By Stacey Nadelhoffer, LCSW
Last summer, the US Food and Drug Administration approved a non-hormonal therapy named Addyi (aka flibanserin, the “little pink pill,” or the “female Viagra”) for treatment of low sexual libido in premenopausal women.
Addyi affects the brain neurotransmitters serotonin, norepinephrine, and dopamine, which regulate feelings of well-being, our interest in reward-seeking behaviors such as sex, and regulation of our our thinking. It therefore thought to impact our interest in, expectations about, and openness to sex. Addyi also impacts the release of oxytocin (the bonding hormone) and prolactin (a hormone released after orgasm). Addy acts on the brain’s 5-HT(2A) serotonin receptors and may also have an inhibitory effect on the orbitofrontal cortex, which is involved in decision making and expectations. The orbitofrontal cortex is inhibited during orgasm.
So is it worth it? Well first let’s look at the side effects. Addyi has serious interaction with alcohol and is thus only available through health care professionals and pharmacies specifically certified in risk evaluation and mitigation strategy. Other risks include low blood pressure and loss of consciousness. Women who drink alcohol, have high levels of certain biochemicals, and liver impairment are at higher risk. Other side effects include dizziness, sleepiness, nausea, fatigue, insomnia, and dry mouth.
Next, let’s look at the effectiveness of the drug. According to the FDA website, a study of over 2,400 premenopausal women showed Addyi increased the number of satisfying sexual events by 0.5 to 1 additional event per month. On the Female Sexual Function Index, which measures arousal, orgasm, satisfaction, and pain on a scale from 1.2 to 6, scores improved by 0.3 to 0.4. On the Female Sexual Distress Scale, which measures distress about one’s sex life and relationship as well as feelings of anxiety, inadequacy, stress, and embarrassment, scores also increased by 0.3 to 0.4. Across three trials, about 10 percent more Addyi-treated patients reported meaningful improvements in satisfying sexual events, sexual desire, or distress.
Here is my take-home message after weighing the pros and cons: While low sexual
desire in women is indeed biologically influenced, many other factors are at play, and to improve sexual desire, those issues must be address as well. In my experience as a sex therapist working with both individuals and couples, I have learned that sex is extremely complicated and is influenced greatly by our personal experiences: messages we receive in our childhoods and families of origin; our dating and sexual experiences; religious values; media influences; and gender stereotypes, to name a few. These factors strongly influence the ways we think about and experience sex, and evidence suggest that our experiences can greatly impact our brains. So if by taking a medication we’re just adjusting our neurotransmitters, we are not really addressing the root of the problem, while taking on the risks and side effects of medication.
If your goal is to be more more liberated and positive about sex, it is critical to address the psychological, social, relational factors at play. From a psychological perspective, the messages we received about sex, as well as our exposure or lack of exposure to physical and verbal affection from our parents, will greatly affect our relationships and sexuality. Our capacity for intimacy is also paramount and is greatly impacted by our experiences in our family of origin, our peer relationships, and our previous romantic relationships. We may have developed a fear of emotional vulnerability, dependency, or being controlled or of losing control. We may also have fears that cause us to anticipate negative outcomes, such as a fears acquiring a sexually transmitted disease, becoming pregnant, or experiencing pain. We may have performance fears and worry about being an inadequate lover or person.
From a cultural perspective, we know that our society greatly sexualizes women, placing them under immense pressure to have unrealistic expectations about their bodies and sexuality. Meanwhile, women are also given the message that “good girls” don’t have sex and that
women who enjoy sex are whores. Thus, our culture discourages sex-positivity, resulting of feelings of guilt and shame about sexuality and causing women to disown their right to genuine sexual desire and pleasure.
In addition, our society does a poor job of educating us about sex. In most sex education programs, we are taught some anatomy but are not taught about how it impacts our sexual pleasure. What did you learn, for example, about how the clitoris, perineum, G-spot, the U-spot, or the A-spot contribute to sexual pleasure? We are thus led to believe that sex is simply about penetration. In addition, neither men or women learn that without proper time for seduction and stimulation—such as compliments, flirtation, caressing, hugs, kisses, or gentle touch of the erogenous zones—a woman might not be physiologically aroused in order for penetration to feel
pleasurable. In summary, we are missing out on what could be an incredibly enjoyable journey and anxiously jumping straight to the destination.
Our culture also discourages us from talking to our partners about our sexual preferences because doing so is somehow considered to be less romantic and spontaneous. And yet it is ridiculous to think that sex is something we should just automatically know about without conversation. Every person is different, and it is essential that we discuss our sexual preferences so that our partners are informed and we can optimize our sexual experiences.
In my work with men, I often explore the idea that perhaps their partners are not interested in sex because they aren’t enjoying themselves. And with women, I explore whether they know that they are responsible for our own sexual pleasure. Not knowing that can lead them into a passive and disempowered role, causing them to feel that sex is obligatory and also placing a lot of performance pressure on the man.
In summary, we idealize romance but we don’t encourage women to embrace sexual pleasure. Our discomfort with educating ourselves and talking about sex greatly contributes to our difficulties with sexual enjoyment. The messages we’ve received from our culture, our families, and our experiences all play a role in women’t sexuality. My advice? See a sex therapist and address the root of the problem so that you can feel liberated and enjoy sexual pleasure. You deserve that.