5 Reasons I Won’t Prescribe the New Pill for Sexual Desire

As much as we think we want a magic pill to turn women into hot, horny sex kittens, even a basic understanding of female arousal, desire and orgasm will show you that women are more complex than one little pill or potion could ever fix!

Pre-menopausal women in the US can now receive the recently FDA-approved drug, Addyi, to treat “acquired, generalized hypoactive sexual desire disorder (HSDD.)”

HSDD is defined as:

low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of medication or other drug substance.

There is a great division amongst professionals who would use this medication in their clinical practice and who wouldn’t touch it with a ten-foot pole.

Here are the top reasons that I would NOT prescribe this drug.

1. High side effect risk

Despite the media hype, this is NOT the ‘female Viagra’. Viagra increases blood flow to the penis to achieve an erection for intercourse, and can be taken any time of day. Addyi is a psychiatric drug that alters brain chemistry. It has no effect on female genitalia and must be taken every night for weeks. Taking flibanserin during the daytime carries serious side effect risks – such as injury due to low blood pressure, fainting or falling. And you cannot drink alcohol while on the drug – ever!

Drug warnings on the package insert state:

Patients should not drive or engage in other activities requiring full alertness until at least 6 hours after taking Addyi and until they know how Addyi affects them.

This drug is also NOT for women who are on oral contraceptives because of an increased incidence of sleepiness, dizziness, and fatigue seen in clinical trials.

A SKETCHY DRUG DEVELOPMENT HISTORY

Over a decade ago, while this drug was being tested for depression, some women found they had more of an interest in sex while taking the medication. This led the drug company to conduct tests to see if they had found the magic pill to make women hot and horny. However, they — and the FDA — were turned off by the high side effect rates, its lack of effectiveness and long-term safety concerns and they sold the rights to manufacture the drug.

In 2011, Sprout Pharmaceuticals, the company currently marketing Addyi, took it to the FDA, who rejected it for HSDD treatment in 2013 and 2014. But Sprout returned with additional data on the drug, leading to a favorable FDA panel opinion on June 4, 2015 with several stipulations.

Addyi was approved with a risk evaluation and mitigation strategy (REMS) because of the risk of severe hypotension (low blood pressure) and loss of consciousness. And it carries the highest level of alert to prescribing physicians.

THE BLACK BOX WARNING

• Treatment carries a Boxed Warning about the risks of severe hypotension and loss of consciousness among those who drink alcohol

• Addyi is contraindicated in patients with liver impairment and with certain medications for migraine, depression, antifungal medications ketoconazole and fluconazole, used to treat vaginal yeast infections and some skin conditions such as pityriasis versicolor.

• The drug should be discontinued if there is no positive response within 8 weeks of treatment

2. Female sexual desire is driven by complex turn-ons and turn-offs

I would not reflexively prescribe this drug because I know that female sexual desire is a multifactorial phenomenon. When you unravel arousal in women, the sexual response includes physical, emotional and psychological aspects – which no pill can address all at once.

As a woman if you’re comparing yourself to typical male arousal and desire patterns, you will almost always come up short. For example, when a typical, healthy man sees, hears or imagines something sexy, he gets hard. And when most men have an erection – whether due to erotic stimulation, in a sleepy state early in the morning upon waking, or even medically induced! – the sensation of a hard penis is enough to make a man want to have a sexual encounter!

We females, however, don’t follow the linear sexual response pattern that most males do. Even if a woman’s vagina becomes moist while watching a sex scene or while kissing, she may not even notice or associate the genital response as a cue for being sexual – especially if her mind isn’t turned on.

Research shows that a female’s sexual responsiveness depends on a delicate balance between excitation and inhibition. In short, the balance of sexual ‘turn ons’ and a variety of physical, emotional or social ‘turn offs’ which will dictate whether or not you become aroused and reach orgasm. These are controlled by different parts of the brain and our own mental state can interfere with (or enhance) them as well!

