Sex drug puts women in the driver's seat

The FDA's long-awaited approval of Addyi, a drug promising to recharge waning sex drive in some women, has led to happy-dance sightings, grouchy doomsayer warnings about its side effects and the usual misinformation about the act in general.

But, hey, we're talking about sexual desire in females and it's only 2015!

The drug with the cute name (it's pronounced "ADD-ey") probably will be available in October to doctors who have been certified to prescribe it, which hints at the roadblocks women still encounter in the libido lane.

Still, Addyi's arrival should be viewed as good news for women and their partners — as long as neither views it as a magic bullet.

Despite comparisons to Viagra, and cries to "even the score," the fact is that Addyi is the first FDA-approved desire enhancer for anybody. Men don't have libido-lifting drugs, either; Viagra works by increasing blood flow to the penis, but it does not cause sexual arousal.

And before you say, "Thank God!" know that loss of sexual desire is a real and growing problem for men and they don't find it funny, either.

It's hard to put a number on how many American women suffer from a sexual "disorder," and how many of us are just damn tired. It's perfectly normal for desire to wax and wane over the course of a lifetime, a fact that should be neither feared nor medicalized.

Still, about 40 percent of women in the United States report some type of problem with sexual function, which could mean loss of libido, but also painful intercourse, trouble with arousal or difficulty achieving an orgasm.

Most issues are treatable — if a woman wants to treat them.

"If a woman is not distressed by this problem, and it is not causing problems in her relationship, then this is not a disorder," said Dr. Stephanie Faubion, director of the Women's Health Clinic at the Mayo Clinic.

While many postmenopausal women, usually in their 50s or older, suffer from "hypoactive sexual desire disorder" (aka a dozing libido), Addyi targets premenopausal women. These are women typically in their 30s and 40s who don't seem to have any identifiable reasons for a flipped-off switch.

Brain scans of some women in this age group who report low sexual desire show that the trigger simply isn't happening. That can be devastating to a woman and can lead to tensions at home.

"Women often come in confused and upset by what has happened," Faubion said. "Their partners sometimes think they're having an affair, because their interest in sex has changed so significantly."

A trusted health care provider can help a woman rule out any number of potential explanations, including depression or anxiety, certain medications, needy young children, unfortunate self-criticism of a changed body, relationship tensions around money, parenting or in-laws, even a sink full of dirty dishes.

"When that woman comes into my office, we will talk about all of the things that could be impacting her," Faubion said. "We'll review what is normal, in terms of sexual functioning, the importance of good sleep and date nights and normal body changes.

"If she says, 'I still don't have that desire,' I'll tell her that this drug is a treatment option."

The drug's side effects are outrageous, or not worth losing sleep over, depending on whom you ask.

Included are nausea, dizziness and drowsiness. Women will be advised to avoid alcohol when taking Addyi.

Faubion supports proceeding with caution. "While this drug has several potential side effects, so do many antidepressants that are given to women routinely," she said.

And, let's remember that, while rare, Viagra's potential side effects include four-hour erections, as well as the sudden loss of vision and hearing. None of that has hampered the drug's popularity.

Addyi acts on the central nervous system in the brain, spurring the production of dopamine and noradrenaline, the neurotransmitters that regulate mood, behavior and sexual excitement.

In one clinical trial, women taking the drug reported an average of 4.4 "satisfying sexual experiences" in a month, compared with 2.7 before taking Addyi.

While a few extra close encounters might not seem like a big deal, Faubio emphasizes quality over quantity.

"Wanting to want sex is more important than the number of sexual encounters a woman has," she said.

Addyi must be taken daily. Those who don't experience improvement in eight weeks will likely be advised to discontinue it.

Faubion calls Addyi "truly very exciting."

"It's been a long time coming for women," she said, noting that the drug was twice rejected by the FDA.

Equally important, she noted, is that Addyi opens the door for other effective libido drugs. "It's really important that this drug was passed, because there are others in the pipeline. Those drugs would have died if this hadn't passed in its third attempt."

While Faubion doesn't support "off-label" use for Addyi, there is social media buzz that postmenopausal women will be next in line to get it, along with a growing number of men.

While generally reluctant to seek professional help, men in their 20s and 30s have been reporting erectile dysfunction and diminished libido in significant numbers over the past decade. Some studies have found that as many as one-fourth of college-aged men are facing these challenges.

The culprits are many. Too little sleep. Too much porn, which sets up unrealistic expectations for real-life partners. Alcohol and cigarettes, which inhibit erections. Antidepressants, which can lower desire.

And many men feel lonely in their relationships, too.

These are all issues that a marriage counselor or sex therapist can help couples address, at any age or stage, and with or without the help of a little pill.

gail.rosenblum@startribune.com 612-673-7350 • Twitter: @grosenblum