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Sexual Chemistry - programme transcript
DR GILL SAMUELS (Pfizer Ltd): This is Viagra. This is the first sample that was made of Viagra. NARRATOR (DILLY BARLOW): It is five years since Viagra was launched on the world. Heralded as a miracle cure by millions, it has changed forever our perception of male sexual dysfunction. But giving men erections is only half the story. The question is: can modern medicine do for women what Viagra CRAIG ZIEGLER: But I know it works for me. Whether it's going to do anything for her or not NARRATOR: This is the story of how science is at last starting to understand the essence of male and female sexuality - and is trying to learn how to fix it when it goes wrong. NARRATOR: Frances Quirk seemed to have it all: a successful career, a happy marriage and lovely children. Then one day she came back from a business trip and something had clearly changed. FRANCES QUIRK: All of the, the sort of feelings that I'd had before about, you know, wanting to make love with my husband, feeling like having sex, feeling sexy just disappeared. They'd just sort of switched off. There was just this sort of nothing where before there had been something quite powerful for me and it was almost as if, you know, there was a little button somewhere with my name underneath, you know, Frances's sex drive and somebody had just pressed it and turned it off because it was that dramatic and it was really quite scary. NARRATOR: Frances is not alone. Karen Speck is a mother with three children. Her problems started KAREN SPECK: He was a big baby, he was like 11½lbs and I had a Caesarean and well you know yourself when you're trying to get over having a Caesarean it's a bit hard ain't it, do you know what I mean, but I just didn't want to do anything at all, do you know what I mean, there was no desire there, no loving, no nothing. Was strange 'cos I've always been sexually active and I've always liked the intimacy, the passion, the touching, pleasing each other and like I said before, having the orgasm at the end of it, but to have that go out the window completely I didn't even want to masturbate meself or anything 'cos it just wasn't there, the appeal wasn't there, the desire or anything like that. It just wasn't NARRATOR: Until very recently doctors just didn't understand the difficulties of women like Karen. But now there are signs that help may be at hand. Science is at last nearing the end of a long quest to understand sexual problems, in both men and women. That quest began, of course, with men for one PROF JEREMY HEATON (Queen's University, Kingston, Ontario): The man has a penis that is an obvious culprit in sexual dysfunction. If you don't have an erection you don't have sex and that focussed people's attention on correcting erections and it was, therefore, the man that was the focus of all research at that point. NARRATOR: Craig and Dorothea Ziegler have been happily married for 40 years. Then seven years CRAIG ZIEGLER: The male impotence thing, nobody talks about it. As time went on there were just, you know, my erection was not as firm… CRAIG ZIEGLER: Erect as it should have been and you know I guess it's a man thing. It started bothering me and I finally decided to go to the doctor. I guess I was a little apprehensive. NARRATOR: Suffering from impotence can make men feel depressed. But until very recently most doctors believed that depression and anxiety were the cause not the symptom. DR FRIEDMAN (Horizon, 1972): Most sexual problems are caused by anxiety, well over 95% of sexual problems are psychogenic - concern about performance, concern about manliness, concern about ageing, concern about have I made her pregnant, concern about living up to her orgasmic expectations. NARRATOR: With only a basic understanding of male sexuality, for decades impotent men were either sent to psychiatrists or told to just pull their socks up. CAR ADVERT VOICE-OVER: What a girl, what a night, what a car! NARRATOR: But in the American state of Georgia one of history's most unlikely medical innovators didn't accept that his impotence was in his mind. He was convinced that it was a simple physical problem with a simple physical solution. Geddings Osbon, known publicly for his tyre retreading service, applied himself in private to the problem medicine had ignored: how to physically get an JULIAN OSBON (Son of Geddings Osbon): His doctor was a good doctor, and he said Mr. Osbon, we don't know what causes erection problems, or impotence, we don't know what to do about it, my recommendation is that you appreciate the years you've had with your wife and all the loving years and all the children and forget about it. The only thing he knew about was maybe taking a small pump. This time he got a regular bicycle pump. This tube is tubing that was used on the windshield wipers of cars. This metal valve is the kind of metal valve you find on truck tyres. He reversed the cylinder in here to make it to where