Hypoactive Sexual Desire Disorder (HSDD) is the most common type of female sexual dysfunction affecting an estimated six million pre-menopausal women in the United States. The condition is characterized by low sexual desire and marked distress which are not attributable to existing medical, pharmacologic, psychiatric, or relationship issues. It is thought to result from an imbalance in certain chemicals in the brain that affect sexual excitation or inhibition. Patient awareness and understanding of this condition remains low, and few women currently seek or receive treatment. Recent industry-sponsored market research indicates that up to 95 percent of premenopausal women suffering from low desire with associated distress are unaware that their condition is HSDD, a treatable medical condition.
Women who experience diminished sexual desire report feeling like something is missing and experience distress as a result. They want to get their desire back but may not think to attribute its loss to a medical condition that can be treated.
Functional magnetic resonance images (fMRI) of women with and without HSDD who were exposed to visual sexual stimuli has demonstrated less activation in the areas of the brain associated with sexual interest and arousal in women with HSDD.
HSDD means a woman who is otherwise healthy has a lacking libido, or a lack of sexual desire. Studies show that about 10-20% of women face this problem, and some say HSDD outnumbers men with sexual problems.
- Testosterone Cream (Not FDA-Approved, but I can give it to you.)
Testosterone cream (or any other testosterone product) is not FDA-approved in women. So, if you would like this prescription, it has to be compounded by a pharmacist. Some women choose to use testosterone that is prescribed for men, but in lower doses. Again, because it is not FDA-approved for women, your insurance will not pay for the drug. The cream is placed on your skin every day in a small amount. Many women say that this helps tremendously with libido. All women are different. Testosterone can have some side effects (whiskers, baldness, lowering of the voice, clitoral enlargement, and worsening of cholesterol and triglycerides - which can lead to a heart attack or stroke.)
- Hormone Replacement Therapy
Estrogen or Estrogen/Progesterone combination
Some women feel that they have a higher libido when they take systemic hormones. Hormone replacement therapy is not indicated for libido – it is indicated for hot flashes only. Talk to me if you would like to explore this option further.
- Husband Replacement Therapy
Just kidding…kind of. Men need to understand that a lot goes into our “desire.” Women need to feel good about themselves. They need to feel pretty and loved. They need to feel good about their husband or partner. If you are in a bad relationship, getting out may be the best thing to do. Counseling can be offered or arranged.
There is no pill to fix a miserable relationship.
There is no pill to fix an insensitive, uncaring husband.
There is no pill to fix an angry woman who has had it with her marriage.
All involved need to be honest about WHY there is not a sexual relationship in a marriage.
- Flibanserin (FDA-Approved for Libido 2015)
Flibanserin is a drug approved for the treatment of hypoactive sexual desire disorder (HSDD) in woman.
Flibanserin is not a hormone. It increases dopamine and nor-adrenalin within the brain and decreases serotonin. This has a positive effect on a woman's sexual craving who was otherwise lacking in this area.
Flibanserin or Addyi® works by rebalancing key brain chemicals and is not a hormone. Women now have a choice of an approved drug just for them – not an off-label use of a drug approved for men. Just because there is a medical option does not mean that sexual counseling or sex therapy is not needed. It just gives healthcare providers another option to treat a problem that is very prevalent in women. Healthcare providers have enormous empathy and sympathy for women with low sexual desire. We are very excited to have a drug that will work in up to 50% of women with this problem.
If you are a “responder” to the drug (up to 50% of women who take it), you may have:
- Doubling of your satisfying sexual events
- Up to a 53% increase in sexual desire (per the Female Sexual Function Index
- Up to a 29% decrease in your distress about low libido
When healthcare providers give a new drug to a patient, the patient should be told about the benefits, side effects, and risks of that drug. We are not going to do anything different for this new medication for low libido. This drug will not make you hypersexual. This drug will not make “sex” better. It will not make you a better lover. However, if you feel better and less distressed about your sexual experiences, your relationship with your intimate partner may improve significantly.
5. A new drug became available in September, 2019: Vyleesi, FDA-Approved
Vyleesi or Bremelanotide, which is designed to be used in anticipation of a sexual encounter, has a novel mechanism of action that impacts the balance between inhibitory and excitatory neural pathways in the brain to restore sexual desire.
This treatment is available as a self-administered, disposable subcutaneous auto-injector to be used in anticipation of a sexual encounter.
Bremelanotide is a new chemical entity (NCE) that has been studied in more than 30 clinical trials with over 2,500 women. Bremelanotide results in improvement in desire and decrease in distress associated with low sexual desire.
Bremelanotide is thought to possess a novel mechanism of action, activating endogenous melanocortin pathways involved in sexual desire and response.
IT CAN LEAD TO SOME DISCOLORATION OF THE SKIN BECAUSE IT ACTS ON MELANOCYTES.
Women in the trials had the option, after completion of the trial, to continue in an open-label safety extension study for an additional 52 weeks. Nearly 80% of patients who completed the randomized portion of the study elected to remain in the open-label portion of the study.
There is no pill to fix a miserable relationship.
There is no pill to fix an insensitive, uncaring husband.
There is no pill to fix an angry woman who has had it with her marriage.
All involved need to be honest about WHY there is not a sexual relationship in a marriage. Oops...did I say this already? ;-)