For many women, the ebb and flow of sexual desire can significantly impact various aspects of their lives, including relationships, emotional well-being, and personal confidence. These fluctuations are often linked to a variety of factors such as changing relationship dynamics, persistent stress levels, and physiological phases such as pregnancy and menopause. However, approximately 10% of women experience a persistent, low sex drive that ultimately leads to feelings of distress and discontent. This condition is medically recognized as hypoactive sexual desire disorder (HSDD), and it can greatly affect quality of life.
Historically, treatment options for HSDD were limited to over-the-counter supplements, many of which demonstrated only modest and largely unverified effectiveness. Thankfully, the medical landscape has evolved, and in recent years, the FDA has granted approval for two prescription medications specifically designed to address HSDD. These treatments are frequently dubbed “female Viagra,” a reference that acknowledges the well-known erectile dysfunction drug available for men. Yet, it is important to understand that these treatments function in fundamentally different ways within the female body.
Dr. Judith Volkar, MD, a specialist at UPMC Magee-Womens Hospital in Pittsburgh, elucidates this distinction by comparing Viagra's function to resolving a plumbing issue. “In men, Viagra fixes a ‘plumbing problem,’” she explains, “by directly addressing erectile dysfunction. These men often still possess a sexual desire, but they are unable to achieve the necessary physical response during intimate moments.” The mechanism of action for Viagra involves relaxing the muscles in the penis and enhancing blood flow to facilitate an erection.
In stark contrast, the intricacies of low libido in women present a far more complex problem. “I often say you can picture men’s sexual desire as a light switch, and women’s sexual desire as the cockpit of a 747,” Dr. Volkar states, highlighting the multifaceted nature of female sexual arousal and desire. Numerous psychological, emotional, and physiological factors interplay in influencing a woman’s libido, requiring a more nuanced and comprehensive approach to effective treatment.
The two FDA-approved medications specifically designed to treat HSDD are as follows:
- Flibanserin (Addyi): This medication is administered in pill form and taken daily in the evening, regardless of whether sexual activity is anticipated.
- Bremelanotide (Vyleesi): This treatment involves self-administering an injection in the abdomen or thigh approximately 45 minutes before sexual activity. Notably, only one injection is permitted within a 24-hour period, with a maximum of eight injections recommended for any given month.
Mechanism of Action. Both of these medications enhance the levels of key neurotransmitters in the brain that play a vital role in sexual arousal. Flibanserin must be taken consistently, regardless of sexual activity, while bremelanotide is reserved for when the need arises. It’s vital to note that neither drug enhances sexual performance or pleasure directly; instead, they simply increase the likelihood of a woman feeling in the mood.
In conjunction with these medications, your healthcare provider may suggest complementary practices such as sex education and counseling, which can provide additional support. Additionally, if a woman faces other physical issues affecting sexual function, hormone therapy may also be recommended as a component of her treatment plan.
Obtaining the Medications. To receive a prescription for either flibanserin or bremelanotide, a physician must formally diagnose you with HSDD. This diagnosis typically involves a series of screening questions, which may include:
• Have you previously been satisfied with your sexual desire?
• Has there been a noticeable decline in your sex drive?
• Does the lack of libido cause you distress?
• Would you prefer to increase your sexual desire?
• Are any external factors (such as medication usage, pregnancy, or stress) potentially impacting your libido?
A “yes” to the first four inquiries, in the absence of other identified causes for low sex drive, may indicate HSDD. Dr. Volkar emphasizes that the emotional distress associated with a woman’s sexual desire is often the primary motivating factor for pursuing medical treatment. “If you aren’t bothered by it, it’s not a problem,” she explains.
Furthermore, it is crucial for the physician to determine whether the low libido is related to the woman’s current life situation or intimacy with her partner. “You can’t fix HSDD if the underlying issue is dissatisfaction with your relationship,” Dr. Volkar states.
Financial Considerations. Coverage for HSDD medications may vary among insurance providers. Although your personal financial responsibility will largely depend on your specific health plan, the out-of-pocket expense for flibanserin is roughly $100 for a month’s supply of 30 pills, highlighting the importance of discussing financial options with your healthcare provider.
Choosing the Right Medication. When considering which treatment option is most suitable, it is essential to evaluate individual lifestyle preferences and comfort levels. The two medications present distinct concerns and risks, and the choice between them is highly personal. “Some women have no interest in injections, while others prefer not to take a daily pill,” Dr. Volkar notes, indicating the necessity of consulting with your doctor to determine the ideal course of action.
It is important to recognize that clinical research has primarily focused on the efficacy of these medications in women who are not yet postmenopausal. As such, the FDA has only approved both drugs for premenopausal women. Women who are pregnant or nursing should avoid using either medication.
Additionally, certain individuals should refrain from using these treatments, including those who:
- Have liver disease
- Have cardiovascular disease
- Take medication for HIV, hepatitis C, or uncontrolled high blood pressure
“Both medications can interact with various commonly prescribed drugs,” Dr. Volkar warns, citing fluconazole (Diflucan, used for treating yeast infections) as an example, alongside certain antibiotics. It is prudent to maintain an open dialogue with your physician regarding any medications you are currently taking to avoid potential complications.
Women prescribed HSDD medications are advised to abstain from consuming alcohol from two hours prior to taking the medication until the following morning, as combining the two can result in dangerously low blood pressure levels.
Notably, the medications can produce side effects, including:
- Nausea
- Headache
- Flushing, characterized by red, warm skin
- Dizziness and sensations of fainting
- Fatigue
- Dry mouth
Furthermore, bremelanotide may lead to darkening of the skin and gums.
To evaluate the efficacy of these drugs in treating HSDD, medical professionals typically monitor changes in sexual desire and any reduction in associated distress. Dr. Volkar notes that flibanserin generally leads to an additional sexually significant event per month, although individual interpretations of this statistic may vary.
“It depends on how you define success,” she adds. “Is that progress, or is it not satisfactory? I encourage my patients to define what improvement means for them personally.”
There is no universal standard for sexual frequency or desire; thus, a reduction in distress related to a woman’s sexual drive can often serve as a reliable indicator of treatment effectiveness.
If, after an 8-week trial period on the medication, there is no observable change, your healthcare provider may suggest discontinuing the treatment.
In conclusion, Dr. Volkar believes that while these medications may not provide a perfect solution, the emergence of two treatment options for HSDD marks a positive advancement in addressing women's sexual health. “I am encouraged by the growing research into medications aimed at enhancing female sexual desire. Although we’re not there yet, this is a significant first step toward progress,” she states.