when he pulled up it created negative pressure, but he found that if he could take this tube here and connect it that he could pull the air out of the cylinder, so then he would place this against his body and he would pull up and then it would pour blood into the penis and in the NARRATOR: Geddings Osbon achieved mechanically what the body normally does itself, drawing blood into the spongy erectile tissue running the length of the penis. When naturally filled with blood the penis maintains the erection by closing the veins. Osbon used a rubber band. JULIAN OSBON: As you can see on the cylinder he would measure his success in his ability to create vacuum to get the fullest engorgement possible. NARRATOR: The device was put into production and some doctors still prescribe it today, but it was JEREMY HEATON: There are a lot of details with the vacuum erection device, or the pump, that make it unattractive. You have a band to keep the blood in the penis which can interfere with ejaculation and can be uncomfortable and if you leave it on and it's too tight you can actually cause damage. NARRATOR: But for many years the vacuum pump was the only solution available for men with erection problems. Then 20 years ago a British neuroscientist flew to Las Vegas for an international meeting of specialists. A packed conference room of urologists were in for a rude awakening. PROF ALVARO MORALES (Queen's University, Kingston, Ontario): He excused himself for a few minutes. He disappeared and he came back, he was wearing a funny kind of pants - it's a long time ago - like running pants and then he explained to us that he had injected himself with Phenoxybenzamine and he was going to show us what happened when you do that, and he proceeded to drop his pants in front of the audience and he had a very respectable erection. NARRATOR: The injection was a turning point. This was the first time doctors had found a drug which could give men back their erections. It was finally becoming clear that impotence was not all in MAN: This image is measuring the diameter of the vessel itself. NARRATOR: And when they started to investigate, they learnt that there were clear physical causes of impotence, including some very common conditions, like thickening of the arteries, high blood- pressure and some types of diabetes. Among those who've used the injection is Craig Ziegler, but right from the start it became clear that it was still not the ideal solution. CRAIG ZIEGLER: I didn't really know what to expect. We went, the doctor talked to us for a couple of minutes. He said, you know, he was going to give me the first injection, show me how to do it, and they needed to know the strength of the medication. It just kept growing and growing and growing CRAIG ZIEGLER: Arousal, no touching or anything. I mean I became very erect and you know I sat there a couple of min, I guess 5 minutes, 10 minutes, I don't remember the exact time and the doctor came back in and he said, you know, the erection's very firm. What I need you to do now is tell me how long this thing lasts and that was it. Get dressed, go home, do whatever. Well we live about an hour away from where the doctor, 45 minutes away, so Dot decided she wanted to go shopping for patio furniture which became quite a sort of a fun type thing for both of us because as we're shopping and of course I'm walking around in shorts with an erection trying to hide it and it was, it was quite an ordeal DOROTHEA ZIEGLER: We're riding up the road and I kind of. CRAIG ZIEGLER: …and she'd reach over to see how firm it still was. CRAIG ZIEGLER: .and you know we're sort of looking at our watch and seeing how long… CRAIG ZIEGLER: .it would last and it was actually to the point of being uncomfortable. NARRATOR: The injections revolutionised the lives of many men. You give yourself the injection and you get an erection - simple and practical. But because it gave an instant erection it just didn't feed into the natural rhythm of sex. What was needed was a treatment that was less disruptive to love- making, something altogether simpler, like a pill. Viagra, the fastest selling pill in history, was about to be born without its makers even knowing what it would be used for. Eighteen years ago the drug company Pfizer began to search for a chemical capable of relaxing blood vessels in the heart to relieve the pain of angina. And eventually they found a drug that might just do the trick and started human trials. But things didn't go quite as expected. DR IAN OSTERLOH (Pfizer Ltd): In the seventh clinical trial the desired effects on the blood-pressure were rather less than we had expected, but there was also an interesting side-effect reported to us which was increased erections by some of the volunteers. NARRATOR: What they found was the drug did indeed relax blood vessels by blocking a specific chemical process in the body. It's just that the process wasn't happening in the heart. GILL SAMUELS: What we discovered in the seventh study of