An advisory committee to the Food and Drug Administration (FDA) has recommended the approval of Sprout Pharmaceutical’s flibanserin, for premenopausal women who are distressed by decreased sex drive. The little pink pill, marketed under the name Addyi, has been hailed by some as “female Viagra”.

Up to one third of all women experience decreased sex drive, termed Hypoactive Sexual Desire Disorder. Women’s sexuality is very complicated and it is uncertain if “just taking a pill” will significantly improve things. There are complex issues that can lead to decreased libido, including fatigue, stress, and problems in the relationship.  In addition, many medications, including antidepressants and some birth control pills, can also suppress desire. While some advocacy groups claim approval would be a pivotal step towards gender equality, others question whether low sexual desire in women can actually be “fixed” by a drug. However, a 2013 study in The Journal of Sexual Medicine showed that women taking the drug reported an average increase of 2.5 satisfying sexual events in four weeks, compared with an increase of 1.5 among women using a placebo.

Racing to liken the drug to Viagra, however, may be a mistake. Flibanserin works on the central nervous system by increasing dopamine and dealing with two different forms of serotonin. In this way, it is more similar to an antidepressant (and in fact was initially tested as an antidepressant before researchers realized it had pro-sexual effects) rather than Viagra which increases blood flow to the genitals. Also unlike Viagra, which is taken only when needed and works within 45 minutes, flibanserin must be taken every day. Potential side effects include low blood pressure, fatigue, and fainting, which may be worsened if a person drinks alcohol while taking the medication.  Because of this, the FDA panelists recommend that physicians who prescribe the drug obtain additional special certification.

Although estrogen topical preparations are already available for painful intercourse in women, a drug that improves sexual desire and satisfaction in women would represent a new indication, if flibanserin is recommended for approval on August 18th. Historically, the first drug in a new pharmacological or functional class is allowed to not be perfect. Advocates for the drug told the FDA panelists that they should approve the drug, even if it isn't perfect, to expand options for female patients struggling with sexual dysfunction. Critics argue that the final consideration should be on efficacy being “the best one”, not just “the first one”.

What Else is on the Horizon?

Another possible option for female decreased libido is treatment with a testosterone pellet.  The pellet is injected into the patient’s buttocks every three months.  This treatment is not FDA-approved, but is has been shown to be successful in many patients.  Dr. Astrid Gonzalez is undergoing training to provide this treatment for our patients, which will be available in mid-June.  To learn more, please call our office directly.

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