The ‘Pink Pill’ Isn’t Viagra for Women

The new options to enhance sexual desire in women haven’t had many takers, in part because of side effects and possibly embarrassment. Here’s what you should know.

Do you wish you felt more desire? You can ask your gynecologist about pharmaceutical options, but evaluate them carefully. Neither of them is comparable to drugs like Viagra for male erectile dysfunction.

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The ”pink pill”  

The Food and Drug Administration approved flibanserin (Addyi), a daily “pink pill,” in 2015. The medication has not sold well, however, and as recently as last year the agency considered regulatory action to warn users about its interactions with other common medications.  

Another issue is that Addyi has rare side effects (low blood pressure and fainting) that become more likely if you drink alcohol. This means you’re advised to stay away from alcohol at least two hours before your nightly dose. What if you drink a glass of wine or two to relax for sex? You’ll have to time things carefully. That’s work.

It’s incorrect to think of flibanserin as a “Viagra for women.” Viagra helps the penis function. But it is not a mechanism that affects sex drive.

Flibanserin doesn’t target blood flow to the vagina. Instead, it affects the level of serotonin in the brain, with indirect effects on dopamine and norepinephrine. You may have heard the terms serotonin and norepinephrine in discussions of antidepressants. Addyi flunked trials as an antidepressant before Sprout Pharmaceuticals’ campaign to get it approved as a lust-enhancer.

The pill’s effects on libido aren’t huge but sufficient to meet the agency’s standards. It won’t work for everyone, and the impact may be minor. Compared to a placebo, women taking flibanserin have reported one more “sexually satisfying event” a month on average.

Note that a “sexually satisfying event” need not include an orgasm. On questionnaires, the women reported a slight increase in desire and a slight decrease in stress. On the other hand, some women have reported more dramatic responses.

Ten to 12 percent of patients in the company’s research experienced each of the most common side effects: sleepiness, dizziness, and fatigue. Those side effects seem to be more common in women who take hormonal contraceptives.

You may also run a higher risk of side effects if you take antidepressants or benzodiazepines and other medicines.

You may worry about cost. Many insurers, including Medicare, aren’t covering the cost of flibanserin.   According to the company website, you can get the drug for $99 a month, shipped free to your home.

Vyleesi

In 2019, premenopausal women got another option: bremelanotide (Vyleesi), which you inject at least 45 minutes before having sex. It also focuses on brain chemistry, not blood flow to the vagina. Specifically, it increases dopamine, the excitement chemical.

There are big differences between Vyleesi and Addyi. You can drink as much as three glasses of wine (that’s more than you can drink and still safely drive home) and take Vyleesi at the same time. Vylesi may make other drugs like antibiotics and pain medications less effective, however. It’s also off many insurers’ list of covered drugs, but the company that makes Vyleesi, AMAG Pharmaceuticals, offers discounts.

What you can do about low desire

It makes sense to try other remedies first. If the problem is dryness, talk to your primary care doctor or gynecologist about taking vaginal estrogen. It comes in a cream, a ring, or pills — all inserted directly into your vagina. None of these methods pose the cancer risks possible from taking oral estrogen.

Vaginal estrogen doesn’t help if you have a pelvic floor problem or pain with intercourse, the kinds of issues that women take to urologists. In a survey of female urology patients, 36 percent of women ages 18 to 30 reported low desire, along with 48 percent of women ages 31 to 45, and 65 percent of women 56 to 64.

Beyond those issues related to your vagina, ask your gynecologist to help you rule out the many possible reasons why you’d rather wash dishes than seduce your mate. Anti-seizure drugs and SSRI antidepressants can dampen lust. Desire-killers include fatigue sleep apnea, depression, arthritis, diabetes, high blood pressure, and other medical problems. Treating those issues could enhance your life inside the bedroom and out.

Is the problem bad sex?

Relationship problems are, of course, the ultimate buzz kill. If you used to like sex with your current partner, did your habits change? You may have cut back on foreplay or stopped taking time to be affectionate outside of bed. Maybe your husband is more bothered by your lack of desire than you are. It’s not necessarily wrong to push yourself by taking a medication to please him, but only if you don’t end up feeling resentful. Many husbands are eager to do what it takes — can the two of you make that happen?

In a 2017 survey of more than 50,000 Americans, heterosexual women orgasmed 65 percent of the time during sex. Heterosexual men orgasmed 95 percent. You might think it’s just easier for men. But in this survey, lesbians orgasmed 86 percent of the time.

What’s a normal sex routine in a relationship?

You (or your husband) might imagine that happy couples have sex every morning or night. In a large survey, about half of married women ages 30 to 49 said they had intercourse “a few times per month to weekly.” About a quarter had sex twice a week or more — and the rest less often than weekly.

Are you afraid he’ll cheat or leave you if your sex life has dwindled into the low end of that curve? Those kinds of fears require candid conversation. Be candid with yourself as well. If you’ve lost interest even in masturbation and rarely have sexual thoughts, you’ve lost touch with that side of life. You may not care — but, then again, you may be grateful if you get effective help.

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