Imagine you could increase your desire with a simple pink pill. Imagine that months or years of sexual indifference could end, thanks to a prescription purchased for about the same price as Viagra. Imagine skipping the aphrodisiacs and well-meaning but useless advice of friends and bedroom "experts." Imagine wanting your partner again.
Now, imagine the purported side effects of that pill include drowsiness, nausea, and fainting. Imagine it’s a daily medication, and the U.S. Food and Drug Administration (FDA) says you shouldn’t drink alcohol while you’re on it. Imagine that it’s clinically shown to increase satisfying sexual events (SSEs) 0.5 to 1 times per month. Imagine that, to take it, you should have been experiencing dissatisfaction for at least six months and it can’t be a result of relationship issues, medications, and pre-existing psychiatric or medical problems.
As of last month, that pill is here.
On October 17, 2015, flibanserin (brand name Addyi), sometimes referred to as "Female Viagra," hit shelves for the first time. While it’s not currently available to women after menopause, "[parent company] Sprout’s priorities would be to get it approved next for postmenopausal women," according to CEO Cindy Whitehead in The New York Times.
So, Female Viagra is most likely coming for you. But is it worth it?
A Little Background
First things first: Female Viagra isn’t Viagra at all. "Viagra works on blood flow," says Dr. Bat Sheva Marcus, Clinical Director and Co-Founder of Maze Women’s Sexual Health in New York. "Flibanserin works on the brain, changing the brain chemistry that affects desire." In essence, the drug balances neurotransmitters norepinephrine, dopamine, and serotonin, all partially responsible in women’s arousal. The result, at least some of the time, is increased excitement.
Despite that ostensible benefit, flibanserin’s road has been a rocky one. "It was initially tested as an anti-depressant before researchers realized there was a libido effect," says Dr. JoAnn Pinkerton, Executive Director of the North American Menopause Society. Concerned by side effects, the FDA rejected it in 2010 and again in 2013, at which point Sprout helped establish an advocacy group called Even the Score to push its approval. The group positioned the drug as a specific response to a diagnosable ailment—Hypoactive Sexual Desire Disorder (HSDD)—as well as a leap forward for feminism. In August 2015, flibanserin went in front of the FDA one more time. This time, it passed.
Supporters, including the National Organization for Women and the American Sexual Health Association, were thrilled. Finally, women suffering from a very real, emotionally devastating condition could boost their libidos with a prescription—no small victory in a country where every FDA-approved sexual enhancement drug is intended for men. What’s more, even if flibanserin didn’t help everyone, it paved the way for better medications down the line.
Detractors, on the other hand, were less than impressed. They argued that harmful side effects and a multitude of stipulations outweighed flibanserin’s advantages—not to mention the pill didn’t seem to work very well. One group of 100 doctors, nurses, psychiatrists, and sexologists even wrote the FDA, arguing the drug passed thanks to, "a confusing scientific picture and the interference of 'Even the Score,' a carefully orchestrated public relations campaign initiated by the makers of flibanserin and other companies with sexual pharmaceuticals in the pipeline."
Either way, it’s here. Addyi hit pharmacies near you in mid-October, backed by a subdued marketing campaign, muffled while Sprout looks to ensure the pill’s safety. Sales numbers are being tabulated as we speak, and similar medications are coming down the pike soon. "They’ve been testing a few different drugs," says Dr. Marcus. "There are three or four in the pipeline."
Flibanserin and the Post-Menopausal Woman
In the meantime, Sprout is studying Addyi's effects on older women, whose sex drives can be diminished by the usual culprits—depression, rocky relationships, health problems, and stress—but also issues specific to menopause like hormone shifts, hot flashes, and vaginal discomfort. "For postmenopausal women, we worry about vaginal atrophy," says Dr. Pinkerton. "Do they have a thinning of a lining of the vagina, so that sex has become painful?" Once those issues are taken into account, "For the women who truly seem to have an imbalance in their serotonin and dopamine and are having stress about their libido, I would certainly consider it," she says.
Early test results are promising, too. In a 2014 study published in the journal Menopause, researchers found that flibanserin, "has been associated with improvement in sexual desire, improvement in the number of SSEs, and reduced distress associated with low sexual desire, and is well tolerated” by women after menopause. That could be good news for the right person, if Addyi is approved for this age group by the FDA.
"The best candidate," says Dr. Pinkerton, "has to be someone willing to go on the medication, give it the eight weeks to work, and understands that the benefits are modest." She adds, "However, if you’re a patient who hasn’t had sex in a year, and you now have successful sex once a month—that’s a win."
In some situations, it’s already being prescribed off-label. "We are absolutely using it on postmenopausal women," says Dr. Marcus, though it’s always accompanied by other forms of therapy. "It depends on the circumstances," she says. "It’s depends on what the woman wants, and how well she responds to it. And in any of those cases, we would also do behavioral or psychological intervention."
Despite the hurdles, many experts remain hopeful about Addyi after menopause. "Do women need options? Yes. Does it have to be a medication? Not necessarily. But if this were to work for women, it would give us an option," says Dr. Pinkerton. Because ultimately, "Women deserve to have non-painful, enjoyable sex no matter what the age."
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