our programme was that this compound had, or might have, an effect more selectively in the penis. NARRATOR: Pfizer suddenly realised they might be on the verge of a major medical advance. Unwittingly they had become sexual pioneers. GILL SAMUELS: We had an observation in the clinic, we had our own science and we had emerging data from external investigators, so it was a very exciting time. You were right at the cutting edge of, of NARRATOR: So studies were started in Bristol and they were some of the most unusual clinical trials in history. The researchers had to create a library of explicit pornographic films in the hospital and to be certain they were as sexually stimulating as possible. IAN OSTERLOH: The design of the first study in men with erection difficulties was very important. We deliberately built into it a period of sexual stimulation with erotic videos during which the response of the penis would be monitored. If we hadn't done that, if there'd been no erotic videos or other stimulation then almost certainly the drug would have done very little, the results would have been negative and that would have been the end of the story. NARRATOR: And so they began to piece together how Viagra worked. When aroused by feeling sexy, a chemical messenger called cyclic GMP is produced in the penis. This leads to blood entering the penis which causes an erection. In impotent men the erectile tissue doesn't get enough cyclic GMP. Levels of cyclic GMP are normally controlled by an enzyme which works as a chemical off switch by constantly breaking it down. Viagra was found to block the enzyme off switch allowing more of the cyclic GMP to get through. And best of all, Viagra would only work in a sexual situation, it would only turn you on when you wanted to be. IAN OSTERLOH: And that's the beauty of this approach to treatment. When there's no stimulation and no chemical signal there's nothing for the drug to block. When there is a chemical signal and the enzyme in the body is breaking it down the drug blocks that enzyme, allows the signal to build up and there's a better chance of getting and keeping an erection. NARRATOR: Five years ago Viagra was launched and no-one could have guessed the impact it would have. NEWS MONTAGE: Viagra mania, a new prescription for love… …it's one of the fastest selling drugs in history. Viagra, the so-called miracle pill… CRAIG ZIEGLER: You could not pick up a newspaper without reading about Viagra. DR JIM PFAUS (Concordia University, Montreal): The more people talked about it the more they wanted it. The more they wanted it the more they talked about it. NEWS MONTAGE: (DANISH) …States a new pill to treat impotence is being hailed as a wonder drug after being on sale for less than a month. JIM PFAUS: People were astonished, right. The potential, the promise to affect the lives of millions who could now be able to have normal sex. CRAIG ZIEGLER: Dot said to me you ought to see about that, you know, it's got to be easier than giving yourself an injection. JEREMY HEATON: They all wanted to come into the clinic, they all wanted to try it. Very quickly we understood that this really was an excellent solution for a large number of these men. JIM PFAUS: It really began what many people have called the second sexual revolution. NARRATOR: Since its launch, over 20 million men have been prescribed Viagra. Pfizer has made almost $6bn, an impressive return for a pill that they weren't even looking for. Then, as Viagra was hitting the shelves, people started wondering if, in fact, it could become twice the drug. Men had their little blue pill. Would a little pink pill help women with sexual problems? DOROTHEA ZIEGLER: We decided to buy some stock in Pfizer when all this Viagra stuff came out, so we were kind of doing that. We got on the Internet, we just started looking at different things that were going on about Viagra and we saw some little blurps about Viagra for women which I hadn't even really thought about. NARRATOR: In their marriage Craig isn't alone in having problems with sex. Fifteen years ago Dorothea had a hysterectomy in which her womb and her ovaries were removed. Since then she has DOROTHEA ZIEGLER: I noticed right away that I had lost the sexual feeling in my breasts and the doctor told me that that was not possible, that having a hysterectomy and removal of the ovaries had nothing to do with that and that it was all in my head. NARRATOR: Dorothea found the change in her sexual feelings to be every bit as devastating for her as Craig's impotence was for him. DOROTHEA ZIEGLER: Outwardly I look fine, but inwardly I feel very empty since I've had everything removed, sexually and I feel that I'm at the bottom of the barrel. If there's anything out there that I could possibly do that would help in the sex area that we could still have, or that I could still have, orgasms naturally I would really like to be involved in that and if Viagra is the way then so be it. NARRATOR: Dorothea enrolled in one of the first