Does the new female libido drug really work?

DEAR DOCTOR K:

I am a woman in my 30s. I love my husband, but I am just not interested in sex. Will the new female libido drug help?

DEAR READER:

You’re referring to flibanserin (Addyi). This is the first medicine to be approved by the FDA for low libido (little interest in sex) in women. It is designed to help women who would like to increase their sexual desire, and it has been shown to slightly improve sexual satisfaction in some women. Flibanserin is only approved for pre-menopausal women. So it would be appropriate for you, but not for post-menopausal women.

First, let me dispel a common misperception. Flibanserin is not a “pink Viagra.” Viagra (sildenafil) and the several other drugs like it treat erectile dysfunction by improving blood flow to the penis. This causes the penis to be more erect when a man has sexual desire. But these drugs do not increase a man’s sexual desire; they help a man with the mechanics of sex, not the passion of sex.

In contrast, flibanserin is thought to work by modifying the levels of certain neurotransmitters in the area of the brain that regulates sexuality. Although I hate to reduce it to this, the fact is that sexual desire is basically just brain chemistry.

Like every medicine, flibanserin can cause side effects in some people. These include low blood pressure, nausea, fainting, and possibly sleepiness while driving. Women should not drink alcohol or use birth control pills while taking it because they can worsen the side effects. These side effects and conditions can be pretty big drawbacks for a drug designed to improve the sex lives of pre-menopausal women.

I spoke to my colleague Dr. Hope Ricciotti, associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, and editor in chief of the Harvard Women’s Health Watch. She is better prepared than I to discuss the complexity of women’s sexuality, as I have only secondhand knowledge.

Dr. Ricciotti emphasizes that for many women, strategies other than taking a drug can help improve sexual desire and create a satisfying sex life. These strategies include reducing stress and taking care of their health, since both stress and illness can curb desire.

Women should also check with their doctor to see if any medicines they are taking may have reduced their desire. Obviously, tensions in a relationship can affect sexual desire, but that’s not the case with you.

For some women, these steps are not enough. These women are typically in healthy relationships, and yet they have no desire, sex drive or response to sexuality. Women who fit these criteria are often diagnosed with hypoactive sexual desire disorder (HSDD). Flibanserin is intended for this group of women.

Female sexual dysfunction is an important unmet medical need and deserves appropriate research and treatment options. But whether flibanserin will help the women for whom it is appropriate, and the degree to which it improves sexual function, remains to be seen.