Non-Hormonal Approaches to Female Sexual Function

“I often say you can picture men's sexual desire as a light switch, and women's sexual desire as the cockpit of a 747,” she says. “There are more factors at play in female sexual desire.” As a result, the treatment for HSDD requires a more nuanced approach. The drugs the FDA has approved for HSDD are: Flibanserin (Addyi): It’s a pill you take every evening. Bremelanotide (Vyleesi): It’s a shot you give yourself in the belly or thigh 45 minutes before you have sex. You take one in a 24-hour period, and doctors recommend only eight shots per month. Both drugs boost the activity of chemical messengers in your brain, called neurotransmitters, that are key to helping you feel aroused. You take flibanserin every day, whether you plan to have sex or not.

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You inject bremelanotide only when you need it.

What to avoid

You take it at bedtime because the side effects include low blood pressure, hypotension, fainting, dizziness, headache and sleepiness. About 10% of women are going to have that effect. So 10% of women are going to have a benefit, 10% of women are going to have a side effect. We don't know if it's the same 10%. So they recommend taking it at bedtime so that you're less likely to be dizzy or to pass out, so I think that's the issue.

Are OTC supplements for sexual health FDA approved?

I'm glad that women have something that might work for them, and like birth control methods, not all methods are right for everyone. They recommend that if a woman takes it for eight weeks and she doesn't notice a difference, remember that half the difference that she notices is going to be placebo effect. So if she doesn't notice a difference then she shouldn't take it anymore. It's going to be $30-$75 per month and we don't know whether insurance companies are going to cover it. But you can bet your booties that if insurance companies cover the Viagra type drugs and they don't cover Addyi, there's going to be some ladies marching on your insurance company's front door. It’s important to note that neither drug makes sex better. They just make you more likely to feel in the mood. Your doctor may recommend that you try sex education and counseling along with the medication. You may also need hormone therapy, if you deal with any physical issues that affect sex, such as vaginal dryness. Your doctor needs to diagnose you with HSDD in order to prescribe either drug.

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They can do that by asking screening questions, such as: • Have you been satisfied with your level of sexual desire before?• Has your sex drive gotten lower?• Does your lack of libido bother you?• Would you like it to increase?• Are there other things (medication, pregnancy, surgery, stress) that could be affecting your sex drive? If you answer “yes” to the first four questions, and there’s no other cause for your low sex drive, you probably have HSDD. Volkar says the distress that a woman feels about her sex drive is often the driving factor in whether or not she needs to take medicine for it. “Because if you aren’t bothered by it, it’s not a problem,” she says. Also, your doctor will want “to make sure it's not related to your present situation or relationship.

2. Chasteberry

It’s a condition known as hypoactive sexual desire disorder (HSDD). There are a few over-the-counter supplements that aim to treat the problem, which have limited, mostly unproven, effects. But in recent years, the FDA has approved two prescription drugs to treat HSDD. These treatments are often referred to as “female Viagra” -- a nod to one of the medicines that men can take for sexual problems. But increase libido in women they’re not much like Viagra at all. Because you can't fix HSDD if the problem is you really don't like your partner,” she says.

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Some insurance companies will cover HSDD medications.

Country/Region	Regulatory Body	Regulation Level	Requirements	Notable Restrictions
USA	FDA	Strict	Must be approved, safe ingredients	Ban on unapproved claims
EU	EMA, national agencies	Moderately strict	Clinical trials, labeling	Ingredient restrictions
Australia	TGA	Strict	Safety testing, registration	Claims verification
China	CNCA	Varies	Sometimes less regulated	Quality standards adherence
Russia	Rospotrebnadzor	Moderate	Certification required	Ingredient testing mandated

Your cost will vary based on your plan, but out-of-pocket cost for flibanserin is about $100 for 30 pills (1 month’s supply).

9. Probiotics

Interviewer: So there are a lot of pills for men, as you mentioned, this is really the only one for women. Is there a medical reason for that? Is it more difficult to create a drug, or is it what a lot of people claim that it's a man's world and I don't even know the words, but that argument. Dr. Jones: Well it's been unfortunate that we've considered men so simple.

In people who are postmenopausal

All they need is something to make their switch go up instead of down and that should be very easy. Whereas women, desire is a complicated thing. We don't know how flibanserin works, if it does, and why it only works for 10% and not on the others, because we don't know where desire comes from in women. Why is it common, 50% of women don't have desire until they're already in the middle of being stimulated, so they only have responsive desire? So we're not very smart about where desire comes from, and there aren't very many good animal models for desire. Both drugs have different concerns and risks.

🛒 How to Find High-Quality Products?

