“Not tonight, dear. I have a headache.” Or not.

I’ve been thinking about what turns women–OK, me–on. And by turns me on I mean interested in engaging in getting busy with my main squeeze.  I’ve been pondering this for two reasons.

The first is that earlier this week an advisory committee recommended that the FDA approve Sprout Pharmaceuticals’s drug flibanserin to treat low libido in women. (Disclosure: My husband knows the founders of this company.) Unlike Viagra, the go-to drug for male sexual dysfunction, flibanserin doesn’t treat a clear cut physical problem. As Cindy Pearson, the executive director of the National Women’s Health Network, writes this week in the Washington Post:

Viagra addresses a physical problem by easing blood flow in men who desire sex but have difficulty functioning. Flibanserin, on the other hand, addresses arousal in women who lack sexual desire by targeting neurotransmitters in the brain, our most complex organ.

Flibanserin has been rejected twice before by FDA advisory committees. Previously the agency’s studies showed the drug isn’t very effective (only 10-12% of women taking the drug showed improvement) and has too many negative side effects. Its passage this week is attributed by many to intense lobbying by those who believe the FDA’s earlier rejections are rooted in sexism and that women’s sexual dysfunction is such a pervasive and serious condition that any steps toward addressing the problem are inherently beneficial.

Not everyone shares this view. Others have decried the medicalization of desire. Women’s desire is complex and its causes are subjective and variable. If you Google “women’s sexual desire”–and I have–you’ll come away thinking no one is clear on how and why women are turned on. One article I read used the terms “spontaneous” and “responsive” to describe different types of desire. Women, in general, have more of the latter than they do of the former.

If I had to choose, I’d side with the latest FDA decision. I’d rather patients have an option than not. If you never want to have sex and that is making you crazy, I’d rather your doctor be able to recommend a treatment–with all the caveats a good practitioner will–and see if it helps you. We won’t know if flibanserin works until far more patients at different places in their hormonal life (the studies haven’t looked at the drug in menopausal women, for example) use it.

That said, I suspect flibanserin won’t work to boost desire in most women who struggle to find an interest in having sex. If I work backwards from the often quoted–by me–statement that women who read romance novels have sex more often than women who don’t, that says to me that desire often comes from something external to women.

This brings me to the second reason I’ve been thinking about desire in women. A friend recently asked if I had any suggestions for something romantic he could do for his wife for her upcoming birthday. This couple has two children, both under twelve. I’ve never met his wife (they live elsewhere), so I wrote back I didn’t know what she might find appealing. However, I love giving advice, so I shared with him two instances when my husband swept me off my feet and why I think they worked. (Some day I’ll write a column about the most annoying things my husband has ever done but today is not that day.)

The first was a time, easily fifteen years ago, where my husband surprised me at a lunch date. I thought I was going to lunch to celebrate my birthday with a good friend. Instead, my husband was there–he’d arranged it with her. This was a time in our lives where he worked sixty hour work weeks at a busy teaching hospital. We never had lunch. After I got over my shock at seeing him in the middle of a workday, we sat down to eat and–this was an era before carbs terrorized diners–the wait brought us a basket of bread. I grabbed the loaf–why was there a loaf?–and realized something was off. I put the bread down on my plate and realized it was cut in two like a sub roll. I then opened the bread and discovered a long narrow jewelry box. In it was a bracelet I’d longed for months earlier.

And while the bracelet is beautiful what I really love about what my husband did is that at a time when spare time was something he had hardly any of –did I mention we had four kids under ten at the time?–he did something for me that took time. His effort made me feel resoundingly valued and had we not been in a public place…. You get my point. This is the sort of act that makes me want to get behind closed doors.

The other example was the night when, for our anniversary, we got a sitter for the evening, and went out to dinner at the new ritzy hotel that had recently been built in our town. After dinner, we checked into the hotel… for two hours. This was a time in our life when our first two children were small and I didn’t have anyone in town with whom I felt comfortable staying with them overnight. My husband had taken into account my discomfort and arranged a stay in a hotel that worked around it. That was sexy.

My friend wrote back he thought his wife would love the second example. Maybe she will, maybe she won’t. But whatever she loves–and whatever makes her or any of us desirous of right here, right now sexual intimacy–will be endemic to her and her current context. And I’m pretty sure a pill won’t be that thing.

But if it is, that’s great. We all deserve great sex. We all deserve to want great sex. And in the meantime, thank the gods for chocolate, wine, good friends, and romance novels.