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Viagra-vation and the search for the lost libido

ALBUQUERQUE, N.M. — A revolution in men’s sexual health roared to life in 1998 when the U.S. Food and Drug Administration approved Viagra for male erectile dysfunction.

The event created reverberations from millions of women who were not at all delighted. When their man came home with a Viagra prescription, the welcome mat was not out. These women had become accustomed and perfectly happy to spend the rest of their lives free from the encumbrances of having sex.

One woman told me, “That part of my life is over, and I am furious that you have given my husband this medication.”

Conversely, the revolution amplified a problem that was vexing many marriages. Many younger women had lost their desire for sex and were unhappy that a solution for men’s sexual health was discovered. These women were saying, “What about me?”

They had lost their interest in sex and wanted it back. Trials with Viagra in women failed to awaken the lost libido. The failure was not surprising as Viagra and other drugs in the PDE5 inhibitor class do not provoke desire, rather the drugs work to increase blood flow to the pelvic organs.

Psychiatrists identified this problem for women as hypoactive sexual desire disorder or HSDD. It is an illness characterized by lack of sexual interest and arousal capability. Many argued that this is not an illness at all and simply a manifestation of aging. Multiple etiologies for HSDD, including menopause, chronic illness and most prominently the use of SSRI antidepressants, can produce the symptoms. Regardless of the cause, many women reprise the lyrics from the Gordon Lightfoot song, “I don’t know what went wrong, but the feeling’s gone and I just can’t get it back.” Although some did not want it back, many others did and so did the men in their lives.

A study from Germany illustrates the frequency and rapidity with which a woman’s libido lags. Psychologist Dietrich Klusmann studied the sexual history of men and women, aged 19 to 32, who had been in monogamous relationships. He found that sexual activity and sexual satisfaction declined in both men and women the longer the relationship lasted, but only sexual desire declined in the females while their desire for tenderness increased. Interestingly, he found that women living away from their partners did not show this decline.

Pharmaceutical companies anticipating another Viagra bonanza have jumped on finding a cure for HSSD, but until recently have largely been shooting blanks. For many years doctors have prescribed testosterone for women to increase libido and satisfaction.

In Europe, the testosterone patch has been available for 10 years and clinical trials show it to be helpful but the improvement in women’s sexual health has been nowhere near that seen with Viagra for men. The FDA denied request for approval of the patches and only a testosterone gel is available in the U.S. and its benefits are minimal.

Recently, two drugs may have the potential to resuscitate lost libidos. Lybrido (where do they get those names?) is a pill coated with testosterone wrapped around a Viagra-like drug. Sort of a testosterone-flavored M&M. The other drug, Lybridos, contains buspirone that acts on the central nervous system, boosting serotonin levels in the brain; it also contains testosterone.

The initial trials offer some hope that the drugs might be effective in improving libido and satisfaction. We will need larger and longer term trials with more patients to assess outcomes. The concept behind the drugs is they work both to enhance blood flow to a woman’s pelvis and also change brain function. An indication of the magnitude of HSDD is reflected by the fact that when the trials were announced, the number of volunteers was so great that the trials filled almost immediately.

A pharmacologic solution for HSDD will not be available in the near future. So women suffering from this problem should have a discussion with their partner to bring the issue into the open. Men can help and clean up their act as well. For example, a shower, brushed teeth and attention to personal hygiene, as well as staying in shape might have some surprising aphrodisiac qualities.

Because all the current literature says a woman’s most powerful sex organ is her brain, take some advice from an Otis Redding song and “try a little tenderness.”

Dr. Barry Ramo is a cardiologist with the New Mexico Heart Institute and medical editor for KOAT-TV. Send questions for him to Albuquerque Journal Live Well, P.O. Drawer J, Albuquerque, NM 87103, or email them to htaylor@abqjournal.com.

 

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