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On the other side of the FSD divide, allied with the pharmaceutical companies, is a group of physicians who are prescribing off-label treatments for women vexed by their sex lives. (Off-label means the drug hasn't been approved by the FDA for that specific treatment.) The highest-profile of the bunch is Irwin Goldstein, the director of sexual medicine at San Diego's Alvarado Hospital. He and Tiefer have debated the topic of FSD for a decade, but as far as he's concerned, there's really nothing to discuss. He's been using hormones to treat women, and he'll happily put you in touch with patients who will rhapsodize about the results.

It's tricky business

On one point everyone agrees: The search for pink Viagra is proving trickier than anticipated. So far it's been one flameout after another.

There was PT-141, by Palatin Technologies of New Jersey, a drug inhaled via nasal spray and found, in preliminary tests, to produce friskiness in men and women, leading to buzz in 2005 that people would soon be able to snort themselves into the mood.

Nuh-uh. In August, the FDA stopped clinical testing, citing concerns about a side effect: high blood pressure.

There was Intrinsa, a patch made by Procter & Gamble that transmitted testosterone into the bloodstream through the skin. (Testosterone, associated with sex drive, is produced naturally in women, though in far lower quantities than in men.) Also dinged by the FDA.

With men, all a medication needs to produce is arousal, aka an erection. A guy will conjure lust on his own. A woman, on the other hand, can get aroused -- or have the physical signs of arousal -- and remain uninterested in sex. That's why Viagra doesn't work for women, even though it produces roughly the same physical effect -- rushing blood to the nether regions -- on them as on men.

Arousal for women does not always lead to desire.

"What we know is that very little of what's going on with women and sex is below the waist," says Anita Clayton, a professor at the University of Virginia's Center for Psychiatric Clinical Research and co-author of "Satisfaction: Women, Sex and the Quest for Intimacy." "Almost all of it is above the neck."

This brings you to another complexity: If lust is "above the neck" for women, how exactly do you measure it? To win the pink Viagra sweepstakes, the FDA wants data demonstrating an increase in the number of a woman's "sexually satisfying events." But that's hard to define and fantastically varied, and it doesn't necessarily translate as "orgasm."

So pink Viagra must clear a higher hurdle than Viagra ever did -- it has to spark desire that also leads to satisfying events. To Clayton, it seems as if the government has set a standard that is unreasonably high -- perhaps because the government doesn't want to see a desire drug marketed to women, for vaguely puritanical reasons.

"It's as though the government is worried women will be turned into nymphomaniacs," she says.

Promising ideas

A number of drug companies say they can clear the FDA's bar, no matter how high. In January, 100 clinical trials began across the country for LibiGel, a testosterone gel made by BioSante. Women rub a dab of LibiGel into their upper arms once a day. (It builds up testosterone levels over the course of months.) A German company, Boehringer Ingelheim, discovered that a drug it developed for depression didn't lift anyone's mood but boosted desire in women. It hopes to win FDA approval for the drug in 2009.

The sooner the better, say many physicians in the field of sex medicine. They describe FSD as a kind of silent epidemic, particularly among postmenopausal women. Surveys on this issue, like just about every issue related to sex, vary widely in their results, depending on how you phrase the question. A recent paper in the journal American Family Physician combed through a bunch of surveys and decided that anywhere between 10 percent and 46 percent of women suffer from "hypoactive sexual desire disorder," a term often used for FSD.

Other studies have found that most women who are distressed by their sex lives are too embarrassed to discuss it with their doctors. Those who do speak up are often told they need a shrink.

"When I started this field in the '70s, 90 percent of the treatment was psychological," says Irwin Goldstein. "It was just assumed that every couple needed therapy."

The success of Viagra changed that. Viagra redefined impotence as "erectile dysfunction" and revealed that a lot of men didn't need to plumb their psyches at all; they needed a pill.

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