A changing sex drive is a normal part of life, but there are some women who have a condition called hypoactive sexual desire disorder (HSDD).
It’s defined as a mental and physical sexual dysfunction in which women lack motivation or lose desire to have sex for at least 6 months, causing distress to themselves or problems in their relationships (or both).
The condition may also be referred to as female sexual interest and arousal disorder (FSIAD).
About 10 percent of women live with HSDD. The condition can affect a woman’s quality of life and mental health.
HSDD is thought to be caused by an imbalance in the neural pathways in the brain, according to a 2019
Certain factors put women at risk for HSDD, including:
- sexual functioning of a partner
- medical conditions such as diabetes
- medication side effects such as commonly used antidepressants or blood pressure medications
- problems in a relationship, including emotional or physical abuse
- psychiatric issues such as anxiety and depression
There are two prescription drugs on the market that have been approved by the Food and Drug Administration (FDA) to specifically address HSDD. They are available only for premenopausal women.
These drugs are dubbed “female Viagra,” as a play on the medication for men to alleviate erectile dysfunction. They work in the body in different ways and are also administered differently.
- flibanserin (Addyi), a pill taken every evening.
- bremelanotide (Vyleesi), a self-administered injection before sex
It should be noted, the FDA has not approved sildenafil (Viagra) for women to use, but it has been prescribed off-label for a women with low sex drive.
Both Addyi and Vyleesi work differently than Viagra, says Dr. Puja Uppal, a board certified family medicine physician and the chief medical officer at Think Healthy.
Addyi, manufactured by Sprout Pharmaceuticals, is a multimodal serotonergic agent originally developed for the treatment of major depressive disorder. Unlike Viagra, which works on men’s organs, Addyi targets the neurotransmitters serotonin, dopamine, and norepinephrine.
Addyi was unsuccessful in clinical trials for treating depression, but it was reported to have the side effect of increased libido in female patients, according to a 2017
The Vyleesi injection is in a class of medications called melanocortin receptor agonists.
“It’s injectable and works by activating our melanocortin receptor 4 (MCRs) which helps to modulate sexual function,” says Uppal.
Both drugs have shown modest efficacy in trials, but the long-term effect is still unknown.
Addyi was rejected by the FDA twice before it was approved. Once it was rejected because it wasn’t more effective than a placebo. The second time was because of safety concerns. Some studies have shown about 10 percent of women notice a difference with HSDD after taking Addyi, according to the National Women’s Health Network.
A 2017 Pharmacy & Therapeutics
So, it depends.
“They are fairly good but aren’t miracle pills for women,” says Uppal. “They do have a large side effect profile, but in the right person they can make a huge difference.
Women with depression and those who drink alcohol should not take Addyi, according to Uppal.
The major side effect of Vyleesi is an increase in blood pressure.
Nausea after the injection and during sex was reported by about 40 percent of women in one study. The company’s website says the drug is not for women with cardiovascular disease.
“Women who are taking Naltrexone, a medication used for alcohol or opioid dependence, should not use Vyleesi because it can lead to a failure of Naltrexone,” says Uppal.
Both drugs need to be discontinued if symptoms do not improve around 8 weeks, but your physician can advise on the exact time frame.
In order to get female enhancement pills, you’ll need a diagnosis of HSDD. There’s no specific test for HSDD, rather a combination of factors that lead doctors to diagnose it.
First, your healthcare professional will likely do a thorough medical exam, to rule out any health conditions that may be contributing to your low sexual desire.
Your doctor may diagnose you with HSDD if your low sex drive is causing you distress (this is key to the diagnosis) and you exhibit one or more of the following symptoms for more than 6 months:
- lack or loss of interest to initiate or engage in sexual activity
- absence or decrease of spontaneous desire, which is the need to experience sexual arousal
- not responding to sexual stimulation or cues, which can be visual or related to other senses
Remember, having a low libido does not necessarily mean you have HSDD. “Sex drive varies from one woman to another, and what bothers one might not bother another,” say the medical professionals at the International Society for Sexual Medicine.
According to the Addyi website, an online consultation starts at $19 and a prescription is around $20 a month with commercial insurance coverage. The caveat at the bottom of the page says it’s only for a limited time and for certain customers.
In general, most insurance companies will not cover the cost. There are manufacturer coupons that can be found online to save money on the drug. Be sure to check with your insurance provider, however, because some, like Blue Cross Blue Shield, cover Addyi. If you pay out of pocket it can cost hundreds for a 30-day supply.
Vyleesi offers a similar promotion. Some patients will not pay a copay for their prescription and no more than $99 for four injection refills, with or without insurance coverage. Paying out of pocket for Vyleesi can cost more than $4,000 at commercial pharmacies.
“Women can have low libido for a number of reasons, such as depression, pain with intercourse, or even from negative associations because of atrophic vaginitis,” says Uppal. “One of the biggest things that a person should know is that this is actually very common.”
According to Uppal, other treatments may include psychological interventions, cognitive behavioral therapy, couples therapy, and mindfulness-based therapies.
Depression and anxiety medication may also have some effects on sexual desire. “For women with antidepressant-related female sexual arousal syndrome, bupropion can sometimes help with their symptoms,” adds Drupal.
If you suspect you have HSDD and you find that this condition is impacting your personal life and mental health, it’s important to talk to a doctor about your options. You may have an underlying health concern that is affecting your libido, such as undiagnosed diabetes.
Female enhancement drugs may not be perfect when it comes to treating women’s waning sexual desires, but they can be a leap forward for women’s health.