Hypoactive sexual desire disorder can be present in both men and women, but, this article will only address the issue in women. HSDD in women can be treated with therapy and medication or a combination of both. However, this article will only explore the effectiveness of flibanserin (Addyi) as HSDD Medication.
What is HSDD?
Now more commonly referred to as female sexual arousal disorder, Hypoactive sexual desire disorder is abbreviated as HSDD. As evident from the name, it is a sexual dysfunction due to low sexual desire or inability to easily experience sexual arousal. Both men and women can suffer from HSDD, however, this problem is two times more prevalent among women than men. It is the most common sexual disorder women suffer from, especially common among women reaching menopause.
Often women experience fluctuation in sexual desire or libido over the years in their life. Such decline in libido that is triggered by psychological factors like stress or physiological changes like pregnancy and health issues, recovers after some time. For HSDD to be diagnosed the symptoms have to be severe enough to disrupt the normal life of an individual for a significant period.
Although main presenting complain is inability to feel aroused or lack of libido, HSDD is diagosed on basis of following symptom.
- A decline in, or a complete lack of sexual desire
- A decline in, or a complete lack of sexual fantasies towards a sexual partner or other individuals
- Lack of interest in initiating sexual activity
- The decline in or complete inability to experience sexual arousal
- The decline in or complete inability to experience pleasure from sexual stimulation
These symptoms must be sever enough to cause personal distress or distress in relationship with romantic partner. The symptoms must have been present for six consective months for diagnosis to be considered.
What Causes HSDD?
As women sexual desire is dependent on a lot more factors when compared to men sexual desire, it can be influenced by several reasons and it can at times get tricky to pin down one single reason for a decreased libido or inability to experiec arousal. Genrally following reasons can cause HSDD:
- Physiological factors such as hormonal imbalance, changes in neurochemicals, gynechological diseases and gynecological conditions such as pregnancy, upcoming menopause.
- Psychological factors such as work related stress, complications in romantic relationship or distress in other aspects of life.
- Drug induced HSDD can be caused by birth control pills, antidepressants, SSRIs, SNRIs and many other medication.
Treatment of HSDD should be led by the determined cause of HSDD, if therapy can resolve decline in sexual desired it should definetly be considered as first line of action and on need basis it ca be combined with HSDD medication.
How is HSDD treated?
While there are many pills like viagra and several other treatment options for sexual problems faced by men, there are very few treatment options for women. Unfortunately for a very long time, there was no attention paid to female sexual disorders or even female sexual experiences. Medical science and research community work in the direction they receive the funding from. When there was little debate or market for treatment for HSDD, there was evidently no progress in medicine. Hence only in the past decade, the feminist movement fought to highlight this lack of interest from medical scientists in solving the sexual issues faced by men.
This is why after rejecting twice, when in 2016 Food and Drug Administration FDA was hesitant in approving Flibanserin as a prescription medicine for HSDD, the “Even the Score” campaign was started to get the drug approved. Women just needed something, anything, that gave them some hope of relieving the symptoms that are considered “normal” for premenopausal women.
The options currently available have a scarcity of scientific research to testify their effectiveness and measure their worth when weighed against the possible side effects. This includes the famous pink pill Addyi, bremelanotide, or Vyleesi (the self-administered injections) and the O Shots (derived from platelet Rich Plasma therapy PRP).
What is Flibanserin (Addyi)?
Often referred to as the pink pill, Flibanserin is the Food and Drug Administration FDA approved medication for treating women with HSDD. Flibanserin is a postsynaptic serotonin-1A (5HT-1A) receptor agonist and 5HT-2A receptor antagonist and was originally tested as an anti-depressant. It is commonly marketed as Addyi.
Pink Pill vs Blue Pill
It is important to understand that Addyi is not female viagra, as the viagra for men fixes erectile dysfunction, the problem; “inability to achieve or maintain an erection that is strong enough to have sexual intercourse”. Men suffering from this problem, still have sexual desires and can experience pleasure, they can be as aroused as possible but just can’t keep their penis up and erect. On the other hand, HSDD is the inability to experience sexual desire or arousal.
Addyi vs Aphrodisiacs
It is also important to understand that flibanserin is not a drug to increase the libido and thus not be treated as an aphrodisiac. It is a prescription to treat symptoms of HSDD. Even, in theory, it will unblock the already present neurotransmitter receptors that impact the libido but it will not stimulate increased production of neurotransmitters or result in achieving a level of libido that was never there.
Does Flibanserin (Addyi) work?
A few studies have shown that this drug shows a significant improvement in the frequency and intensity of pleasant sexual experiences in comparison to placebo groups. Theoretically, it works bringing the neurochemicals in the brain to a “normal” level. It is intended to unblock the receptors that work to boost norepinephrine and dopamine activity, and also regulate the production of serotonin. These neurotransmitters are important in overall mood stability, however, there is a serious lack of scientific research in support of Addyi as an effective treatment for HSDD.
The available research is obviously funded by the pharmaceutical companies and thus their reliability is questionable.
What is the recommended dosage for Addyi?
It is recommended that doctors should prescribe one tablet per day to be taken in the evening or night. Addyi is to be taken regularly, each day even if you do not plan to or intend to get physically intimate that day. You will need to take the pink pill every day even if you are not sexually active every day of the week. This is why the drug has a lower compliance rate as many women find it hard to commit to the drug and prefer need-based shots aka Vyleesi.
What are the side effects of Flibanserin (Addyi)?
The common side effects of Addyi are similar to other neuropharmacological drugs, including dizziness, flushing, nausea, dry mouth, and fatigue. The risk of drug interaction with alcohol, hormonal birth control methods, and yeast infection medication. There have been reported cases of women passing out when taking Addyi and consuming alcohol. It is important that doctor and patient sit and discusses the benefits and risks and after weighing out all aspects, decide on prescribing flibanserin as HSDD medication.
Seeing that Addyi was effective in treating drug induced HSDD, it was tested for safety regarding drug interaction with SSRIs and SNRI, and it was found to be safe.
Who should not take Addyi?
If after two months of taking medicine you do not experience an improvement in your symptoms, you must stop taking the medicine. Individuals suffering from liver and cardiac diseases, autoimmune diseases, and blood pressure problems should not be prescribed Addyi. It should also not be prescribed to women under treatment for vaginal infection or any fungal infection. Flibanserin is not recommended for pregnant women or breastfeeding mothers and has been only tested for premenopausal women. Its effectiveness or side effects for women post-menopause are yet unknown.
Other HSDD Medication and Treatment Options Available
Bremelanotide (Vyleesi) is a self-administered shot that you give to yourself 45 minutes before you plan to engage in sexual activity. These injections are FDA approved but it is recommended that you do not use more than eight shots a month. O Shots are injections of platelet-rich plasma that are administered around and inside the walls of your vagina by a certified practitioner. It is claimed that they improve symptoms of HSDD such as vaginal dryness within a week of administration. The treatment promises better, stronger, and more frequent orgasms, heightened sexual desire and the effect can last up to a year or more.