The little blue pill that would change the lives of many men across the globe was first approved by the FDA in 1998. Initially studied as a potential treatment for heart disease, Viagra, or sildenafil, was found to have significant effects on treating male impotence. In the first few weeks after its approval, over 40,000 men received prescriptions for Viagra. By 2012, 8 million prescriptions had been written, with sales totaling about 2 billion dollars.
The little pink pill known as Addyi, or flibanserin, was approved by the FDA this August (2015) and is due to be released October 17. Will it change women’s lives the way Viagra changed the lives of men? Many are calling it the “female Viagra.” But is that moniker actually appropriate? Unlike Viagra and other such drugs including Cialis which are indicated for the treatment of erectile dysfunction, Addyi is indicated for hypoactive sexual desire disorder. So what’s the difference?
Erectile dysfunction is actually an arousal disorder, a difficulty getting or keeping an erection firm enough for intercourse. But this problem may not relate to sexual desire at all. Low sexual desire was first labeled by psychiatrists “inhibited sexual desire disorder,” later changed to “hypoactive sexual desire disorder” (HSSD), and more recently split into male hypoactive sexual desire disorder and female sexual interest/arousal disorder. Thus for females, sexual interest and arousal are now grouped together as one.
Hypoactive sexual desire disorder, to use the older term as it was applied to both sexes, is defined as a lack or absence of sexual fantasies and desire for sexual activity causing significant distress or interpersonal difficulties. It is the most common sexual dysfunction in women, affecting 5.4 to 13.6 percent of us (ACOG 2011). HSSD also requires that low desire is not better accounted for by another psychiatric disorder or a general medication condition. Therefore certain medical or psychiatric causes of low sexual desire must be ruled out in order to qualify for the disorder.
The causes of low sexual desire are many, and include:
- hormones – hormonal changes during menses, menopause, pregnancy etc. can affect women’s libido.
- medical diseases – such as diabetes, arthritis, heart disease, and hypothyroidism
- medications – certain pharmaceuticals, such as antidepressants, anti-seizure medications, and chemotherapy drugs, can affect one’s desire for sex
- lifestyle habits – smoking, alcohol, and other street drugs have been shown to affect arousal
- sexual problems – if one has pain or inability to orgasm it can reduce one’s interest in sex
- psychological problems – mental health problems, stress, poor self esteem, or a history of sexual abuse
- relationships problems – poor communication, infidelity, or fighting with one’s partner can alter libido
Treatment for hypoactive sexual desire disorder is therefore aimed at addressing these issues, with lifesteyle changes, medical management of disease, and with psychotherapy or couple therapy. Now with the little pink pill, Addyi, we have one more possible way to approach the disorder.
Addyi affects serotonin in the brain; it is a serotonin-1a receptor agonist and a serotonin-2a receptor antagonist. In fact, the way in which it helps to improve sexual desire and related distress is unknown.
In three randomized, double blind clinical trials of about 2,400 premenopausal women, those who took Addyi daily for one month had between 0.5-1 more “satisfying sexual events” per month on average than women who took a placebo, or sugar pill. Thus the effect was considered significant, though it’s hard to know how real-life women felt about the experience of taking Addyi. Is one-half to one more “satisfying sexual events” enough of a change to make the drug worth taking? This remains to be seen.
Potential side effects include dizziness, low blood pressure, sleepiness, nausea and fatigue. Addyi may not be taken if you are drinking alcohol.
While the cost of Addyi has not been finalized as of yet prior to its October 17th expected release, it is reported to be similar to a month’s supply of Viagra which comes in at $400, or copays of $30 to $75 a month depending on your insurance plan.
Given this modest improvement and high cost it is important that providers and patients consider all the avenues for treatment before breaking out the prescription pads or popping a pill. First treat underlying medical conditions, address lifestyle habits, and remove offending medications that may be contributing. For example, it may be helpful to switch antidepressants from an SSRI (selective serotonin reuptake inhibitor) such as Prozac or Paxil which are known to cause low libido, to bupropion (Wellbutrin), which has been shown to improve sex drive in some women. In some cases, hormone therapy can be initiated with estrogen either throughout the body in pill, patch, spray or gel form, or more locally by a vaginal cream or ring.
Counseling can also play a significant role in treatment of low sex drive which can be difficult for you and your partner. Skilled sex therapists and marriage counselors can help you learn to communicate with your partner, uncover hidden emotions that may be getting in the way of desire, and explore behavioral exercises that increase trust and physical intimacy.
The Decreased Sexual Desire Screener is a great tool professionals use to help diagnose HSDD and one you yourself can answer. The five simple questions are:
- In the past, was your level of sexual desire or interest good and satisfying to you?
- Has there been a decrease in your level of sexual desire or interest?
- Are you bothered by your decreased level of sexual desire or interest?
- Would you like your level of sexual desire or interest to increase?
- Are there other factors that may be contributing to your low sexual desire?
You can find the full screener here: Decreased Sexual Desire Screener.
If you or your partner believe you suffer from hypoactive sexual desire disorder and are interested in considering treatment, many of our therapists and psychiatrists at Psych Choices of the Delaware Valley are available to help. To rule out any physical or gynecological causes, please consider seeing your gynecologist.
Dr. Erica Borman is a psychiatrist at Psych Choices who has a strong background in women’s health concerns. To make an appointment with Dr. Borman or another clinician at Psych Choices, please use our Schedule An Appointment page.