Hypoactive Sexual Desire Disorder (HSDD) is a condition that causes women to have a low sex drive. About ten per cent of women are diagnosed with this condition that causes a lot of distress. Until very recently there was no prescription medicine to treat women with such conditions. In 2015, the FDA approved two prescription drugs to treat HSDD. These drugs are more colloquially referred to as “female Viagra” which serves as a nod to the male prescription drug to treat erectile dysfunction. It is amusing to note how two different drugs manufactured to treat the same condition were granted approval more than two decades apart just because they were meant for treatment of two different genders. Although both the drugs are aimed to treat similar problems in men and women, the “female Viagra” works very differently from the original drug meant for men.
Judith Volkar, MD, of the UPMC Magee-Women’s Hospital in Pittsburgh says, “In men, Viagra fixes a ‘plumbing problem,’ if you will.” When a man cannot get or hold an erection long enough to have sex, the condition is called erectile dysfunction. Viagra and other similar erectile dysfunction treatment drugs act by helping the arteries and muscles in the penis to relax so that more blood reaches the penis. When aroused—and only when aroused—the combination of relaxation and increased blood flow helps fill the penis with blood which results in a firm erection. In women, however, low sex drive is a much more complicated abnormality. Judith Volkar says, “You can picture men's sexual desire as a light switch, and women's sexual desire as the cockpit of a 747. There are more factors at play in female sexual desire.” It is precisely because of this that the drugs to treat HSDD require a much more nuanced approach.
As of now there are two drugs that have received FDA approval and both work in similar ways:
- Flibanserin (Addyi): It’s a pill you take every evening.
- Bremelanotide (Vyleesi): It’s a shot you give yourself in the abdomen or thigh 45 minutes before you have sex. You take one in a 24-hour period, and doctors recommend only eight shots per month.
Due to the blatant difference in anatomy and hence different method of action, the degrees of risk involved with both the drugs are nowhere close to each other. Hence comes the crucial need to closely study and perhaps also be wary of the exact mechanism of its action and also its possible side effects and long term effects:
According to Wikipedia, Addyi is a psychotropic medication. It acts specifically on serotonergic neurons in the brain, and has indirect effects on dopamine and norepinephrine. Serotonin in the brain is generally thought to put the brakes on sex. Flibanserin may help ease up on the serotonin braking system, so libido can get going again.
Vyleesi (bremelanotide) is a melanocortin receptor (MCR) agonist that non-selectively activates several receptor subtypes with the following order of potency: MC1R, MC4R, MC3R, MC5R, MC2R. At therapeutic dose levels, binding to MC1R and MC4R is most relevant. Neurons expressing MC4R are present in many areas of the central nervous system (CNS). The mechanism by which VYLEESI improves HSDD in women is unknown. The MC1R is expressed on melanocytes; binding at this receptor leads to melanin expression and increased pigmentation.
The side effects and possible long term effects of the drug
The most common side effects reported during clinical trials were nausea, flushing, injection site reactions, headache, and vomiting. Nausea was reported in 40% of patients and 13% of those patients reported having severe enough nausea to necessitate anti-nausea medications. About 1% of the patients experienced gum and skin darkening, particularly in the face and the breasts.
When to get one
You can consult a gynaecologist if and when you start to experience symptoms of Hypoactive Sexual Desire Disorder. Once the doctor confirms that it is indeed HSDD, you can consult her further for treatment options.
How to get one and costs
The average cost is around Rs. 1000/- for one strip of 4 tablets although it varies from manufacturer to manufacturer.
How to figure out which is best for you
Talk to your gynaecologist and go over every detail of your diagnosis. Medical advice is key.
Their efficacy
According to the FDA, clinical trial found that it produced an additional 0.7 “sexually satisfying events” every month.
The risks involved on the drugs’ proximity to alcohol
Coupling alcohol with either of the two “female Viagra” can be disastrous. Both the drugs come with heavy disclaimers about not consuming alcohol while being on the medication. The disastrous mixing of the both can cause the user’s pressure to fall rapidly.
A note on female sexual desire
“Normal” is subjective to the point where some might even question its very existence. Every woman is different. Every woman feels and perceives things radically differently from each other and thus every woman experiences desire in completely different ways. This particular piece from Forbes written by Tara Haelle provides a better understanding of female desire:
In the early 2000s, researcher Rosemary Basson proposed what’s now known as the Basson Model, or what she termed “the new model of women’s sexual response.” For most women, sexual response is more of a circle, and the major point in that circle is emotional intimacy. Feeling emotionally safe with her partner makes her responsive to sexual stimuli. At that point she may begin to feel desire or arousal, which may or may not lead to orgasm. If she has a positive experience, it will bring her back around to emotional receptivity, making her more receptive the next time around. A woman can enter that circle from any point.
The reason this makes sense is that most women don’t walk around with a feeling of just free-floating desire whereas, for men, they usually do tend to have a little more of that initial desire. For women, desire will become part of it, but it’s often not the starting point. Explaining what’s normal can also be very helpful because women wonder why they’re not just thinking about sex all the time.
Experts say that a lot depends on the longevity of the relationship the woman is in. That feeling when you are falling in love, where you think of the person all the time and want to be with them all the time, is a phenomenon called limerence. Limerence causes the elibido of a man and a woman to be on the same level at the initial stages of a relationship. After a year or so, the state of limerence settles down and transforms into feelings of love, comfort, security and safety in women. This can be confusing to many everyday women who might confuse love with sexual desire. It is very much possible to love someone but not want to have sex all the time with them. This is a scientific arena that hasn’t been explored much in the past but more and more research is being done these days which have unearthed that female desire is much more complex than male desire.
In society, the benchmark for normal has always been set by men. Desire too has always been gauged on the basis of how men feel and experience. It is important to create better awareness about female sexual desire and its workings. Only on better understanding the nuanced and elusive mechanism of it can the scientific community have a better chance of treating it right.
References:
https://www.forbes.com/sites/tarahaelle/2015/08/24/female-viagra-everything-you-wanted-to-know-about-sex-drug-flibanserin-but-were-afraid-ask/?sh=6a67f60c336f
https://www.medicalnewstoday.com/articles/294903#-Hypoactive-sexual-desire-disorder-and-the-DSM-
https://www.drugs.com/medical-answers/vyleesi-addyi-difference-3501189/