I’ve had a lifetime of experience dealing with women’s health issues, including 25 years as a psychologist, clinical researcher and professor of reproductive biology and psychiatry. So you might think I’d have seen a variety of milestones in women’s health, not to mention the human experience of being a woman.
Until last week’s highly-anticipated Food and Drug Administration approval of flibanserin, however, I hadn’t. Flibanserin will transform how many practice medicine and benefit the lives and sexual relationships of millions of women and their partners.
The straightforward news is that flibanserin, which will be marketed by Sprout Pharmaceuticals under the name Addyi, is the first drug of any kind to treat hypoactive sexual desire disorder (HSDD). Recent surveys show that between 5.5 million to 8.6 million women in the United States — between 8 percent and 14 percent of women ages 20 to 49 — experience HSDD.
Patients with HSDD have lost their sex drive and are distressed about it. Most of my patients with HSDD are in long-term, monogamous and loving relationships. They want to want again.
The media meme is that Addyi is “the pink Viagra.” While that’s wrong, given their completely different mechanisms of action, there is one way in which they are similar. Prior to the introduction of drugs for erectile dysfunction in the late 1980s – today there are more than 25 of them, by the way – the majority of men complaining about erectile dysfunction were diagnosed as having a psychological problem. “It’s all in their heads,” they used to say. Sounds familiar, doesn’t it?
The approval of Addyi opens the door to momentous change for women, similar to that of the pill in 1960, which allowed women to control their reproductive lives, at once giving them the option and opportunity to recognize and reach their potential. It was a biological battle won for women at the dawn of the sexual revolution. But it did little to win the war and change the cultural values around women’s right to a rich and satisfying sexual life.
What the pill began, I’m confident Addyi will take a giant step further.
FDA approval grants us more than just a way to treat HSDD. It lays to rest any lingering doubts about its existence. Despite being recognized in scientific journals since 1977, those doubts hampered medical progress as well as jeopardized women’s health. Some physicians, having no other medical option, sought to address HSDD with unproven therapies. Some patients turned to the Internet and fell prey to unscrupulous claims and dangerous treatments.
Addyi gets the condition out of the closet by acknowledging a biologic cause of women’s low libido — it’s not just in their heads, nor something a romantic getaway with their partner will cure. For those with a biologic cause of their HSDD, no amount of counseling will help. Addyi restores some women’s libido by adjusting the brain chemistry, just as anti-depressants adjust brain chemistry for some patients suffering from depression.
With FDA approval, health care professionals can prescribe a treatment for HSDD which, after extensive research that included 11,000 women, we know is both safe and effective. In fact, studies show a 53 percent improvement in women’s desire for sex, a doubling of their number of satisfying sexual events and a 29 percent decrease in distress.
Addyi isn’t for everyone, and like virtually every drug on the market, it may cause side effects. That’s why doctors counsel their patients before prescribing treatment of any kind. But its approval is a genuine turning point and a reminder that male and female sexuality are not so different after all. They both involve psychological and biological components and both deserve safe and effective treatments. And now, with Addyi, they both have it.