The Food and Drug Administration has approved a new drug to treat low sexual drive in women, the only one besides Addyi, which entered the market in 2015. The drug, to be called Vyleesi, will be sold by AMAG Pharmaceuticals and is intended to be used 45 minutes before sex via an auto-injector pen that is administered in the thigh or abdomen.

 

Is Vyleesi the female equivalent to Viagra?

Metaphorically yes but the real answer is no. Vyleesi, has similarities to Viagra in that both medications begin with the letter “V”, are designed to address sex-related health issues, and are used only before sex but there are real hard differences between these two medications.

First, its important to note that HSDD is not the “female version” of erectile dysfunction or ED. Viagra for ED was discovered on accident. It was originally being studied as a cardiovascular drug to lower blood pressure when it hit the market two decades ago.

What is HSDD and how is it different from what men experience with ED?

HSDD is a complex medical condition. It is a condition where a woman is otherwise healthy, but lacks libido or sexual desire that is not due to a medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance. Studies show that about 10-20% of women have this problem and some say HSDD outnumbers men with sexual problems.

Having HSDD is analogous to saying that your car doesn’t even start and you are not sure why or even how the car is supposed to run. Of course, one’s brain and body are a lot more complex than a car. In fact, HSDD may actually be a collection of many different causes and issues lumped together simply because they seem to have the similar end result: lack of sexual desire.

By contrast, ED alone is a much more straightforward mechanical issue. Having ED doesn’t necessarily mean a lack of interest in sex. With ED itself, the motor can be running but you just may not be able to get the car out of park, so to speak. ED medications like Viagra, or sildenafil as it’s known generically, work by dilating the blood vessels that provide blood flow to the penis. Blood flow is what leads to an erection.

 

How does the Vylessi work?

It doesn’t work on the women’s genitals, but rather her central nervous system.

In clinical studies the drug was shown to improve women’s self-reported feelings of desire and lowered their distress around having sex, but it did not increase the number of “sexually satisfying events” they had in a statistically significant way.

It works by activating melanocortin receptors, which seem to be involved in many different brain functions including regulation of mood and thinking. However, the FDA announcement admits “the mechanism by which it improves sexual desire and related distress is unknown. That’s quite a bit different from Viagra, where the mechanism is much clearer.

And what important to know that Vylessi won’t be able to fix is that you have to feel good about your body. You have to feel good about yourself. You have to have an interest in having sex. To date scientists haven’t even figured out all the pathways that lead to sexual desire.

 

How is Vylessi different than Addyi, the first female HSDD drug that arrived in 2016?

Addyi, is a once a day pill that was originally developed to treat depression.  It shares mechanisms in common with the antidepressant and anti-anxiety drug buspirone (Buspar). It promotes the release of dopamine. But nobody’s really sure exactly how it elevates lust. According to the FDA, the mechanism of action of Addyi to treat HSDD is unknown. In comparison, Vyleesi is injection you self-administer 45 minutes before sex. So you have to be able to tolerate giving yourself an injection but the up side to that is you take it only as needed.

How much will it cost and will insurance cover this new medication?

The drug manufacturer said they expect for insurance to cover Vyleesi on a scale similar to Addyi and to male erectile dysfunction drugs. Coverage of those drugs by commercial health care plans is mixed and officials declined to say how much Vyleesi would cost. They said they would provide more details when the product goes on sale later this year.

 

What are some of the pros and cons of Vyleesi?

Vyleesi, has some advantages over Addyi (the first HSDD medication released in 2015) and can be taken with alcohol. But the drug also has drawbacks — it does involve needle injections, and in clinical trials, 40 percent experienced nausea after taking it. In all, 18 percent of women dropped out of the trial, including eight percent who stopped participating because of nausea.

 

Is a medication the solution for a low sex drive?

No, it’s only a tool but not the solution. It is important to prioritize female pleasure, and it is significant that we’re finally having open conversations about some women’s dissatisfaction with sex. But in order to close the pleasure gap and truly help women everywhere live their best sex lives, we need more than a medication that promises to treat HSDD. We need to broaden our understanding of what healthy sex and pleasure actually look like, and encourage people to appreciate the diversity of sexual experience, rather than forcing themselves to live up to someone else’s expectations. That requires a deep, intimate understanding of our desires, our body’s capacity for pleasure, and the ways in which we enjoy being intimate with other people.