This month’s Science of Sex post comes on the heels of an announcement that the FDA has approved the second drug that intended’s to treat women with low libido, also known as hypoactive sexual desire disorder and which you might remember is one of several types of female sexual dysfunction. The new medication, called Vyleesi, works differently than the previously-released Addyi. In both cases, however, the efficacy and methods of the drugs leave us with more questions than answers.
Vyleesi binds to melanocortin receptors in the brain. Although researchers aren’t sure why that would lead to increased libido because those receptors deal with pain and food intake among other functions. The current theory is that this helps to increase dopamine. Dopamine is a chemical that functions as a hormone in the body and a neurotransmitter in the brain, sending signals to other cells. Of the dopamine pathways in the brain, one is associated with the reward center. The association with pleasure is why dopamine plays a role in addition. It also helps to regular attention, emotional response, movement, and learning.
This drug may force the brain to process erotic stimulation as rewarding, which boosts libido. Because this happens immediately, Vyleesi only needs to be taken before sexual activity and not every day like Addyi, which has been around for several years but hasn’t performed well commercially.
Furthermore, Addyi works on another brain receptor to block serotonin, a neurotransmitter that contributes to feelings of happiness among many other functions. Serotonin plays a role in reward systems and too much can dampen libido as well as curb dopamine. Taken daily, Addyi can reduce serotonin
Both drugs have their risks. Because low serotonin levels are associated with depression, Addyi may be a poor fit with women who struggle from depression. It may be negated by SSRIs, which mitigate depression by boosting serotonin levels in the body but often reduce sex drive. The drug also comes with side effects such as dizziness and “sedation.” It shouldn’t be used with alcohol.
While Vyleesi isn’t taken daily and can be used with alcohol, which might mitigate some risks, users will face a tighter schedule. The drug can be used once daily, up to eight times a month. Boosting libido twice a week is better than the one additional sack session prompted by Addyi over placebo during clinical trials, but Vyleesi comes as an injection while Addyi is a pill. Furthermore, Vyleesi’s side effects include nausea, which affected 40% of women who took it, mostly after the first injection. A small number of participants experienced changes in skin color that remained even after they stopped the drug. Consider that 90% of participants remained in the trial, however.
Before Addyi was even approved, some sex educators were wary of the drug. I imagine Vyleesi will receive some of the same critiques. Vyleesi appears to be a better deal than Addyi in some ways, but neither drug increased the number of sexually satisfying events n a statistically significant way. The FDA no longer requires companies making these drugs to count sexual sessions, and critics point out that women may simply be having more sex that they don’t enjoy.
And this leads us to one of the main complaints. Is it really beneficial to boost a woman’s sex drive just so it’ll be closer to her partner’s? Should we make women to feel bad for having less desire than men (apparently)? It is a win to force women to sit through more bad sex? Certainly there are women who would feel just fine having less sex if society allowed them to.
The CEO of the drug company has stated “It’s not just about low sexual desire, but about how it impacts patients’ relationships and quality of life. These women are really suffering.” However, this drug doesn’t examine why women are suffering. Dr. Adriane Fugh-Berman, a professor in the department of pharmacology and physiology at Georgetown University Medical Center who studies pharmaceutical marketing has.
I think it’s worth noting what’s an acceptable level of libido is socially influenced. Making women care less about the bad sex that they’re having is a dubious goal.
And for those women who want to want more sex? There are non-drug options that are more effective than both of these options and present fewer risks. Mindfulness can increase libido and sexual satisfaction. Sex education can ensure that women know and ask for what they want in bed, that their partners are better lovers, and that people understand that responsive desire does not necessarily mean low desire. On top of this, education explains concepts such as the dual-control model, which helps explain how external factors play into libido and enables people to ditch the shackles placed on them by society in the form of (useless) sexual scripts.
Can we even diagnose low libido before tackling those issues?
Reading a book or experimenting doesn’t require a prescription, abstinence from alcohol, or perfect health to produce results that are more statistically significant than Addyi and Vyleesi have shown.
Further Reading
- New Sex Drug for Women to Improve Low Libido Is Approved by the F.D.A.
- Dopamine
- Addyi (Flibanserin): 25 Things You Need to Know
- Serotonin
- Is sexual desire a medical issue? An experimental drug for women revives an intense debate
- Nothing Is Wrong With Your Sex Drive
- Come As You Are
- Better Sex Through Mindfulness: How Women Can Cultivate Desire (see my review)
- The World Cup of Women’s Sexual Desire
- What Works to Increase Women’s Sexual Desire?
- A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer
- Group mindfulness-based therapy significantly improves sexual desire in women
- Female Sexual Dysfunction: Therapeutic Options and Experimental Challenges
- I drew this graph about sexual desire… and I think it might change your life.
