Understanding Hypoactive Sexual Desire Disorder (HSDD)
Low sexual desire, or libido, is a complex issue influenced by a variety of factors. When this lack of desire is persistent, causes significant distress, and isn't attributable to a coexisting medical condition, substance use, or relationship problems, it may be diagnosed as hypoactive sexual desire disorder (HSDD). It’s important to distinguish between HSDD and situational low desire, as the approach to treatment can differ significantly. While low libido can be experienced by anyone, current FDA-approved pharmacological treatments specifically address HSDD in premenopausal women.
Sexual desire is regulated by a delicate balance of neurotransmitters in the brain. Key players include dopamine and norepinephrine, which generally enhance sexual interest, and serotonin, which can inhibit it. HSDD is thought to involve an imbalance in these neurotransmitter levels.
FDA-Approved Prescription Drugs for HSDD
Currently, two FDA-approved medications are available for treating acquired, generalized HSDD in premenopausal women: flibanserin (Addyi) and bremelanotide (Vyleesi). These medications work through different central nervous system pathways.
Flibanserin (Addyi)
Addyi is an oral pill, approved by the FDA to help increase sex drive in premenopausal women with HSDD.
- Mechanism of Action: Addyi is a multifunctional serotonin agonist and antagonist (MSAA). It is believed to enhance sexual function by targeting specific serotonin receptors, decreasing inhibitory serotonin and increasing excitatory dopamine and norepinephrine in the brain.
- Administration: Addyi is typically taken once daily and requires consistent use for potential effects.
- Important Safety Information: Addyi carries a risk of severe hypotension and syncope when used with alcohol and has interactions with certain medications. It should not be used by individuals with liver problems. Common side effects include dizziness, sleepiness, and nausea.
Bremelanotide (Vyleesi)
Bremelanotide, known as Vyleesi, is an on-demand injection for premenopausal women with HSDD. It is administered as needed before anticipated sexual activity. Vyleesi works by activating melanocortin receptors in the central nervous system to influence sexual desire. Common side effects may include nausea, flushing, and injection site reactions. Vyleesi is not advised for patients with uncontrolled high blood pressure or cardiovascular disease due to possible temporary changes in blood pressure and heart rate. Unlike Addyi, alcohol use is not a contraindication with Vyleesi.
Comparison of FDA-Approved HSDD Treatments
| Feature | Flibanserin (Addyi) | Bremelanotide (Vyleesi) |
|---|---|---|
| Mechanism | Serotonin agonist/antagonist | Melanocortin receptor agonist |
| Timing | Daily pill | On-demand injection (as needed before activity) |
| Target Population | Premenopausal women with acquired, generalized HSDD | Premenopausal women with acquired, generalized HSDD |
| Onset | Gradual, requiring consistent use for weeks/months | Acute, situational effect |
| Alcohol Use | Strict contraindication; risk of severe low blood pressure and fainting | No contraindication; can cause transient BP/HR changes |
| Common Side Effects | Dizziness, sleepiness, nausea, fatigue, fainting | Nausea, flushing, injection site reactions, headache, vomiting |
| Cost/Availability | Available generically | Brand-name only; available via autoinjector pens |
Other Approaches for Increasing Sexual Desire
Low libido is often influenced by multiple factors, making a holistic approach beneficial.
Hormonal Therapies
- Estrogen: In postmenopausal women, estrogen decline can cause vaginal dryness, impacting desire. Vaginal estrogen can treat these symptoms.
- Testosterone: Although not FDA-approved for female sexual desire disorders, testosterone therapy is sometimes used off-label, though studies have shown mixed results and potential safety concerns.
Non-Pharmacological Treatments
- Sex Therapy and Counseling: Addressing psychological, relational, or emotional issues with a therapist can improve sexual desire.
- Lifestyle Modifications: Improving overall health through stress management, exercise, diet, and sleep can positively impact libido.
- Communication with Partner: Open communication about sexual needs is important for intimacy and desire.
Important Considerations and Next Steps
A medical evaluation is crucial to identify potential underlying causes of low libido, such as hormonal imbalances or medication side effects. Often, a combination of approaches, including therapy and lifestyle changes, is most effective. Consulting a healthcare professional is the best initial step to determine the root cause and explore appropriate and safe treatments.
Conclusion
For premenopausal women distressed by HSDD, FDA-approved medications like Addyi and Vyleesi are available, influencing brain chemistry differently and offering distinct administration methods. However, treating low libido effectively requires addressing psychological, relational, and physiological factors. Consulting a healthcare provider is the best initial step to determine the root cause and explore appropriate and safe treatments.
