'Female Viagra': a primer

It was a case of third time lucky. After a series of applications, the US Food and Drug Administration approved a pill to improve women’s sex drive on Tuesday.

Flibanserin — or Addyi, to use its drugstore name — was created for females with hypoactive sexual desire disorder (HSDD), which impinges on fantasy and the desire for sex.

But what is this little pink pill, exactly? And what are the wider implications? Jim Pfaus, a Concordia expert in human sexual function, clarified a few key points.
 

1) Flibanserin is not Viagra.

JIM PFAUS: Despite the easy comparison, flibanserin is not Viagra (sildenafil), nor does it work by the same mechanism. In fact, Viagra works quite well in women to promote vaginal, clitoral and labial blood flow, though they generally do not "feel" it because such flow is largely internal. 

Flibanserin (Addyi) is a drug that puts the brakes on the neurotransmitter serotonin in the brain. Among other things — like sleep — serotonin is involved in satiety and behavioral inhibition; the latter is an important component of what neuropsychologists call "executive function."

When you have too much inhibition, it is far more difficult to get excited at the prospect of having sex. Putting the breaks on that by inhibiting serotonin release and binding at certain serotonin receptors — which is what flibanserin does — allows the sexual circuitry of the brain, and especially the dopamine systems, to be more excited by sex-related cues. 

This happens in the hypothalamus, limbic system (emotional part of the brain) and in the frontal cortex, and for women who suffer from HSDD that is caused by too much inhibition, flibanserin will increase their desire for sex. 

Of course, just having a desire for sex does not necessarily translate into actually having sex. Thus, this drug is not a replacement for a partner with good social and romantic skills, nor is it a replacement for sex therapy.

It will likely be used in conjunction with sex therapy and a good dose of quality sex education for both partners.
 

2) It is likely only a matter of time before Health Canada approves flibanserin.

JP: Obviously FDA approval is not Health Canada approval, but as goes the FDA, typically so goes Health Canada. I would expect a delay, though, of maybe a half year on that if Sprout Pharmaceuticals makes an application. 

The black box warning comes from the early side-effects that many women experience, including dizziness, drowsiness, and in very few cases nausea. The effects are relatively mild — like one might experience with an antihistamine — and they go away with a short amount of time on the drug.

This is one reason why women are told not to consume alcohol with the drug, and why the prescribed dosing is done every night before you go to sleep.
 

3) Flibanserin is the first drug treatment for female sexual dysfunction.

JP: The new drug and FDA approval is, in a way, quite monumental. It is an admission that women can be in control of their own sexuality and the sexual choices they make. 

Prior to this, there were 26 treatments for men's sexual dysfunctions, but none for women's.

We were told by some special interest groups — mostly clinicians who have a stake in talk therapy and do not like the challenge posed by any kind of drug therapy — that “big bad pharma” was trying to medicalize and take over women's sexuality with a pill.

In fact, most pharmaceutical companies, especially the big ones, do not want to touch women's sexual problems with a 10-foot pole. All the drugs in the pipeline to treat HSDD are coming from small biotech companies, many of which are run by women!

Women who do not need flibanserin will not seek it out, and the ones that do will now be able to make their own choices about whether this is needed as an adjunct to therapy.

And flibanserin opens the door to other treatments that may well end up being even more efficacious. Again — it is only a pill that helps to make the brain more open to sexual cues. It is not a replacement for a good lover or good therapy.

Find out more about Concordia's Department of Psychology.