studies looking at whether Viagra might work for DR JENNIFER BERMAN (Urologist): Hi Dorothea, how are you? NARRATOR: The study was run by Jennifer Berman, one of the first doctors to take a serious look at female sexuality in a medical environment. DR JENNIFER BERMAN: Being a woman in a urologic field, which is a male-dominated field, we do see predominantly mostly men and I deal with erections every day. I just have been thinking all along early through my training why don't we, you know, address women in the same manner, why don't we have the same understanding of female anatomy that we have of the male pelvis, why doesn't anyone ask women questions regarding their sexual function? NARRATOR: Research began some years ago and soon it revealed that the physical sexual response of men and women was, in fact, very similar. By looking at vaginal tissue in the lab they discovered that the chemicals of arousal in men and women are the same. But that was not all. They also found that the clitoris is more similar to the penis than we'd realised. Both are made of erectile tissue and recent research has revealed that the clitoris is a much bigger internal organ than previously thought, wrapping around the outside of the vagina and reaching back into the body. When the vagina responds to sexual stimulation its smooth muscle relaxes, dilating the vaginal walls bringing blood into the area which in turn brings lubrication. Because of this remarkable similarity the hope was that Viagra would help women with sexual problems just as it had helped men. JENNIFER BERMAN: You're going to have to wait an hour, as you know, for the pill to take effect… NARRATOR: This was Dorothea's third and final visit of the trial. JENNIFER BERMAN: Right, so we'll take you up to see Gail, OK. NARRATOR: She'd felt nothing with the first two pills, so Dorothea hoped that they were just inactive placebos and that this time she'd been given the real drug. To see if the pill helped Dorothea, Gail, a nurse on the team, used an ultrasound probe to measure her level of vaginal blood flow. But for Viagra to work Dorothea first had to be sexually stimulated. And that meant there was something she had to DOROTHEA ZIEGLER: Then they say well now we're going to leave you alone for 15 minutes and we want you to stimulate the area and it's like you want me to do what, huh? DOROTHEA ZIEGLER: Is my face red you know? GAIL SANDAGER: You know, it's, it's a little red, but usually the Viagra red is a, is a hot, you know NARRATOR: By the end of the trial it was clear that Dorothea had not responded to Viagra. DOROTHEA ZIEGLER: I'm not getting the feeling that I would like to get. It's, it's a cold feeling basically of, of something that's supposed to be a warm, fuzzy. It's just the opposite. NARRATOR: The vaginal blood flow reading confirmed what Dorothea already knew. GAIL SANDAGER: I don't observe much of a change and you can probably hear with your own ears NARRATOR: Although Dorothea hadn't responded to Viagra in the clinic, the hope was she might at DOROTHEA ZIEGLER: But I'm still hopeful that when I get to use the pill at home in a more natural setting that the results will be better than they were in the hospital setting. NARRATOR: But again things didn't work out as she'd hoped. DOROTHEA ZIEGLER: Lit candles, you know, set the whole scene, the music and everything. For me, you know, there were no rockets. I cried, I really did, I just cried. I said, you know, it didn't work. NARRATOR: Although it hadn't worked for Dorothea, Pfizer funded two much larger studies looking IAN OSTERLOH: When we got the results of the two large multi-centre studies in women the results were negative and it was so disappointing for the whole team. There was a lot of expectation that we would at least find one of the trials working, or a sub-set of patients who were working, but results were uniformly negative and our investigators could almost not believe it. NARRATOR: Since then there have been more studies and Viagra has been shown to be effective in women with spinal cord injury and some very specific problems with vaginal blood flow. But overall the results are revealing that the little pink pill is not going to live up to the media hype. IAN OSTERLOH: From what we know today it seems possible that there may be a specific group of women with problems of blood flow to the pelvic organs for which Viagra might be helpful, but there's a lot of other sexual disorders in women for which this treatment is very unlikely to be helpful. PROF JULIA HEIMAN (University of Washington): Viagra in women so far has clearly shown that it's not as broadly effective in women as it is in men. However, for a sub-group of women it may be very helpful and very effective, but it's, for those people who were hoping for the Viagra revolution to be of a similar intensity in women as in men those people are disappointed. NARRATOR: This realisation has not just been a blow to Pfizer, but also to the millions of women with sexual