Science of Sex: Using Drugs to Raise Women’s Libido

June 29th, 2019

Raising Women's Sex Drive with Medication

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.

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Science of Sex: Arousal, Disgust, and Decision Making

November 24th, 2018

Welcome to November’s issue of Science of Sex, wherein I tackle issues about human sexuality. Why do we do that? How do we know? This month, I discuss another issue related to arousal (although I’ve barely scratched the surface, it seems) and what happens when the arousal cycle ends.

I hope you enjoy this article, and if you’re interested in more, check out the Science of Sex archives.

science of sex - arousal disgust decision making

Initially, I was just going to write about the interplay between arousal and disgust, but sexual arousal affects so many of our systems — especially cognitive ability.

If you’ve given a thought to how being aroused affects your thinking process, you’ve probably realized how easy it is to make poor decisions when aroused. Anecdotally, I have risked my sexual health by not using condoms, but foregoing protection and birth control is only one example of this risk. Arousal might lead you to have sex with someone who is a bad choice (an ex, a friend, someone with whom romantic feelings are unbalanced, etc). Disgust plays a role in why most people don’t have sex with family members; although, Science of Sex: Genetic Sexual Attractionsome people do.

Studies have even found that a woman’s attractiveness can influence whether a man chooses to use a condom during sexual activity with her.

Less obvious and perhaps more indirectly related to cognitive ability is how arousal seems to lower disgust, at least, in some individuals. Researchers theorize that disgust evolved as a way to keep us away from potentially dangerous things. So humans developed aversions to things that are dirty and “yucky,” such as fecal matter, bodily fluids (urine, blood, semen etc), and even actual dirty in our environment. It makes sense that arousal would inhibit disgust because sex involves precisely some of those things.

This interplay explains why you might be more open to the idea of a certain sexual activity, say, anal sex, once you’re already aroused than you would be “cold.”

You might even notice disgust returned once the arousal cycle has completed, either through orgasm or simply subsiding over time. This can manifest as disgust or guilt toward yourself or partners after sex. If you’ve ever found yourself completely disinterested in any sexual activity, then you know what I mean. As you’re frantically closing every browser tab once you’ve finished masturbating because you cannot stand to see it, you’re experiencing the return of disgust.

At least one study finds that this isn’t the case with women. This could perhaps be due to arousal non-concordance: a woman’s mental and physical arousal is typically less in sync than a man’s. The canceling out of disgust when aroused that men experienced could simply be an effect of their higher levels of arousal concordance.

Arousal continues to affect our system in other ways, too. Sexual arousal is often accompanied with the promise of sexual gratification through either solo or partnered activity. Dopamine receptors activate when aroused, which is one reason sexual tension can feel so good. The promise of sexual reward can also encourage poor decision making. The drain of dopamine and hormones after your arousal cycle completes can also contribute to negative post-masturbation or post-sex feelings.

This is also related to post-sex blues (described as postcoital dysphoria in research), something that women experience more frequently than men. As hormones decrease in your body after a sexual experience, you might feel down even if the sexual encounter was enjoyable.

I suspect that arousal inhibits or overrides a number of feelings and responses that we either don’t yet know about or understand, and I look forward to telling my readers about them in a later post.

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