Many women face changing levels of sexual desire, influenced by factors such as emotional relationships, daily stressors, and significant biological changes such as pregnancy and menopause. Approximately 10% of women may struggle with low sexual desire, a condition known as hypoactive sexual desire disorder (HSDD), which can have profound effects on their quality of life.
While a variety of over-the-counter supplements claim to resolve these issues, research often indicates that their effectiveness is limited or unverified. Recently, the FDA has approved two prescription medications, commonly referred to as “women's Viagra,” designed specifically to treat HSDD. However, these treatments differ fundamentally from those used for male erectile dysfunction.
“Men's Viagra solves a physiological problem by enhancing blood flow, enabling the necessary physical response for sexual activity,” explains Dr. Judith Volkar from UPMC Magee-Womens Hospital. Women's libido is often influenced by more complex and multifaceted factors.
For women, a lack of libido doesn't merely arise from physical issues; it involves a multitude of emotional and psychological factors. Dr. Volkar further clarifies, “The dynamics of female sexual desire are akin to the complexities of an airplane cockpit, requiring a nuanced approach to treatment.”
Currently, the FDA has sanctioned two significant treatments for HSDD:
- Flibanserin (Addyi): This medication is taken daily, ideally every evening.
- Bremelanotide (Vyleesi): Administered through an injection in the abdomen or thigh approximately 45 minutes before sexual activity, but limited to one dose every 24 hours.
Mechanism of Action: Both treatments aim to enhance neurotransmitter activity in the brain, which is pivotal for sexual arousal. Flibanserin is taken daily regardless of sexual plans, while bremelanotide is used on an as-needed basis. It is important to understand that these medications do not inherently enhance sexual experiences; rather, they serve to increase the likelihood of arousal occurring.
In addition to medication, healthcare practitioners may recommend comprehensive strategies incorporating sex education and therapy as complementary treatments. Hormone therapy may also be indicated if hormonal imbalances contribute to symptoms like vaginal dryness.
Accessing These Medications: A formal diagnosis of HSDD by a healthcare provider is necessary before obtaining prescriptions for these medications. Common screening questions may include:
- Have you previously felt satisfied with your sexual desire?
- Has there been a noticeable decline in your sexual interest?
- Does this low sexual desire cause you emotional distress?
- Would an increase in sexual desire be welcome?
- Are there external factors (such as other medications, stress, etc.) influencing your desire?
If you affirmatively respond to the first four questions and can rule out alternative causes for low libido, you may be diagnosed with HSDD. Dr. Volkar highlights that the emotional impact of HSDD often determines the need for medication: “If it doesn’t trouble you, it’s not a problem.”
It is also crucial for clinicians to assess whether a decline in libido is related to personal or relational issues, as HSDD treatment may not be effective if the low desire is rooted in dissatisfaction within a relationship.
Cost Considerations: The cost for HSDD medications may vary, with some insurance plans offering coverage; for those paying out-of-pocket, flibanserin typically costs around $100 for a month’s supply.
Choosing the Right Treatment: The decision between flibanserin and bremelanotide largely depends on individual preferences and lifestyle. While some women may prefer the convenience of a daily tablet, others may opt for the flexibility of an injection. Discussing options with your healthcare provider is essential for determining the best treatment path for you.
Research to date has mainly focused on premenopausal women, which is why both medications have received FDA approval specifically for use in this demographic. Women who are pregnant or nursing should avoid these treatments.
There are specific populations advised against using these medications, including:
- Individuals with liver disease
- Patients with cardiovascular issues
- Those with untreated high blood pressure or using treatments for HIV or hepatitis C.
These drugs can also interact unfavorably with commonly used medications, including fluconazole (Diflucan) and various antibiotics.
Alcohol should be avoided for two hours before taking these medications and continue through to the following morning due to the risk of severe blood pressure reductions.
Possible side effects may include:
- Nausea
- Headaches
- Facial flushing
- Dizziness and fainting
- Fatigue
- Dry mouth
Furthermore, bremelanotide can lead to skin darkening or gum discoloration, known as hyperpigmentation.
Effectiveness is often measured by any increase in sexual desire or reduction in feelings of distress regarding sex. Dr. Volkar notes that flibanserin typically results in “one extra sexually meaningful event per month.” Although subjective, this can be seen as a success, as perceptions of success differ among individuals.
Conclusion: There is no rigid benchmark for sexual frequency or desire, and often the level of distress a woman experiences serves as the most critical measure of treatment success. If no improvements are detected after an eight-week period, discontinuing the medication may be advisable.
Dr. Volkar concludes that while these treatments may not be a panacea, the availability of targeted medications for women's sexual health signifies significant advancement in recognizing and treating female sexual desire issues.
“It’s a monumental first step toward inclusive research in women’s health,” she asserts.