problems. Despite all the physical similarities between male and female sexual organs, it's clear that female sexuality is very different from men's. If women were ever to get medical help then science had to understand them better. One of the crucial clues to this difference came from work by the pioneering Dutch psychologist, Ellen Laan. She monitored healthy women's physical response whilst they watched two types of erotic video. One made by a woman and one made by a man. ELLEN LAAN (University of Amsterdam): The differences between the clips are not in sexual activity, but more in the way the woman is portrayed in the films. For instance, in the woman-friendly film the woman is clearly enjoying what is going on. She takes the initiative, the focus is on her pleasure, whereas in the male-oriented films you see the women portrayed as, you know, not having a lot of fun and just doing all the hard work so to speak and the focus is on his pleasure. NARRATOR: What Ellen found was that the women's vaginas showed all the signs of physical arousal, such as increased blood flow, no matter which film they watched. But the women only reported being turned on by the video made by the woman. ELLEN LAAN: What we found was that there was no differences in vaginal blood flow at all, but there were subjective differences. Women reported higher levels of subjective sexual arousal or more sexual feelings to the woman-friendly film and less arousal feelings to the male-oriented film. NARRATOR: In other words, Ellen's study revealed that in women the sexual response is less to do with straight physical issues like blood flow and is more about the mind. ELLEN LAAN: If you really want to know if a woman is sexually aroused you shouldn't assess what's going on in her genitals. You should just ask her if she wants to have sex. NARRATOR: So this is why Viagra helps men, but probably won't help the vast majority of women. In men blood flow to the penis is at the heart of their sexual response. But for women it seems that there can be a schism between the body and the mind. The problem for many women, it appears, is not physical, but a loss of desire. There are many reasons for a loss of desire. it can be caused by taking the contraceptive pill and some anti-depressants, by hormonal changes and, of course, by unhappy relationships. And sometimes there is no clear explanation at all. And that is what makes it so difficult to deal with. With so many different causes there seemed to be no obvious single cure. As Frances found, with neither an obvious physical problem nor any clear solution, her lack of desire was difficult for her husband to understand. FRANCES QUIRK: I worked really hard to explain to my husband that it wasn't about him at all, not about him, him as a lover or a man or, you know, my partner. It was, you know, something almost completely separate from that, you know that was still there for me very much so, but just the feelings that I had had before that I really did assume were mine had just gone. It certainly crossed his mind that, you know, maybe I had had a relationship with somebody whilst I was away, you know, on business I'd had an affair and that that was the reason for the change in my behaviour. NARRATOR: Frances turned out to be lucky. In her case her doctors quickly found a clear medical FRANCES QUIRK: It became apparent that my thyroid function was abnormally low and one of the consequences of a low thyroid is your sex drive switches off, so, you know in a way for me that was a really great explanation. Here it was a medical problem, all I needed to do was to take a supplement on a daily basis and I would in a way be back to normal. If I hadn't had a medical problem that was the explanation and there wasn't treatment for that then oh boy would I have been devastated. KAREN SPECK: Right ladies, everything alright? NARRATOR: But for many other women there is no clear medical solution, so the problem can drag on and on. With Karen it led to the breakdown of her relationship. KAREN SPECK: There was tension there because obviously he'd say like little jibes and I'd react on it and I would feel bad because I wasn't playing my part as like a partner would in the sexual side of it, so there was a lot of tension in the end. It didn't seem like it to start off with, but as the time went past it obviously progressed and that's when like the rows started and it just progressed from there. NARRATOR: There is currently no drug available to treat women with a general loss of desire. But there is possibly a breakthrough on the horizon. And ironically that breakthrough may have come about through problems not with women but men. The person responsible is not part of a major medical institution and he's not even a doctor. Ian Russell is a nurse who has specialised in sexual dysfunction for over 15 years. He works out of Dumfries & Galloway Royal Infirmary, but his patch covers a 2,500 square mile area of rural Scotland. IAN RUSSELL (Dumfries & Galloway