Jennifer Anger, MD, MPH, urologist, associate professor of surgery at Cedars-Sinai in Los Angeles and coauthor of the study “Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis” published in Obstetrics & Gynecology.
Bottom Line: There’s no “little blue pill” for women, but there are ways to enjoy sex again
Your male partner can take a pill to reverse erectile dysfunction and be ready to go. That’s just not the case for you. There are a handful of medications approved or in the pipeline that treat female sexual issues, but it turns out that most of the time, they don’t work much better than the placebo treatment.
So if you’re a woman with a sexual function issue, are any of these drugs worth trying?
The latest findings: Researchers from Cedars-Sinai Hospital in Los Angeles took a deep dive into eight studies that involved various medications aimed at improving women’s problems with sexual function—meaning low desire (low libido), a lack of sexual arousal, inability to achieve orgasm and painful intercourse. To gauge these aspects of sexuality, these studies used something called the Female Sexual Function Index, a standardized scale of women’s sexual satisfaction that has a maximum score of 36 points.
In these studies, around 2,200 women had been given medication, and around 1,700 had been given a placebo. The women who received a placebo improved by 3.62 points on the index, on average, compared with a 5.35-point improvement seen among women receiving medication. This means that overall, women who only thought they were taking sexual function drugs achieved two-thirds as much improvement as those who actually did take the drugs. Or looked at another way, just being part of a study on sexual drive improved their sex lives.
But could you be one of the women helped by a drug…and which one? To find out, your first step is to identify the area or areas of sexual function causing you difficulty.
Many of these problems have different treatments, and there isn’t one single drug that works for every problem in every woman. Matching medication to your specific issue maximizes the chance of experiencing more than a placebo effect…and makes any side effects a better trade-off.
For low libido and a lack of arousal: Flibanserin (Addyi) was often referred to as the “female Viagra” when it was introduced in 2015. That was always a misnomer—while Viagra is chiefly a physiological drug (increasing blood flow to the penis), flibanserin was designed to boost the brain chemicals dopamine and norepinephrine and decrease serotonin to increase women’s sex drive. Studies on it continued after its FDA approval because of concerns ranging from side effects such as dizziness and insomnia to low blood pressure. But its biggest problem is that it isn’t the magic pill we had hoped—meaning that it doesn’t increase sexual function significantly for most women taking it.
A different type of drug, bremelanotide, is under FDA review. Its aim is to activate brain pathways involved in the body’s normal sexual responses to improve low libido.
For low libido related to depression: If some or part of your sexual function problem is underlying depression, treatment with the antidepressant bupropion can help in both areas. Other antidepressants can cause sexual problems, so if you are on an antidepressant, switching to bupropion might help—ask your doctor about it.
For low libido and an inability to achieve orgasms: Oxytocin, often called the love hormone because the body usually releases it during intimate moments, is available as a nasal spray and may help women achieve orgasm, but women taking a placebo also improved, likely because of the better communication with their partners about sex that often occurs when a woman is part of a study. Oxytocin is not FDA approved specifically for sex, which may explain why you haven’t heard much about this use (it also can improve depression).
For dryness and/or painful intercourse and possibly a lack of arousal: During menopause, the drop in the female sex hormone estrogen affects the entire body, including the vagina, with dryness and thinning tissue that can make sex painful. Using a lubricant can help, but in many women, that’s not enough to compensate for these physical changes. Locally targeted drugs aim to replace the lost estrogen and make sex more pleasurable. Vaginal estrogen is available in many formulations including creams, tablets and a vaginal ring. Vaginal estrogen is not the same as systemic hormone replacement therapy and does not increase the risk for breast or gynecologic cancers. Newer agents include prasterone (Intrarosa), a bullet-shaped pill inserted into the vagina. It contains DHEA, a “precursor” to estrogen. Ospemifene (Osphena) is a selective estrogen receptor modulator, meaning that it acts like estrogen in some places, such as the vagina, and not others, such as the breasts. These new agents show promise in helping to jump-start feeling aroused.
Some women are helped by Botox injections—the same drug that eases wrinkles helps relax pelvic-floor spasms, responsible for a different type of pain during intercourse.
There are things you can do for sexual dysfunction instead of or in addition to taking drugs…
Open communication with your partner can make a real difference. It may be as simple as telling your partner that you would enjoy more foreplay or a little romance…something that often has faded away in long-term relationships. Some women (and men) will benefit from individual or couples therapy to break down barriers to intimacy.
Doing Kegels. Medications all have side effects, but Kegels don’t. These exercises, which tighten and hold the muscles that control urine flow, can help reduce urine leakage—a common impediment to feeling comfortable about sex—and boost sexual function in many ways. Aim for at least three sets of 10 Kegels each day. Each contraction should last for at least three seconds. If you don’t notice major improvement, talk to a urogynecologist—a specialist with training in urology and gynecology with expertise in female pelvic floor disorders—about what else you can do.
Note: To better understand and identify any sexual problems you’re experiencing, you can take the Female Sexual Function Index assessment at http://www.fsfiquestionnaire.com/FSFI%20Scoring%20Appendix.pdf