Cacchioni, T.Big Pharma, Women, and the Labour of Love. Toronto: University of Toronto Press. 2015. 184pp. $50 ISBN‐10 1442611375 (hbk) $21.95 ISBN 13: 978‐1442611375 (pbk) $21.95 ISBN 978–1‐4426–1137–5 (ebk)

In the summer of 2015, the US Food and Drug Administration (FDA) finally approved female Viagra (the pink pill) as a ‘fix’ for female ‘sexual dysfunction’. This decision was made after rejecting the drug twice due to its limited effectiveness as a sex ‘corrector’ drug. Should we consider this drug as a sexual enhancer for women and a solution to women's ‘sexual problems’? Does the drug offer women a sense of choice and equality and what does this mean for how we understand women's sexual experiences? Although Big Pharma, Women and the Labour of Love was published before the FDA's final approval, it is a key reference for responding to the above questions. Cacchioni's important book sits at the intersection of medical sociology and the sociology of sexualities. It explores diagnostic procedures of female sexual dysfunction, the medicalisation of women's sexual problems, and the influence of pharmaceutical companies in this process. Using empirical data, Cacchioni examines the impact of pharmaceutical companies on women's sexual expectations and norms, exploring how women's sexual problems are constructed in the sexual pharmaceutical era when a woman's voice has rarely been heard. The vivid narratives illustrate women's understanding of their sexual problems and the strategies they use to address them in their everyday lives. Moreover, by conducting in-depth interviews with the practitioners who treat these women, and attending sex-related community events for women experiencing sexual pain, Cacchioni explores the ways that medical and sexual experts maintain a heteronormative definition of sexual desire. By connecting feminist and sociological arguments on sex and medicalisation with an analysis of heteronormativity, Cacchioni challenges the pervasiveness of the medicalisation of heterosexuality which constructs norms that remain relatively unachievable without the use of drugs. The book is organised into six chapters and an epilogue. Chapter 1 chronicles the making of a sexual enhancement drug which involves oversimplifying our understanding of human sexuality. Drug companies first ‘make the illness’ and then manufacture and commercialise their products to fix the problem. Chapter 2 develops this discussion by concentrating on the treatment of women who experience sexual pain as an example of validating penetrative sex, even if the women themselves are not willing in this act. In this chapter, Cacchioni unfolds a nuanced and critical evaluation of medical experts’ strategies (medicalisation, demedicalisation, and do it yourself) for sexual pain treatment. In Chapter 3, Cacchioni challenges the definition of normal and successful heterosexuality and elaborates on how it can restrict women's experience of sexual pleasure. Chapters 4 and 5 make wider claims on the commodification, liberalisation, and medicalisation of sexual relationships which, by creating gold standards for sexual pleasure and desire, make pleasurable sex complicated for women. These two chapters develop the literature on ‘sex work,’ tailoring women's sexual response to fit sexual norms, and Cacchioni identifies three types of sex work in this respect: ‘discipline work,’ performance work and ‘avoidance work.’ Discipline work intends to change a woman's mental and physical sexual response by strategies such as sex therapy and taking medicine. Women, also, may engage in performance work by faking orgasm and avoidance work by practicing sexual avoidance strategies. Chapter 4 analyses the accounts of participants who actively tried to achieve the gold standard of heteronormativity and Chapter 5 explores the ways in which some participants challenged these standards. In her final chapter, Cacchioni makes a case for critically considering the relationship and connections between medicalisation and heteronormativity. Throughout this book, Cacchioni challenges the dominant theory that sees ‘hypoactive sexual desire disorder’ as a derivative of biomedicine. Instead, she tries to relate female sex and sexual responses to broader sociocultural conditions and changes in the pharmaceutical-related sex era. She scrutinises the ways that drug companies try to gain support - such as funding certain research projects, using social media, and creating their own clinics - in order to create a market of women who identify themselves as having hypoactive sexual desire disorder. Cacchioni's analyses are carefully nuanced, tending to emphasise the complexity of sexuality while connecting with frequently opposed domains. Cacchioni was among the activists who campaigned against the approval of the drug. Therefore, her knowledge of the field and impressive documentation contributes to the development of a sophisticated understanding of the growth of pharma-sex and its critiques. As a feminist sociologist, she argues that cultural expectations of sexual desire, pleasurable sex, and heterosexuality have a critical impact on women's experience of sex. Cacchioni insightfully characterises this as the paradox of the post-feminist age and highlights the importance of exploring women's lived experience in order to understand sexual pleasure from their point of view. In sum, Cacchioni's book is an interesting and engaging read for sociologists, medical practitioners, sexologists and women who identify themselves with sexual problems.

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