When you examine the prescribing information for this drug you read this:

The mechanism of action of ADDYI…is not known.

It is thought to boost libido by increasing the release of dopamine, and adjusting the levels of serotonin in the brain – neurotransmitters thought to play a role in sex drive. While this drug may hit some of the brain centers which turn down our inhibitions, we can still override them.

The female sexual response, arousal and even orgasm, are mediated by more than a few brain chemicals. Which means this potent psychotropic drug with all of it’s side effects may not even work for the majority of women! (After all, in clinical trials, not even half of the study participants had a positive response to the medication.)

3. Scary side effects + ‘modest’ effectiveness do not add up to being ‘worth the risks’

If this drug does help to lower some inhibitions it may influence only one piece of the desire puzzle. But how much of a response is worth the risk of scary side effects?

In clinical trials, the drug doubled ‘satisfying sexual encounters’ for women who responded to the drug, but only increased ‘satisfying sexual encounters’ by 1 per month over placebo. Watching soft porn, seeing a sex therapist or reading an erotic novel may offer the same level of libido boosting.

4. A pill cannot create the right context for sex

Consider that most of the women who are diagnosed with Hypoactive Sexual Desire Disorder are in long-term relationships. Single women, in general, do not complain of low desire.

Research shows that female sexual desire declines not only with a woman’s chronological age but it also plummets the longer she is in a relationship. Introduce a new partner, and guess what, sexual desire peaks again! Even if she is menopausal, sex therapists recount story after story of women who find themselves with a rip roaring libido upon starting a new relationship.

What this means is even if this pill can magically turn on desire if the woman doesn’t have a good intimate relationship with her partner she may not act on the desire! Can a pill create the right ‘context’ to peak our desire for sexual play? Not likely.

We need excitement and anticipation to stimulate us. So while her long term partner is still someone she truly loves it is possible that she is bored with him sexually. She may want to want him, but won’t become turned on unless there can be some playfulness, flirtiness and newness introduced into the erotic exchange.

 In order to want sex, it needs to be sex that is worth wanting! ~Esther Perel

Can this pill do that? Nope.

This is also why Viagra doesn’t lead to more sex for women. Remember, Viagra and drugs like it increase blood flow to the vagina, but if you don’t notice or aren’t aware of it, it won’t make you wanna get it on. And even if you did notice throbbing in your lady parts, studies show that the level of physiological arousal is irrelevant if psychological barriers are not addressed

I teach a sexual confidence course and a 21-day orgasmic bliss workshop that helps women rediscover passion, fun and eroticism. Sign up here to receive info on our new online class as well as a bonus chapter from my upcoming book “The Orgasm Prescription for Women: 21-Days to Heightened Pleasure, Deeper Intimacy and Erotic Bliss.”

5. You’ve gotta be labeled with a syndrome to get it

Finally, I don’t believe that we need to slap on a diagnosis for what happens naturally in our sexual life-cycle.

At any given moment, most women over forty are found to be in a neutral state of desire. The average woman is just not walking around totally turned on unless they are in a relatively new relationship or within a window of peak fertility which may give rise to the biologically driven desire, commonly known as the ‘urge to merge.’

The primal sexual force is generally accepted as the ‘normal’ driver of the sexual response cycle which has led many women to self-diagnose as sexually dysfunctional. But women engage in sexual activity for many more reasons than a physical release or biological imperative. So the markers of the animalistic side of our ‘sex drive’ are less relevant when determining whether we are dysfunctional, normal or somewhere in between.

I am in full support of giving women the tools, tricks and techniques they need and want in order to have a robust sex life full of passion and orgasmic delight. But I don’t want my clients to walk around feeling like they are broken in need of a pill to fix them.

What about you? Are you intrigued or seriously in need of a libido boost such that you would consider taking Addyi? Tell us why in our women-only Sensual Vitality-TV Facebook group.

To your passion & vitality,