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2001, lm­maker Liz Can­ner was asked by Amer­i­can phar­ma­ceu­ti­cal com­pany Vivus to help with tri­als of a new drug. Al­ista was a top­i­cal cream de­signed to rem­edy sex­ual dys­func­tion in women. It was branded, breath­lessly, as an “or­gasm cream”. Can­ner was com­mis­sioned to edit a se­ries of erotic videos which would be shown to women par­tic­i­pat­ing in early clin­i­cal tri­als. She was per­plexed, en­thralled, a lit­tle ap­palled. “How could I take this job? How could I not take this job?” she says. Ul­ti­mately, she agreed. She was in­ter­ested in the na­ture of fe­male de­sire, and a lit­tle weary of mak­ing lms about geno­cide and hu­man rights vi­o­la­tions. She had also gained per­mis­sion from Vivus to make a lm study of the process.

Through the course of her in­volve­ment with the Al­ista tri­als, Can­ner be­came con­fused about the na­ture of fe­male sex­ual dys­func­tion (FSD). She hadn’t re­ally come across the term be­fore she be­gan work­ing with Vivus, and yet the more she heard it in­voked the more con­fused she be­came. Can­ner ex­tended the lines of her en­quiry be­yond Vivus, and ended up de­vot­ing much of the next nine years to her lm Or­gasm Inc – a jewel of a doc­u­men­tary in­tended, Can­ner says, to “doc­u­ment the med­i­cal in­dus­try’s at­tempt to change our un­der­stand­ing of the mean­ing of health, ill­ness, de­sire and that ul­ti­mate moment – or­gasm.”

In it, Can­ner meets the CEOs and mar­ket­ing heads of dif­fer­ent drug com­pa­nies, and she meets doc­tors, sci­en­tists and ther­a­pists, all of whom are work­ing fren­ziedly to­ward pro­duc­ing and og­ging the key to the ul­ti­mate fe­male sex­ual ex­pe­ri­ence. She meets the cam­paign­ers who rage against the at­tempts to con­trol and med­i­calise women’s sex­u­al­ity. Most af­fect­ing of all, Can­ner meets the women who suf­fer – or who think they suf­fer – from FSD. She meets Charletta, a mid­dleaged woman, who says that when she thinks about or­gasms, she thinks in terms of “the war – the war in­side my head…” adding, “Not only am I not nor­mal, I am dis­eased.” Can­ner ac­com­pa­nies Charletta on an ap­point­ment to see a doc­tor who in­serts elec­trodes into her spine. This is a de­vice Stu­art Meloy MD calls his “Or­gas­ma­tron”; once it’s in place he prom­ises Charletta will or­gasm spon­ta­neously any time she wants. It doesn’t hap­pen. The Or­gas­ma­tron does, how­ever, make her left leg twitch wildly.

The world’s phar­ma­ceu­ti­cal com­pa­nies have been con­sumed by the race to nd a rem­edy for fe­male sex­ual dys­func­tion ever since the late 1990s when P zer gained FDA ap­proval for Vi­a­gra. Vi­a­gra – so very ef­fec­tive in the treat­ment of erec­tile dys­func­tion in men – has proved to be a “block­buster” drug: a bil­lion-dol­lar-gen­er­at­ing mar­vel of a prod­uct. It worked, it changed lives; it was a sexy drug, in ev­ery sense of the term. It be­came clear that there was a great deal of money and power in the

eld of sex­ual dys­func­tion. Money and power that could be mul­ti­plied, if the mar­ket were ex­panded – which it would be, if phar­ma­ceu­ti­cal com­pa­nies could sell drugs to women, as well as men.

Vivus had a par­tic­u­lar in­ter­est in tap­ping the mar­ket. In 1996, 14 months be­fore Vi­a­gra launched, Vivus gained FDA ap­proval for Muse – a sup­pos­i­tory which, when in­serted into the male ure­thra shortly be­fore sex, im­proved blood ow to the pe­nis, thus al­le­vi­at­ing the symp­toms of erec­tile dys­func­tion. Muse did ex­tremely good busi­ness un­til Vi­a­gra launched. It had sales of $130 mil­lion be­fore Vi­a­gra, and $59 mil­lion in the year af­ter­wards; these gures have dwin­dled ever since. Men pre­ferred a pill to a sup­pos­i­tory and aban­doned Muse en masse.

Around the same time, Le­land Wil­son, pres­i­dent and di­rec­tor of Vivus, gave a TV in­ter­view about sex­ual dys­func­tion and men­tioned in pass­ing that his com­pany was work­ing on con­cepts for drugs for fe­male sex­ual dys­func­tion. The stock price of Vivus went wild in re­sponse; Vivus be­gun work­ing in earnest on Al­ista. P zer, mean­while, be­gan work­ing hard on dis­cov­er­ing whether Vi­a­gra might work for women as well as men; Proc­ter & Gam­ble be­gan work­ing on a testos­terone patch called In­trinsa. Darby Stephens, Vivus’s man­ager of clin­i­cal re­search, es­ti­mated that at the time her com­pany was work­ing on Al­ista 12 phar­ma­ceu­ti­cal com­pa­nies were de­vel­op­ing al­ter­na­tive cures for FSD. “We are in a race to see who can be rst to mar­ket,” she said. Can­ner called it a gold rush.

All of which would be ne if any­one knew ex­actly what FSD was, whether or not it truly ex­ists and what cur­ing it might en­tail. At the be­gin­ning of Or­gasm Inc (sub­ti­tled The Strange Sci­ence of Fe­male Plea­sure), Vir­gil Place MD, the founder of Vivus, ad­dresses a meet­ing of his em­ploy­ees. “What does the name of the com­pany mean?” he asks. “It’s Latin for ‘alive’. I had the feel­ing that our ob­jec­tive was to put the life back into dead penises.” Place is play­ing for laughs – but he draws at­ten­tion to a signi cant is­sue. We know what a “dead” pe­nis looks like, and so we know what male sex­ual dys­func­tion looks like. We equally know an erect pe­nis when we see one, and so we have a de­cent mea­sure for the ef cacy of a drug de­signed to treat erec­tile dys­func­tion. But it’s much harder to quan­tify FSD. What is sex­ual dys­func­tion as far as women are concerned? Re­ally? It’s cat­e­gorised med­i­cally as a lack of arousal or de­sire to have sex; dys­pare­u­nia (pain or dis­com­fort dur­ing in­ter­course), di­min­ished blood ow to the vagina, and an in­abil­ity to achieve or­gasm.

It rst be­gan ap­pear­ing in med­i­cal dic­tio­nar­ies in the 1970s, but started gar­ner­ing se­ri­ous at­ten­tion and

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