What you need to know

For many women, sexual desire goes up and down over the years, often linked to changes in relationships, stress, and physical changes such as pregnancy and menopause. But about 10% of women deal with a low sex drive that causes them distress. It is a condition known as hypoactive sexual desire disorder (HSDD).

There are a few over-the-counter supplements that aim to treat the problem, which have limited, mostly unproven, effects. But in recent years, the FDA has approved two prescription drugs to treat HSDD. These treatments are often referred to as “female Viagra” — a nod to one of the drugs men can take for sexual problems. But they don’t resemble Viagra at all. In fact, they work very differently in the body.

“In men, Viagra solves a ‘plumbing problem,’ if you will,” says Judith Volkar, MD, of UPMC Magee-Womens Hospital in Pittsburgh. Viagra and other similar drugs treat erectile dysfunction, when a man cannot get or maintain an erection firm enough to have sex. These men often still have sexual desires, but they just can’t get their bodies to react physically if they want to have sex. The drugs help by relaxing the muscles in the penis and stimulating blood flow so that an erection can take place.

In women, low libido is a more complex problem.

“I often say that you can think of men’s sexual desire as a light switch, and women’s sexual desire as the cockpit of a 747,” she says. “There are more factors that play a role in women’s sexual desire.”

As a result, the treatment of HSDD requires a more nuanced approach.

Two drugs

The drugs that the FDA has approved for HSDD are:

Flibanserin (Addyi): It’s a pill you take every night. Bremelanotide (Vyleesi): It’s an injection you give yourself in the abdomen or thigh 45 minutes before having sex. You take one in a 24-hour period, and doctors recommend only eight shots a month.

How they work. Both drugs stimulate the activity of chemical messengers in your brain called neurotransmitters, which are essential for feeling aroused. You take flibanserin every day whether you plan to have sex or not. You inject bremelanotide only when you need it. It’s important to note that neither drug makes sex better. They just make you feel more in the mood.

Your doctor may recommend that you try sex education and counseling along with the medication. You may also need hormone therapy if you are dealing with physical problems that affect sex, such as vaginal dryness.

How do I get them? Your doctor must diagnose you with HSDD to prescribe either drug. They can do that by asking screening questions, such as:

• Have you been satisfied with your level of sexual desire before?
• Has your sex drive diminished?
• Does your lack of libido bother you?
• Do you want to increase it?
• Are there other things (medication, pregnancy, surgery, stress) that can influence your sex drive?

If you answered “yes” to the first four questions and there is no other cause for your low sex drive, you probably have HSDD.

Volkar says the distress a woman feels about her sex drive is often the driving factor in whether or not to take medication. “Because if it doesn’t bother you, it’s no problem,” she says.

Also, your doctor will want to “make sure it’s not related to your current situation or relationship. Because you can’t fix HSDD if the problem is you really don’t like your partner,” she says.

What are the costs? Some insurance companies will reimburse HSDD medications. Your cost will depend on your plan, but the out-of-pocket cost for flibanserin is about $100 for 30 pills (1 month supply).

Which one is right for me? Both drugs have different concerns and risks. Which one to take usually depends on what works best for your lifestyle. “There are definitely women who have no interest in injections,” Volkar says. “Others don’t feel like taking a pill every day.” It’s best to talk to your doctor about which one would work for you.

Side Effects and Risks

Researchers have mainly studied how the drugs work in women who have not yet entered menopause. So the FDA only approved both drugs for premenopausal women. Women who are pregnant or breastfeeding should not take either drug.

There are others who should not take the drugs, including those who:

“They can also interact with several medications that women commonly take, such as fluconazole (Diflucan), a yeast infection drug, as well as some antibiotics,” says Volkar. “So it’s good to know what medications you’re taking and discuss them with your doctor.”

Women taking HSDD medications should not drink alcohol from 2 hours before taking the drug until the next morning, as it can lower blood pressure to dangerous levels.

The drugs can cause side effects, such as:

Bremelanotide can cause your skin and gums to darken.

Do they work?

To measure how well these drugs treat HSDD, doctors look at whether sexual desire has increased and whether the fear of it has decreased. Volkar says flibanserin usually leads to “one more sexually significant event per month.” That may sound like a success to some and not to others.

“It depends on how you define things,” she says. “Is that great, or isn’t that great? When I advise a patient, I leave it to their discretion and let them decide what that means for them.’

There is no “normal” amount of sex or desire. So a change in the distress a woman feels about her sex drive is often an important sign of how well the treatment is working.

If you have tried the medicine for 8 weeks and have not felt any change, your doctor may advise you to stop taking it.

The bottom line, Volkar says, is that while these treatments may not be perfect yet, having two drugs on the market is a step in the right direction.

“I’m thrilled that we’re finally doing research on women’s drugs and sexual desire,” she says. “I don’t think it’s quite the answer yet, but it’s an important first step.”

This post What you need to know

was original published at “https://www.webmd.com/women/features/guide-to-female-viagra?src=RSS_PUBLIC”