"Oh yeah, when we're away we have great hotel sex." Well, there are no kids around, there are no dishes, and definitely no bills, you're in a brand new bed, it's a new place. But if women say, "I don't want to do all that thing," it's like dieting and exercise, "Just give me a pill doctor so I can lose weight, just give me a pill." What I am afraid of is that I will get calls from husbands, "I want you to fix my wife. I want you to give her that pill." So if this is being driven by the partner, I need to get buy-in by my patient that she's really interested, because she may have some side effects. And if she's really not interested in becoming interested, then this is not for her. If she's interested in becoming interested, I think it's worth a try for a couple of weeks.

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And if she doesn't have significant side effects and it improves her intimate life, just thinking about sex makes people have sex more often, so the placebo effect can be significant. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. For many women, sexual desire goes up and down over the years, often tied to changes in relationships, stress, and physical changes like pregnancy and menopause. But roughly 10% of women deal with a low sex drive that causes them distress. The one you should take mostly depends on what works best for your lifestyle. “There are certainly women who have no interest in injections,” Volkar says.

Step	Action	Time Frame	Notes
1	Consult with healthcare provider	Before first use	For existing health conditions
2	Follow dosage instructions on package	Daily or as specified	Do not exceed recommended dose
3	Take with water, preferably before intimacy	30-60 minutes prior	To optimize effectiveness
4	Avoid alcohol or other blood-thinning substances	On usage days	Reduces risk of side effects
5	Monitor for adverse reactions	During first week	Discontinue if severe side effects occur

“Others have no interest in taking a pill every day.” It’s best to talk to your doctor about which one would work for you.

Attribute	Most Important	Reason	Typical Response Rate	Preferred Brands
Effectiveness	Yes	Better satisfaction	85%	LibidoMax, FemVibe
Safety	Yes	No adverse reactions	78%	DesirePlus, Eros Boost
Price	Yes	Affordable options	90%	AphroViva, LibidoMax
Natural ingredients	Yes	Desire for herbal or natural options	70%	Horny Goat Weed, Maca
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Researchers have mainly studied how the medicines work in women who haven’t gone through menopause yet.

📝 Appendix and Notes

In fact, they work very differently inside the body. “In men, Viagra fixes a ‘plumbing problem,’ if you will,” says Judith Volkar, MD, of the UPMC Magee-Womens Hospital in Pittsburgh. Viagra and other similar drugs treat erectile dysfunction, when a man can’t get or keep an erection that’s firm enough to have sex. These men often still have sexual desire, but they just can’t get their bodies to respond physically when they want to have sex. The drugs help by relaxing the muscles in the penis and boosting blood flow so an erection can happen. So the FDA approved both drugs for premenopausal women only. Women who are pregnant or breastfeeding should not use either drug. There are others who shouldn’t take the medications, including those who: Take medication for HIV, hepatitis C, or high blood pressure that’s not under control “They can also interact with several drugs women commonly take, like fluconazole (Diflucan), which is a yeast infection medication, and also some antibiotics,” Volkar says. “So it's good to be aware of what medications you're on and discuss those with your doctor.” Women who use HSDD medications shouldn’t drink alcohol from 2 hours before they take the drug until the following morning, because it can lower blood pressure to dangerous levels.

6. Dehydroepiandrosterone (DHEA)

Do you have some inner hostilities and you just don't want to have sex with them? So what are the reasons going on? What I often hear is "I just am not that interested anymore." "Well tell me about your relationship with your husband." "Well we've been together for 20 years and he's my best friend." Well you know, you just don't have sex with your best friend. So having that kind of relationship evolve is great for the marriage, that they're now best friends, but it's not great for sex. The sex needs something a little bit different.

How is low sex drive diagnosed in women?

Interviewer: So if it doesn't bother your patient, then there's not a problem? Interviewer: And before you would recommend this pill you might recommend the 5 Ts that you've talked about. Dr. Jones: Right, and I usually recommend taking some time out for each other. I ask them, what kind of pattern of intimacy do you have when you and your partner go on vacation? The drugs can cause side effects, such as: Bremelanotide can cause your skin and gums to get darker.

Why the FDA rejected Addyi twice

Interviewer: What would you recommend to a patient asking you about this medication? Dr. Jones: I think I'm a fan of the 5 Ts, so when a woman says I'm just not that interested in sex anymore and this bothers me, remember those are the two things. They have to be not as interested, they have to have had interest at least once, so taking a 50-year-old who's never been interested in sex and thinking a pill is going to work, it's not going to work. "So I had interest and now I don't." I say the 5 Ts are, Time - we are over extended.

Professional resources

If you think you're going to have fast food sex the way you did when you were 20 you're not going to. You need to go for gourmet sex which means you have to plan it, you have to think about it, you have to tell your partner what makes you get in the mood. I think touch is important, the kind of quick sex where you didn't have that much time together physically, that's not going to work as you get older, so the right kind of touch. Women need emotional and physical tenderness before they're going to get in the boat and row with you. A lot of women say "I'm not interested but I haven't been interested since my husband had an affair with that woman down the street," well I can't blame you.