NHS Trust): I live in a very nice part of southwest Scotland. I'm very fortunate that we can work in this environment and that does allow us to look closer at the patient. We actually probably see more in the patients and in the problems that they present with than you may do working in a city environment where you're very busy, you have vast clinics, you have not a lot of time. We have time to look, we have time to search. NARRATOR: A year ago Ian began to treat some of his male patients with a new drug for impotence. Marketed as Uprima, apomorphine was launched with none of the media hype associated with the little blue pill. But it didn't go completely unnoticed. A few newspapers did pick up on the crucial difference in the way it was working. While Viagra works on the penis, apomorphine works on the brain. Apomorphine mimics the action of one of the chemical messengers found in the brain called dopamine and dopamine acts directly on an area of the brain called the hypothalamus. JIM PFAUS: Tucked away deep in the brain is a structure known as the hypothalamus. The hypothalamus is the seat of all of our drives including sex. Cells in this particular region here control things like erection and ejaculation. The area is packed with dopamine receptors. NARRATOR: By mimicking the action of dopamine apomorphine strengthens the signal the hypothalamus sends out to the body to have an erection. And then Ian noticed something unexpected. IAN RUSSELL: Myself and others discovered that if you take apomorphine on a regular basis you do get erectile function. The patient gets their erection back, but not only did we find that, we found this increase in interest, this increase in desire. NARRATOR: It was the first drug he had come across that seemed to increase desire. Ian just couldn't IAN RUSSELL: One evening in the bath, which seems to be the only place that I get time to think these days, I had been reading an article on female sexual response and thinking about things I suddenly thought well, it's working in the male, we know that it's given this increase in interest, what would it do for a woman? Would it increase their desire and I pondered over it in the bath and within an hour I had phoned a colleague. He thought I was quite mad. It's a drug for men, it's been developed for that, he didn't think it would have any implication in females at all. NARRATOR: But Ian was convinced he was on to something. So at a conference in Monaco he plucked up the courage to approach the man who had developed apomorphine, Jeremy Heaton, a world IAN RUSSELL: At the end of the day I'm a small fish in a very large pond and my perception of, of this NARRATOR: But it turned out that Ian was not quite as small a fish as he thought. Jeremy knew all IAN RUSSELL: On an escalator going up Jeremy Heaton was coming down. JEREMY HEATON: Ian's not hard to recognise with the ponytail and the Scottish accent. He turns up going on the up escalator as I'm going on the down escalator and you must be Ian Russell. NARRATOR: Soon the expert and the nurse were in deep conversation. And Jeremy was soon hearing things about the drug he had developed that fascinated him. JEREMY HEATON: One of the important things that independent investigators bring to an area like this is they can think out of the box and if you're not involved in medical politics and so on and you're just simply working with the patients that you have in front of you you have natural ideas and, ideas and you do the natural things to try and test these ideas. NARRATOR: Thanks to that meeting Ian was able to get the go-ahead to start his own small study looking at women who were going through the menopause. IAN RUSSELL: Over the past six weeks how often did you feel sexual desire or sexual interest. How often were you interested in sexual activity. Now we've designed a very small… NARRATOR: All the women had reported a loss of desire. IAN RUSSELL: The gynaecologist's written here that you seem to have a lack of interest. Is, has that been a problem? PATIENT: It has. Recently I feel, I really don't fancy it much at all. NARRATOR: First he took a detailed history to exclude those women whose problems had an obvious IAN RUSSELL: The ladies were brought in, they were assessed clinically, physically, social and psychologically. They were given questionnaires to use looking at their sexual function and their perceptions of their sexual function, libido, desire, arousal, pain, discomfort etc. NARRATOR: They filled in those questionnaires at home in their own time. IAN RUSSELL: …my contact number, my colleague's contact number you feel free to phone us any NARRATOR: They then came back to the clinic where they were given a prescription for the apomorphine. Every six weeks they were assessed, filled in the questionnaire again and were given an increased dose of the drug. At the end of the 18 week study Ian and his colleagues analysed the questionnaires to see if the apomorphine had helped. IAN RUSSELL: The results were