Wait a second?
There are medications for women who struggle with their sex drive? Why have I never heard of them?
Why has my doctor told me there were no treatment options for my low libido?
These are great questions and I hear them all the time while giving lectures, in exam rooms, and while engaging with women on social media.
First, what exactly is hypoactive sexual desire disorder (HSDD) or low libido?
Yes, there will be times when you are just not in the mood – you’ve got too much on your mind, you are tired, you are stressed, the kids are driving you crazy, or you simply don’t want to – and that’s okay! So, what is the difference between not wanting to have sex and having HSDD?
HSDD is defined as: The absence of sexual fantasies and thoughts, and / or desire for or receptivity to sexual activity that causes personal distress or difficulties in her relationship for at least 6 months (1).
So, what does this mean? For women it means:
- That there is a decreased or absence of sexual desire,
- It causes distress to the patient,
- It has been going on longer than 6 months, and
- It is not related to another medical or psychiatric condition.
For a woman to be diagnosed with HSDD, she must meet these requirements. There are many things that can interfere with sexual desire, including medications such as antidepressants and birth control, problems in the relationship, other health problems, menopausal status, hormones and pain during intercourse.
I often explain to women that our brain is our biggest sex organ – multiple neurotransmitters are involved in sexual function.
Our brain also protects us and, if sexual activity is painful, it is normal for our desire to decrease. In these instances, even though sex drive is lower, it cannot be called HSDD. That’s why a doctor’s visit is so important. If you are reading this and believe you may be suffering from HSDD, make an appointment with your gynecologist to discuss it. He or she may ask you to fill out a questionnaire called a Female Sexual Function Index (FSFI) to measure the six domains of female sexual health: desire, arousal, lubrication, orgasm, satisfaction, and pain.
Your doctor can also determine if you are distressed by your lack of desire. Some women are not bothered by their lack of sexual desire and that is fine. Providers only intervene or offer treatment to women who struggle due to their low desire or are distressed by it.
Once the diagnosis of HSDD is made, what options are available to women?
If your doctor diagnoses you with HSDD – know that you are not alone. One in every ten women suffer from HSDD – and the good news is that there are two FDA-approved medications for HSDD. The great news is that both are non-hormonal, covered by many insurance plans and are offered by prescription.
Addyi, the first ever FDA-approved medication for HSDD, is known as the “little pink pill”. It works on neurochemistry in the brain to increase desire and lower distress associated with having sexual dysfunction. It is taken nightly regardless of sexual activity.
Vyleesi was FDA approved in 2019 for HSDD. It’s an injection (yes, an injection) that is “on demand”. What does that mean? Women can inject themselves at least 45 minutes before they “want to want to” have sex. The effects last up to 16 hours and a woman can use up to 8 injections per month. The injections are given in the abdomen or thigh. The needle is small and the injector pen is very simple to use.
Both medications have side effects and have a non-responder rate, meaning some women will not experience an improvement with the medications. I find that when we address relationship issues, pain, hormones and overhealth and well being in conjunction with medication, women are more likely to achieve success and find their sex drive again.
I am thrilled women now have two FDA-approved options to treat HSDD. It is not as many as I would like, but it is a start.