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For many women, sexual desire rises and falls over the years, often linked to changes in relationships, stress, and physical changes like pregnancy and menopause.. But about 10% of women suffer from a low libido that disturbs them. 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 look like Viagra at all. In fact, they work very differently inside 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 keep an erection firm enough to have sex. These men often still have sexual desire, but they just can’t physically get their bodies to react when they want to have sex. The drugs help by relaxing the muscles of the penis and stimulating blood flow so an erection can occur.

In women, low libido is a more complex issue.

“I often say that you can imagine male sexual desire as a light switch and female sexual desire as the cockpit of a 747,” she says. “There are more factors at play in female sexual desire.”

Therefore, treating HSDD requires a more nuanced approach.

Two medicines

Drugs approved by the FDA for HSDD are:

  • Flibanserin (Addyi): This is a pill you take every night.
  • Bremelanotide (Vyleesi): This is an injection you give yourself in your stomach or thigh 45 minutes before you have sex. You take one over a 24-hour period, and doctors recommend only eight injections per month.

How they work. Both drugs stimulate the activity of chemical messengers in your brain, called neurotransmitters, which are essential in helping you feel aroused. You take flibanserin every day, whether or not you plan to have sex. You inject bremelanotide only when you need it. It is important to note that no drug improves sex. They just make you more likely to feel 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 have physical problems that affect sex, such as vaginal dryness.

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

• Have you ever been satisfied with your level of sexual desire?
• Has your libido decreased?
• Does your lack of libido bother you?
• Would you like it to increase?
• Are there other things (medication, pregnancy, surgery, stress) that could affect your libido?

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

Volkar says the distress a woman feels about her libido is often the determining factor in whether or not she needs to take medication for it. “Because if you don’t mind, it’s not a problem,” she said.

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 that you really don’t love your partner,” she says.

What is the cost ? Some insurance companies will cover HSDD medications. Your cost will vary depending on your plan, but the cost of flibanserin is around $100 for 30 tablets (1 month supply).

Which is good for me? The two drugs have different concerns and risks. Which one you should take mainly depends on what best suits your lifestyle. “There are definitely women who have no interest in injections,” Volkar says. “Others have no interest in 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 primarily studied how the drugs work in women who have not yet gone through menopause. Thus, the FDA approved both drugs only for premenopausal women. Pregnant or breastfeeding women should not use any of these medicines.

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), which is a medicine for yeast infections, as well as certain antibiotics,” Volkar says. “So it’s good to know what medications you’re taking and discuss them with your doctor.”

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

Medicines can cause side effects, such as:

Bremelanotide can darken your skin and gums.

Do they work?

To measure how well these drugs treat HSDD, doctors look at whether sexual desire has increased and whether distress about it has decreased. Volkar says that flibanserin typically leads to “one more sexually significant event per month.” This may seem like a success to some and not to others.

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

There is no “normal” amount of sex or desire. Thus, a change in the distress a woman feels about her libido is often a key sign that treatment is working.

If you try the drug for 8 weeks and you haven’t felt any change, your doctor may recommend that you stop taking it.

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

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

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