Dr. E Talks Addyi, TheRecently Approved “Female Viagra”

Dr. E Talks Addyi, TheRecently Approved “Female Viagra”

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The discovery of Viagra changed the face of sexual medicine forever.  Before that wondrous little blue pill (and everything else that followed- Levitra, Cialis, Stendra) options for treating erectile dysfunction were limited to uncomfortable penile suppositories, painful injections of medication directly into the penis, vacuum erections devices (penis pumps- I’m looking at you, Austin Powers; it really IS your bag, baby), and surgical implantation of a penile prosthetic.  You can see why this was such a significant problem- there were no really palatable, easy fixes.  You can also see why Viagra was so revolutionary: a PILL, taken an hour or so before you want to have sex, that works (well enough for intercourse) for about 80% of the men who try it, with minimal side effects (insert joke about 4 hour erection and calling everyone, including your doctor, here).  Men everywhere rejoiced!  Unfortunately, not all of the women did.

Viagra and its progeny (PDE5 inhibitors, to describe the class) were great for men.  But what about their female partners who were suffering from decreased sexual desire?  How wonderful that their men could be active between the sheets again; but what about their problems?  I think we have just about eradicated (in the US and most of the western world) the notion that women don’t enjoy sex.  How tragic then is it for a sexual being, who used to enjoy sex very much, to now not have any interest in it, even though she wants to?  There is no quick fix for this, unfortunately, but some new developments in medicine are very promising.

In the past, the mainstay for treating decreased female libido was sexual counseling with a sex therapist, and this remains part of the treatment equation.  Then, experiments were done with actual Viagra, hoping that increased blood flow to the clitoris (the functional and embryologic equal to the penis) would equal increased sexual desire.  This failed, and that’s where things stayed for many years.  Fast forward to today.  The FDA has just approved Addyi (pronounced add-ee) to treat acquired hypoactive sexual desire disorder (HSDD) in premenopausal women.  Addyi (flibanserin) is a medication that must be taken daily, as opposed to on-demand like Viagra.  Its exact mechanism of action is unknown- what IS known is that it binds to serotonin and dopamine receptors in the brain.  Serotonin and dopamine are key neurotransmitters for feelings of well-being and are released in large quantities at orgasm.

In the three studies that were done to gain FDA approval, they found that women taking it (ages 19-55) had an increased number of “sexual events” (defined as oral or penetrative intercourse, masturbation, or manual genital stimulation by a partner) over the 24 week study period, but no real improvement in self-reported level of sexual desire in 2 out of the 3 studies (In the third study, they started asking the questions about level of desire a different way, and an improvement was seen above the sugar pill placebo arm).  Addyi also decreased the amount of anxiety/distress that the women had about sexual performance.  So, it appears to be effective in increasing the amount of sex that women who take it are having and decreasing the amount of stress that they have regarding  performance, but may or may not have an impact on perceived sexual desire.  Keep in mind, only 1177 women have taken the drug so far, so as the medication is prescribed to a larger population, we may see an increase in the level of sexual desire reported.

So what are Addyi’s drawbacks?  The biggest one is that it has a SIGNIFICANT interaction with alcohol.  In fact, if you are taking the medication, you shouldn’t drink alcohol at all.  It can cause drops in blood pressure that make people lose consciousness, lose their balance, and fall down.  This is a serious problem for anyone who needs a little “social lubrication”, and a major reason that all of the study participants were in monogamous relationships.  The low blood pressure problem is SO significant, that the FDA is not going to let just ANY doctor write for it, or ANY pharmacist prescribe it.  In order to be able to write for it or dispense it, a doctor or pharmacist will have to get special training and certification.  As with many other medications, it can also cause drowsiness, and so should only be taken at night.

Will Addyi be a “magic bullet” for women with decreased sexual desire?  Only time will tell.  It will start to be available to certified prescribers by mid-October of this year.  With any luck, it will revolutionize female sexual medicine the way PDE5 inhibitors did for men.  With any luck, we will also succeed in finding new medications with fewer  side effect concerns.  Until then, I am excited to see what Addyi does for the population of women suffering from HSDD, and hopeful that it will make sex a pleasurable part of their lives once again.

 

-Dr. E, MD Urologist

 

 

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