difficulty in establishing the ‘normal’ range for free and
bioavailable testosterone in women, because it is only recently that the
ultrasensitive assays have become available. Many of the assays used
previously have not been able to detect any circulating testosterone in
women. Thus, much of the initial data used to create the ‘normal range’
may not have taken this into account, and so it is highly likely that many
of the women used to establish ‘normal’ values had some form of sexual
dysfunction, with a large proportion having low testosterone levels. This,
however, would underestimate the true prevalence of this condition.

1. Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE,
Redmond GP et al. Transdermal testosterone treatment in women with
impaired sexual function after oophorectomy. N.Eng.J.Med. 2000;343:682-8.

2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United
States prevalence and predictors. JAMA 1999;281:537-44.

3. Nazareth I, Boynton P, King M. Problems with sexual function in
people attending London general practitioners: cross sectional study. BMJ
2003;327:423-8.

4. Guay AT,.Jacobson J. Decreased free testosterone and
dehydroepiandrosterone-sulfate (DHEA-S) levels in women with decreased
libido. J.Sex Marital Ther. 2002;28:129-42.

5. Mercer CH, Fenton KA, Johnson AM, Wellings K, Macdowall W,
McManus S et al. Sexual function problems and help seeking behaviour in
Britain: national probability sample survey. BMJ 2003;327:426-7.

Competing interests:
My NIH/Mayo Foundation funded research assessed the effects of the adrenal androgen precursor dehydroepiandrosterone on sexual function in hypoadrenal women and healthy elderly women.

Competing interests: No competing interests

24 January 2005
Ketan K Dhatariya
Consultant Endocrinologist
Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital, Norwich, NR4 6PR, UK