Does Female Viagra Work?

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The media reported the news giddily: The pill dubbed “the female Viagra” was back on the market, and the manufacturer had halved the price, from $800 to $400. One business website even claimed the little pink pill could disrupt the $6 billion sexual dysfunction market.

But gynecologists who treat patients complaining of low sexual desire haven’t matched that enthusiasm for the drug — and their reasons are plenty. First, there’s the misconception that Addyi, whose generic name is flibanserin, is similar to the drugs men take to treat erectile dysfunction.

“It’s simply not comparable,” says Dr. Tarek Bardawil, a gynecology expert at the University of Miami Health System. “It works in a completely different way.”

Viagra and similar drugs prescribed for ED increase blood flow to the penis so a man can get and keep an erection hard enough for sex. It works only if the man is sexually aroused. Female viagra, in contrast, works on the brain, by reducing serotonin, a neurotransmitter that inhibits sexual desire. It also affect dopamine and norepinephrine, which can help in restoring sexual desire.

While men’s sexual dysfunction medication treats an actual physical issue, Addyi seeks to address what Dr. Bardawil says is a more complex problem. “There are multiple causes for low libido,” Dr. Bardawil says. “We can’t say it’s just this or that or that it’s even physical.”

That’s not to say Addyi doesn’t work. “It might increase the mood in certain women, but the effects have been very modest,” he adds. “I’ve never prescribed it.”

Which is not to say he won’t, he’s quick to add. He prefers, however, to try other solutions, including couples therapy. Moreover, like many medications, Addyi has several side effects, including dizziness, sleepiness, and low blood pressure. Alcohol and birth control medication can amplify those effects, too. Addyi has to be taken daily and works after several weeks, unlike a drug such as Viagra, which is used only when needed. In addition, doctors are required to take a training course to be certified to prescribe and patients must sign a form that shows they understand the risks.

Flibanserin, which was originally developed as an anti-depressant, was first approved about three years ago by the Food and Drug Administration for low libido. It was hailed as a game-changer, a medication that would even the playing field between the sexes. But marketing of the drug suffered when its parent company had to deal with unrelated business issues. It didn’t help that the pill’s high cost kept many away. Now some hope the much-awaited drug might have a better reception the second time around.

Addyi, however, has limited use. It is approved for women who are not in menopause and are diagnosed with hypoactive sexual desire disorder (HSDD), or low libido not caused  by a relationship, medication, medical or mental problem.  The low libido should be present for at least 6 months and causes stress to the patient. “If a lower sexual desire doesn’t bother the woman, Dr. Bardawil says, the woman is not considered to be suffering from HSDD and therefore not a candidate for the pill. The drug also targets only pre-menopausal women, yet the majority of women who complain about flagging sexual desire in Dr. Bardawil’s practice are actually post-menopausal women.

“It could be part of the body or physiological changes [that come with menopause],” Dr. Bardawil says, “but I also think probably women have more time to think about it at that time in their lives. What we need to ask is, do they really have a disorder?”

In the case of a post-menopausal women — in fact, in any across age groups — Dr. Bardawil prefers having a frank conversation with a patient. First, he wants to know about expectations. Is the woman concerned because she is having less sex or no sex at all? Is there something different in her life? Is the woman depressed or having relationship problems? Is there the possibility of a medical condition? Is she taking a new medication that interferes with sexual desire? Has she gained weight? Does she have a good body image?

“Once you rule out all these multiple factors, I encourage the patient to see a therapist, to work on the relationship and having an open communication with her partner, having date nights and more time together,” Bardawil says.

Sometimes he finds low libido can be situational. A new baby — and lack of sleep — dampens sexual desire and a long-time couples may need to shake off complacency and re-ignite romance.

“I see it [Addyi] as an addition to all the other life-changes they should try,” he adds.

Now that the drug has been re-introduced into the marketplace, Dr. Bardawil hopes more data about the pill’s effectiveness, as well as side effects, will lead to a better understanding of female sexual desire and how to stimulate it when it diminishes. It may also prompt other drug makers to tackle this complex condition.

For now, however, he cautions, “One medication isn’t going to solve the problem by itself because we truly don’t know exactly what causes the problem.”


In Their WordsAna Veciana Suarez
Ana Veciana-Suarez, Guest Contributor

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami HeraldThe Miami News and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.