For many women, the ebb and flow of sexual desire fluctuates greatly over the years, often correlated with significant changes in personal relationships, emotional stressors, and various physical transitions such as pregnancy and menopause. However, it’s estimated that roughly 10% of women experience a low sex drive that leads to emotional distress and impacts their quality of life. This condition is medically recognized as hypoactive sexual desire disorder (HSDD), which can be both confusing and frustrating for those who suffer from it.
While there are several over-the-counter supplements claiming to alleviate this issue, the effectiveness of these products is largely unproven and inconsistent at best. In more recent years, the FDA has approved two specific prescription medications designed to treat HSDD. These treatments are often colloquially referred to as “female Viagra,” drawing a parallel to the well-known medication used by men for sexual health issues. However, despite the namesake, these medications operate through entirely different mechanisms within the body.
“In men, Viagra addresses what could be described as a plumbing issue,” explains Dr. Judith Volkar, MD, from UPMC Magee-Womens Hospital in Pittsburgh. Medications like Viagra and similar drugs target erectile dysfunction, which is a condition where a man struggles to achieve or maintain an erection that is sufficient for sexual activity. Even when facing this challenge, many men continue to have sexual desires; the issue lies in their physical ability to respond at the moment. The medications function by relaxing the muscles in the penis and enhancing blood flow, allowing for a successful erection.
In contrast, the situation regarding low libido in women is considerably more complex. “I often make the analogy that a man’s sexual desire can be likened to a simple light switch, while a woman’s sexual desire resembles the intricate controls of a 747 cockpit,” she illustrates. “Various factors crucially influence female sexual desire, making it a multifaceted aspect to address.”
This complexity necessitates a more sophisticated and tailored approach when treating HSDD, as the therapeutic options must reflect the nuances of female sexuality.
The FDA-approved medications specifically for HSDD include:
- Flibanserin (Addyi): This is a daily oral medication that is taken every evening, regardless of whether sexual activity is planned.
- Bremelanotide (Vyleesi): This treatment involves a self-administered injection into the abdomen or thigh approximately 45 minutes prior to engaging in sexual activity. Only one injection is permitted within a 24-hour period, and medical professionals recommend limiting usage to a maximum of eight shots per month.
How they work. Both of these medications enhance the functioning of essential chemical messengers in the brain, known as neurotransmitters, which play a pivotal role in arousal and sexual desire. While flibanserin is taken daily, bremelanotide is used on an as-needed basis. However, it’s essential to understand that neither of these drugs is intended to improve sexual experiences directly; instead, they aim to increase the likelihood of feeling sexually interested.
Your healthcare provider may suggest integrating sex education and counseling along with the prescribed medication as part of a comprehensive treatment plan. Additionally, hormone therapy may be recommended if there are underlying physical issues contributing to sexual dysfunction, such as vaginal dryness or hormonal imbalances.
How do I get them? In order to receive a prescription for either medication, your doctor must formally diagnose you with HSDD. This diagnosis process typically includes asking a series of screening questions, such as:
• Have you previously been satisfied with your sexual desire?
• Have you noticed a decrease in your sex drive?
• Does the lack of libido cause you emotional distress?
• Would you like your sexual desire to increase?
• Are there external factors (medications, life circumstances, surgery, stress) contributing to your low sex drive?
If you respond affirmatively to the first four questions and no other identifiable cause for your low libido exists, it is likely that you have HSDD.
Dr. Volkar emphasizes that the distress women experience regarding their sexual drive plays a crucial role in determining whether they need medication. “If you find that this is not bothering you, then it’s not an issue that requires intervention,” she notes.
Furthermore, your doctor may want to explore whether the feelings related to your sex drive are connected to your current relationship or personal circumstances. “It’s important to address relationship dynamics, as prescribing medication won’t resolve HSDD if the source of the problem is dissatisfaction with your partner,” she points out.
What’s the cost? Some health insurance providers may cover the cost of medications for HSDD, but out-of-pocket expenses can vary broadly depending on individual plans. For reference, the typical cost for flibanserin can average around $100 for a month’s supply of 30 pills.
Which one is right for me?When deciding between the two drugs, it’s essential to consider their unique benefits and potential risks. The choice ultimately depends on what aligns best with your lifestyle preferences. “Some women may strongly prefer not to deal with injections,” Dr. Volkar states. “Conversely, others might find it inconvenient to take a daily pill.” Consulting with your healthcare provider is crucial in determining which option may be the most suitable for you.
It is noteworthy that most research on these medications has predominantly focused on women prior to menopause. Consequently, both drugs have only been FDA-approved for use in premenopausal women. Furthermore, women who are pregnant or breastfeeding are advised against using either of these treatments due to safety concerns.
Additionally, certain populations should avoid using these medications. This includes individuals who:
- Are diagnosed with liver disease
- Have existing cardiovascular conditions
- Are undergoing treatment for HIV, hepatitis C, or have poorly controlled hypertension
“These medications can interact with various commonly prescribed drugs, such as fluconazole (Diflucan), a medication used for treating yeast infections, as well as certain antibiotics,” Dr. Volkar explains, highlighting the importance of discussing current medications with your healthcare provider.
Women who are prescribed HSDD medications are also advised to avoid alcohol consumption beginning two hours prior to taking the medication and continuing until the following morning to prevent dangerously low blood pressure levels.
The medications can lead to side effects, which may include:
- Nausea
- Headache
- Flushing (red, warm skin)
- Dizziness and a risk of fainting
- Fatigue
- Dry mouth
Notably, bremelanotide has also been shown to cause darkening of the skin and gums in some users.
To evaluate the effectiveness of these medications in treating HSDD, healthcare providers typically monitor changes in sexual desire and any reduction in distress associated with it. Dr. Volkar notes that flibanserin generally results in an increase of “one additional sexually significant event per month.” While this may be perceived as a success by some, others may regard it as insufficient.
“It ultimately hinges on individual expectations,” she explains. “Is that considered impressive, or does it seem lacking? When I counsel my patients, I allow them to define success for themselves based on their unique perspectives.”
There is no universally accepted standard for the frequency of sexual activity or desire. Thus, a significant decrease in the distress a woman experiences regarding her sexual drive often serves as a crucial indicator of treatment efficacy.
If the prescribed medication does not yield noticeable changes within an 8-week timeframe, your healthcare provider might suggest discontinuing its use, evaluating if other options may be more beneficial.
In conclusion, Dr. Volkar emphasizes that while these therapies may not provide absolute solutions, the availability of two medications specifically aimed at addressing women's sexual desire represents a pivotal advancement in women's health. “I believe it’s a significant milestone that we are finally investing in research pertaining to female sexual desire,” she remarks. “While we may not have all the answers yet, this certainly constitutes an important step forward.”