Does Addyi work?

Addyi – also popularly referred to as female Viagra have recently been approved by FDA for use in women with hypoactive sexual desire syndrome. The active compound in Addyi is flibanserin, which is believed to exert its action by improving the biochemical balance in the females to strength libido naturally while reducing the distress associated with sexual encounters by more than 29%.

Hypoactive sexual desire disorder is fairly common in females and according to rough estimates, approximately one out of ten females suffer from HSDD; which is classically defined as “an extremely low urge to engage in sexual encounter despite being in a normal, healthy and loving relationship”. According to another study, more than 5 to 25% females experience low libido and sexual distress that can significantly affect the quality of relationships (1).

How does addyi work?

Traditionally, Viagra in males exert its action by increasing the perfusion of blood to the sexual organs (or penis). The female Viagra (or Addyi) on the contrary, exerts its action by restoring the natural balance of neurotransmitters in the brain.

It has been reported that the primary pathophysiology of HSDD revolves around poor rhythm or balance between classic neurotransmitters in the brain; such as serotonin, dopamine and norepinephrine. Addyi, once consumed can help in restoration of biochemical balance to promote libido and sexual desires in the females. The ideal candidates for this drug are; pre-menopausal women who are in happy relationships and wants to engage in sexual intercourse but suffers from unexplained poor libido or low sexual desires.

Based on the clinical trials conducted in over 11,000 females with a known history of HSDD for a period of at least 4 years, it was concluded that:

• Addyi does not cause any weight gain or changes in metabolism
• The drug is generally well-tolerated by females.
• The most common side effect of consuming Addyi is, mild nausea, excessive sleepiness, fatigue and occasional vomiting after use. These adverse effects are transient and resolves spontaneously without requiring any intervention. It is ideally recommended to avoid driving after consuming Addyi.
• Since it is not a hormone, it has no effect on the menstrual or ovarian cycles.

What are some cautions or side effects of Addyi use in females?

It is imperative to mention that based on the findings of SNOWDROP Trial (3), it can be safely concluded that the drug flibanserin (or Addyi) is safe and effective even in post-menopausal females if consumed in a dose of 100

mg/ day. If you are experiencing low libido due to menopause, make sure to speak to your primary care provider for Addyi prescription.

Some cautions and concerns that should be maintained with Addyi are:

• Limit your intake of alcohol if you are planning to take Addyi. Although, no immediate association or cross-reactivity to alcohol is reported in women who were a part of clinical trial, the data is still insufficient to make sound assumptions.
• Avoid Addyi if you have severe liver dysfunction or other serious health issues.
• Addyi may cross-react with certain herbs or Ayurveda supplements, which is why caution must be maintained.
• Breast-feeding women should avoid Addyi.

What else should you know about Addyi?

• The effects of Addyi are not immediate (like Viagra). In other words, you may begin to experience positive effects of Addyi after a period of up to 2 -3 weeks. However, if you do not achieve any positive effects after a period of up to 3 months of regular use, you should stop the therapy.
• A number of females are concerned if Addyi use may lead to excessive sexual interest/ desire or make females too sexual. Fortunately, so far the trials have been very successful and women does not report hyper-sexuality or nymphomaniac state with the use of Addyi.
• Addyi does not have any effect in women who experience sexual dysfunction due to an organic issue (such as vaginismus) or psychological ailment (disgust for the partner or for act of intercourse, marital discord etc.)
• Generally, females report a 53-55% improvement in the sexual desire after initiating the therapy with Addyi. This corresponds to an additional 8 to 10 meaningful and successful sexual encounters per months. The effects were measured by Female Sexual Function Index (FSFI)

Can psychotherapy help in Hypoactive Sexual Desire Disorder?

A lot of people argue if females actually need Viagra like drug instead of psychotherapy. The answer is pretty clear. Women who suffer from hypoactive sexual desire disorder have a biochemical disturbance. In other words, psychotherapy is only helpful in cases when sexual dysfunction is due to a marital issue, psychological dysfunction or other social/ personal or cultural issues and may have no effect in women who are suffering from true HSDD.

It is very important to identify the actual cause of sexual dysfunction before opting for any treatment.

References

1. Jin, J. (2015). Flibanserin for Treating Low Sexual Desire in Women. JAMA, 314(12), 1312-1312.

2. Dhanuka, I., & Simon, J. A. (2015). Flibanserin for the treatment of hypoactive sexual desire disorder in premenopausal women. Expert opinion on pharmacotherapy, 1-7.

3. Simon, J. A., Kingsberg, S. A., Shumel, B., Hanes, V., Garcia Jr, M., & Sand, M. (2014). Efficacy and safety of flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the SNOWDROP trial. Menopause, 21(6), 633-640.