Posts Tagged ‘hypoactive sexual desire disorder’

Addyi: Female Viagra Or What?

May 14, 2016

Andrew Siegel MD  5/14/16


Clearly, sexism exists in the field of sexual medicine with a large gender gap with respect to the recognition and treatment of sexual issues. Numerous medications and options are available for male sexual dysfunction, but choices are few are far between for females with sexual problems.  Men have pelvic floor muscle training, vibrational stimulation, vacuum suction devices, pills (Viagra, Levitra, Staxyn, Cialis, Stendra), testosterone replacement, urethral suppositories, penile injection therapy and penile implants. Women have Kegel exercise programs, vibrational stimulation and estrogen replacement.  It is only fair that women have equal sexual medical rights.

One of the issues underlying this sexual gender gap is the erroneous assumption that  by virtue of possessing vaginas, females are less prone to sexual dysfunction than men are. The word “vagina” derives from the Latin word for “sheath,” a cover for the blade of a sword. The sword and sheath metaphor is convenient and assumes that the male plays the fully active role and the female the passive one. A flawed thought pattern is that while a man needs a rigid erection to perform—a complicated nerve-blood vessel-muscular event—a woman can simply lubricate and be ready to go. The truth of the matter is that female sexual response, although more subtle and nuanced than the male response, results in genital anatomical changes as profound as those that occur in males, just less apparent and obvious because the vagina is internal. Under normal circumstances, the vagina is no more “primed” for sex than is a flaccid penis, the un-stimulated vagina being merely a potential space; however, when stimulated, the vaginal walls lubricate and the vagina expands, lengthens and widens in order to accommodate an erect penis, changes that are as dramatic as the transition of a flaccid penis to an erect penis. The bottom line is that the vagina is by no means simply a passive channel.

Female sexual dysfunction is a common condition that can give rise to one or more of the following symptoms: diminished desire; decreased sexual arousal; difficulty achieving orgasm; and pain with sexual intercourse. The most prevalent issue and the subject matter of this entry is decreased or lack of sexual desire, the formal medical title being hypoactive sexual desire disorder (HSDD), although I prefer the less formal, non-medical version: “Honey, I’m not in the mood.” Diminished sex drive is complicated and involves a number of underlying factors–biochemical, psychological, and social.

In terms of biochemical factors, the neurotransmitters norepinephrine and dopamine stimulate sexual desire, whereas serotonin inhibits it. The SSRI (selective serotonin reuptake inhibitors) class of antidepressants function by increasing serotonin levels and are associated with decreased sexual desire as well as difficulty with arousal and orgasm, suggesting the important roles that serotonin plays as a regulators of sexual desire. Additionally, the hormone testosterone is a libido stimulant in both genders.

Addyi was initially developed as an anti-depressant and was investigated in a clinical trial for the treatment of depression. Unfortunately, it failed to offer a meaningful benefit as an anti-depressant, but was found to increase sexual desire in females who had depression in combination with decreased libido, providing the rationale for further investigating it as a treatment for diminished libido.

Addyi is a non-hormonal treatment that acts on the brain to normalize neurotransmitter levels and thus enhance sexual desire. Perhaps TMI… physiologically Addyi is an agonist of the serotonin receptor 1A and an antagonist of serotonin receptor 2A, inhibiting the serotonin “anti-sexual” effects while promoting dopamine “pro-sexual” effects.

Addyi was FDA-approved even though the members of the advisory committee acknowledged that its effectiveness was modest. One of the committee members who voted for its approval stated: “It’s not a little magic pink pill.” Another committee member who voted against approval claimed that it was “a mediocre aphrodisiac with some side effects with marketing winning out over science.”

Addyi 100 mg daily has been shown to be safe and effective and superior to placebo in improving female libido. It is used to treat “pre-menopausal women with acquired generalized hypoactive sexual desire disorder characterized by low sexual desire that causes marked distress or interpersonal difficulty not due to coexisting medical or psychiatric issues, relationship problems or side effects from other medications.” It cannot be used with alcohol, so no romantic dinner with a nice bottle of wine if you are taking Addyi.

Last weekend I attended the San Diego American Urological Association meeting in San Diego, where Dr. Irwin Goldstein (a female sexual dysfunction expert with extensive experience prescribing Addyi) reported effectiveness in 60% of his patients with impaired libido, in some cases with life-changing results.

The adverse effects associated with Addyi –usually mild to moderate in severity–include dizziness, lightheadedness, nausea, dry mouth and sleepiness. On occasion it can cause reduced blood pressure (hypotension) and passing out (syncope), particularly if used with alcohol.

Bottom Line: Although Addyi may not be as effective in increasing libido in women as Viagra is in improving erections in men, in the properly selected female it can provide a meaningful improvement in sexual drive.  It is the first FDA-approved drug for sexual dysfunction in women and hopefully represents the beginning of the end of sexism in the field of sexual medicine. 

Reference: Gao Z, Yang D, Yu L, and Cui,Y: Efficacy And Safety Of Flibanserin Center In Women With Hypoactive Sexual Desire Disorder: A Systematic Review And Meta-Analysis. Journal of Sexual Medicine 2015; 12:2095 – 2104

Wishing you the best of health,

2014-04-23 20:16:29

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