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Straight, No Chaser: A Year Later – Is the Female Libido Enhancing Pill Working?

By Jeffrey Sterling, MD January 16, 2019

It was a year ago that Straight, No Chaser reviewed approval for the first medication meant to address less than optimal sexual desire in females. That drug is flibanserin, which hit the market under the brand name Addyi. Let’s revisit the discussion – mostly as a reaffirmation of a basic Straight, No Chaser lesson.

The idea of a female counterpart for Viagra and other erectile dysfunction drugs has been bantered about for years. After all, it’s been shown in the medical literature that at some point, approximately 10% and up to one-third of women may suffer from hypoactive sexual desire disorder (the actual term for premenopausal women with diminished or absent sexual desire, aka low libido in women) – or should I ignore the fact that Viagra earned its maker more than $1.6 billion dollars last year?


If you think through the premise, the issue existing with women never should have been exactly the same as exists with men. After all, men are treated for erectile dysfunction, and after all, women don’t have penises. Furthermore, the condition in women speaks to diminished desire, not diminished ability as in seen in men. The situations aren’t exactly analogous, thus you wouldn’t think the solution would be as simple as giving women a drug used for erectile dysfunction.
And so, the drug flibanserin, which is not the same drug as Viagra (sildenafil), has been fully approved by the FDA for treating hypoactive sexual desire disorder. Again, it’s important to immediately point out that this is a different medication. In fact, it’s a drug that acts on the central nervous system and is in the same category of pharmaceuticals as antidepressants. Any of you suffering from depression and taking antidepressants may have paused at that last sentence, and here’s a word of caution to those legitimately suffering. The FDA rejected this same drug twice within the last five years prior to its approval, presumably based on its (lack of) merits. Most of the reasons this medication hadn’t been approved previously were related to the associated side effects (often a deterrent to compliance with antidepressants), which include episodic low blood pressure, fainting, and fatigue. Questions continue to exist on interactions with alcohol or birth control pills. The specific challenge in finally getting approval was largely based on getting a better handle on the side effect profile and on weighing the side effects vs. the benefits.


But does it work? You tell me – it’s been nearly a year! Using Viagra as an analogy, has the marketing machines of Big Pharma inundated your televisions with ads trumping Addyi’s success? Do you doubt that this wouldn’t have occurred with overwhelming success? As has often been discussed in Straight, No Chaser (and is echoed by many sex therapists and behavioral psychologists), the cure for such conditions is not likely to be found in a bottle. As exists in this example, when conditions are mental instead of physical or physiological in nature, the solution may need to also be mental. It is fair to say approval of this drug rode a wave based on a combination of existing lack of options in women’s health, politics and the sincere desire to provide solutions to women in need. That is not the same as saying this drug is definitely the solution for hypoactive sexual desire disorder in women (nor does it mean to suggest that it can’t be an option for women in need). Still, the drug has been studied in more than 11,000 women and performed better than a placebo by all measures examined. Specifically, women in clinical trials of the drug experienced two to three “satisfying sexual events” per month before joining the trial, and an FDA analysis showed they had 0.5 to 1 more such event per month with flibanserin compared with a placebo. That’s a fact, and that gets a drug approved. Just remember: just because a drug is approved doesn’t mean in will work in you or be safe for you to take. Discuss this with your physician. In the meantime, remember: diet, exercise, stress reduction and moderation in your indulgences make for a better approach that seeking health from a pill bottle.
Feel free to ask any questions you may have on this topic.
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