For many women, sexual desire can fluctuate significantly throughout their lives, often in response to various factors such as relationships, stress levels, and significant physical experiences, including pregnancy and the transition into menopause. While it is common for desire to vary, approximately 10% of women experience a persistent low sex drive that leads to distress, a condition known formally as hypoactive sexual desire disorder (HSDD). It is crucial to understand that HSDD is not just a fleeting issue but a real medical concern that can affect a woman’s quality of life and emotional well-being.
In addressing this issue, there are several over-the-counter supplements that claim to alleviate the symptoms associated with low sexual desire. However, most of these supplements lack robust scientific backing, resulting in limited and often unproven effectiveness. In a significant development, the FDA has recently approved two prescription medications specifically designed to treat HSDD. These medications are frequently referred to as “female Viagra,” which draws a parallel to the popular erectile dysfunction drug used by men. However, it's essential to note that these medications operate through entirely different mechanisms within the body.
As Dr. Judith Volkar from UPMC Magee-Womens Hospital in Pittsburgh explains, “In men, Viagra addresses a mechanical issue.” This highlights the distinct difference between male and female sexual health challenges. Viagra and comparable medications work by resolving erectile dysfunction, which affects a man's ability to achieve or maintain an erection firm enough for sexual activity. Interestingly, these men typically still possess sexual desire, but when the actual physical response is absent, these medications help by relaxing penile muscles and enhancing blood flow, thereby facilitating an erection.
Conversely, when examining women's sexual health, the complexities around low libido become apparent. “I often say that men’s sexual desire can be likened to a light switch, whereas women’s sexual desire resembles the cockpit of a 747,” Dr. Volkar remarks. This analogy underscores the multitude of factors influencing female sexual desire, making treatment for HSDD a more nuanced and multifaceted process.
The FDA-approved medications available for the treatment of HSDD include:
- Flibanserin (Addyi): This medication is taken as a pill every evening regardless of sexual activity.
- Bremelanotide (Vyleesi): This is administered via injection into the abdomen or thigh 45 minutes prior to sexual intercourse, with a limit of one injection per 24 hours, and a recommendation of no more than eight injections per month.
How these medications function: Both flibanserin and bremelanotide enhance the activity of neurotransmitters within the brain that play a crucial role in sexual arousal. While flibanserin is taken daily to maintain an elevated state conducive to desire, bremelanotide is intended for situational use, injected prior to desired sexual encounters. Importantly, these medications do not enhance sexual experiences; instead, they aim to increase the likelihood of feeling in the mood for intimacy.
In addition to pharmacological options, your healthcare provider may suggest incorporating sex education and counseling as part of a comprehensive treatment plan. Addressing physical issues that may hinder sexual enjoyment, such as vaginal dryness, may also involve hormone therapy.
How to access these medications: To obtain a prescription for either medication, a formal diagnosis of HSDD is required from your healthcare provider. This typically involves answering specific screening questions, such as:
• Have you previously felt satisfied with your level of sexual desire?
• Has your interest in sex diminished over time?
• Do you find your lack of libido to be distressing?
• Is there a desire for your libido to improve?
• Are there other factors (like medication, pregnancy, or stress) affecting your sexual interest?
If you answer affirmatively to the first four questions and no other underlying causes for low sex drive are identified, it is likely that HSDD is present.
According to Dr. Volkar, the level of distress a woman feels regarding her libido often dictates the necessity for medical intervention. “If your lack of interest doesn't disturb you, there is no problem,” she states, highlighting the subjective nature of sexual well-being.
Additionally, healthcare providers will assess whether the condition is related to the current relationship dynamics. Dr. Volkar emphasizes, “You cannot effectively treat HSDD if the root issue is dissatisfaction with your partner.”
What are the costs associated with these medications? Some insurance providers may cover the costs related to medications for HSDD. The amount you pay out-of-pocket will depend on your specific insurance plan, but the average cost for a month’s supply of flibanserin is approximately $100 for 30 pills.
Choosing the right medication: Each of the approved drugs comes with distinct concerns and potential risks, making the choice largely dependent on which aligns better with your lifestyle preferences. “Some women prefer not to have injections, while others may not want to take a daily pill,” says Dr. Volkar. Engage in a dialogue with your healthcare provider to determine the most suitable option for your situation.
It is important to note that research predominantly focuses on the efficacy of these medications in women who have not yet reached menopause, hence both drugs are FDA-approved only for premenopausal women. Pregnant or breastfeeding women are explicitly advised against using either medication for safety reasons.
Moreover, certain populations should refrain from using these medications due to potential health risks, including:
- Individuals with serious liver disease
- Those diagnosed with cardiovascular disease
- Patients on medications for HIV, hepatitis C, or uncontrolled high blood pressure
“These medications can interact with various commonly prescribed drugs, including fluconazole (Diflucan), an antifungal medication, and certain antibiotics,” Dr. Volkar advises. Therefore, it’s critical to have open discussions regarding all medications you are taking with your healthcare provider before initiating treatment.
Women receiving treatment for HSDD are strongly advised to avoid alcohol consumption starting two hours before taking the medication until the next morning to mitigate the risk of dangerously low blood pressure.
Side effects associated with these medications may include:
- Nausea
- Headaches
- Flushing (redness and warmth of the skin)
- Dizziness and potential fainting
- Fatigue
- Dry mouth
It is also noteworthy that bremelanotide may lead to changes in skin pigmentation, including darkening of skin and gums.
To assess the efficacy of these drugs in treating HSDD, doctors typically monitor whether there has been an increase in sexual desire and a corresponding decrease in distress related to low libido. Dr. Volkar explains that flibanserin usually results in “one additional sexually significant event per month.” This metric may be interpreted as a success by some and a disappointment by others.
“Ultimately, it relies on individual perspectives,” she explains. “What may be deemed substantial for one person might not hold the same significance for another. During consultations, I often encourage patients to determine their own definitions of progress.”
There is no universal standard for the amount of sex or desire that constitutes a healthy sexual life. Consequently, a notable reduction in the distress a woman experiences regarding her sex drive can serve as a vital indicator of treatment success.
If a patient tries a medication for eight weeks without noticing any change, healthcare providers may recommend discontinuing its use.
In summary, Dr. Volkar asserts that although the available treatments are not flawless, the introduction of two medications to the market marks a positive development in addressing women's sexual health. “It’s encouraging to see research finally focusing on medications that cater to women's needs regarding sexual desire,” she remarks. “While we may not have a comprehensive solution yet, this represents a crucial first step in the right direction.”