astonishing. We found an increase in arousal, we found an increase in desire and we also found an increase, and probably more importantly, in overall satisfaction in sexual activity for the patient. NARRATOR: The results really were remarkable. It was potentially a huge breakthrough in helping women with a loss of desire. However, it was only a tiny study and might just have been a freak result. But there are some reasons to think not. Recent research into the brain of rats shows a clear link between dopamine and areas in the brain that control our emotions, including desire. JIM PFAUS: We've actually come a long way since we believed that the hypothalamus was the be all and end all of sex. In fact dopamine in the hypothalamus is not the only player. Dopamine elsewhere in the brain plays a critical role in the motivation to have sex. This region under the cortex here is the limbic system, the emotional brain. The limbic system is packed full of dopamine receptors in several different key areas. One of those areas, a small kind of broad-beam shaped area packed deep within here, is full of dopamine receptors and it's an area where desire is. This would be the area where drugs like apomorphine would be active to produce an increase in desire. NARRATOR: Ian Russell's work is still in its infancy, but last year he unveiled the results of his small study at a conference in Montreal. This time everyone listened. JEREMY HEATON: This is the way you do good science. You have a hypothesis, give the drug and you make good observations and Ian's clearly made good observations here. JULIA HEIMAN: Apomorphine is indeed an interesting drug. It's been shown to work in, in men and so there is some promise for it working in women. It has an effect on the brain, it's a dopaminergic and so people are starting to test it right now and there's some indication that it might be helpful. We have to wait until there's really controlled double blind studies before we know. NARRATOR: Ian has started just such a study looking at the effect of apomorphine in over 300 women, from the young to those who have been through the menopause. The study will be completed next year and will give a much clearer ideas of whether he really has found something that will help IAN RUSSELL: I would like to think that maybe 18 months/two years from now we will have the all being, all knowing drug, or potentially a pathway for the all being, all knowing drug, all sorting drug for women, or at least it's a start and that's the positive thing. It's a start. The door's now open. NARRATOR: What is certain is that the brain is now one of the hottest areas for those looking at female sexual problems. Amongst those leading the way is Professor Julia Heiman and her collaborators at the University of Washington. JULIA HEIMAN: What we're really looking for is what areas of the brain might be important to female sexual arousal and desire and this is just the beginning to try to understand that. NARRATOR: Julia and her collaborators are the first to monitor the brains of normal, healthy women NARRATOR: They also image the women's brains while they watch neutral material. DR KEN MARAVILLA: These are the images after they've been processed in the computer… NARRATOR: They then use a computer programme to analyse the data. JULIA HEIMAN: Seems like a few of the same areas are lighting up across subjects. JULIA: Pretty clear image of the amygdala. NARRATOR: They are starting to uncover whole areas of the brain that may be linked to the female sexual response. JULIA HEIMAN: The MRI scans are indicating that there are several areas of the brain that may be important in terms of sexual arousal and desire and there's the, that they're engaged and that other areas actually are inhibited and so it's going to be fascinating to try and find out what exactly is the process that really goes on among these areas of the brain as we try to understand sexual arousal and NARRATOR: Though it is still early days, it really does seem that the brain could be a key to helping some women with a loss of desire. Pharmaceutical companies are already developing new drugs specifically designed to target desire. It means that for women like Frances, now three years into her thyroid treatment, things could get even better. FRANCES QUIRK: What's actually happened is that I'm not quite back to normal. My sex drive now is not as high as it was before. It's a hell of a lot better and, you know, in, in a way that I can live with and that my husband is happy with, but it isn't the same as it was before entirely. NARRATOR: In Karen's case her desire came back without the need for prescription drugs, as it does for many women. Karen is now in a new relationship. KAREN SPECK: I can honestly say I've fallen in love with him. You know when you hear other people saying oh, you know, that's too soon, but it has happened and the love-making and the sex, or whatever you want to call it, is hot.

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