Viagra for Women?

Two new drugs claim to enhance female libido, but what's needed is more than just a physical boost

By Robyn Griggs Lawrence
Originally Posted On September 12, 2013

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When it comes to sex, men and women are not created equal. And so, sexual performance drugs geared to women must take this fact into account. Men have Viagra, which makes things work when they have to, and that’s about all the help most guys need. Women’s sexuality is harder to amp up because it’s not just a mechanical problem. The organ that needs to be addressed is the brain.
 
The most common female sexual dysfunction is hypoactive sexual desire disorder, or HSDD, characterized by very low libido. According to the International Society for Sexual Medicine, about 10 percent of all women are affected by the disorder, which can wreak havoc on overall health and spell disaster for long-term relationships. Worse, 43 percent of all women have some sort of sexual dysfunction, defined by low levels of arousal, excitement, orgasm and/or satisfaction. This becomes more common with age, but after 60, a lot of women quit stressing over it and accept their fates

This year the Dutch pharmaceutical firm Emotional Brain announced a promising clinical trial of two Viagra-like drugs that enhance testosterone's effects on women’s cerebral pleasure centers, priming them to respond to sexual cues and, in effect, remember that sex is fun.
 
One of those new drugs, Lybrido (which combines testosterone and Viagra’s main ingredient, sildenafil), is designed for women with low desire. The other, Lybridos (with an s), a mixture of testosterone and the antidepressant busiprone, is for women who want sex but have difficulty becoming aroused. Busiprone’s discovery as an aphrodisiac was serendipitous: Researchers learned about it when women in clinical trials reported having more and better sex.
 
Emotional Brain founder Adriaan Tuiten, called the trial “very, very promising” and the company hopes to bring both drugs to market by 2015. But for the drugs to be effective, they will have to counteract physical and emotional barriers to desire, including everything from depression and anxiety to symptoms of fluctuating hormonal levels: lower libido, loss of concentration and thinning vaginal walls and dryness.
 
That’s a mighty tall order for one pill.

'Medical Aphrodisiacs'?
 
Pfizer originally assayed Viagra as a treatment for hypertension in the 1990s. The drug didn’t perform well in clinical trials for heart patients, but researchers were intrigued by a notable side effect: It induced erections in male subjects. The company decided to market Viagra as an erectile dysfunction drug and received FDA approval in 1998. Within months, Newsweek declared it the “hottest new drug in history almost everywhere in the world.”
 
From there, its popularity exploded. Penthouse publisher Bob Guccione commented that Viagra will "free the American male libido" from the emasculating doings of feminists. Celebrity spokespeople, including Sen. Bob Dole and soccer star Pele, began appearing in ads promoting Viagra, removing any stigma. And in perhaps the most creative application, according to The Washington Post, the CIA used it to recruit Taliban insurgents in Afghanistan.
 
Soon, a host of copycat drugs, like Cialis and Levitra, followed, and the Internet has been a sea of counterfeits — “herbal Viagra,” “professional Viagra,” “generic Viagra” — ever since. Today Viagra is the 45th-best-selling pharmaceutical in the world, raking in some $2 billion a year in sales.
 
On a purely physiological level, the drug can be as effective at turning on women as men. As many women know from helping themselves to their partners’ pills, Viagra works for them — provided they’re already in the mood. Increasing blood flow to the genital area enhances arousal, lubrication and orgasm in women. Because Viagra works by inhibiting an enzyme (phosphodiesterase-5) present in both male and female genital tissue and relaxing smooth muscle, it does increase blood flow to the nether regions.
 
Yet, notes Daniel Bergner, author of What Do Women Want? Adventures in the Science of Female Desire, “Lybrido and Lybridos have only the slightest relationship to Viagra. Both drugs target sexuality, but Viagra is not dealing with the emotion of desire. In a way, these drugs are medical aphrodisiacs. Viagra mettles with the mechanics, but these drugs tinker with the mind.”
 
Taking a broader view of sexuality, women are vastly more complex than men. Jennifer Berman, M.D., director of the Female Sexual Medicine Center at UCLA Medical Center in Los Angeles, says when it comes to female libido, the mental and emotional issues are just as important as physical and hormonal imbalances.
 
Because several “problems” must be dealt with simultaneously, drug companies’ quests for a female sexual enhancer have been less than successful. Pfizer tested Viagra on women shortly after it began marketing it to men, but it didn’t do well across the board. In 2004 the FDA rejected Intrinsa, a testosterone patch designed to increase women’s desire, because concerns about long-term safety trumped benefits. (Testosterone has been linked to cancers.) Similarly, libanserin, an antidepressant found to enhance female desire, and Bremelanotide, a nasal inhalant that causes genital warmth and a strong desire to have sex, were not approved because studies couldn’t prove they were more effective than placebos.
 
Problems get even more complicated as women age. Physical changes, like vaginal dryness (which can make sex painful and lead to avoidance), increase and emotional factors, like lack of intimacy and relationship problems, play more heavily into female libido. “For women who have low desire and don’t respond to testosterone replacement therapy, something else is inhibiting them from recognizing sexual cues,” Berman says. “Many women who can’t have orgasms have anxiety disorders. A male-oriented, strictly physical approach won’t help them because it’s a mind-body-spirit issue.”
 
Let’s Talk About Sex
 
A constant topic among women, rarely discussed in clinical circles, is the frustration and dissatisfaction many feel trying to communicate with their male partners, especially when things get rocky. And women aren’t always the greatest communicators themselves. Programmed to believe that good girls are monogamous, they’re hesitant to talk about how sex with the same man for decades can get boring.
 
“Our society seems so liberal, but we don’t have candid conversations about women’s desire,” says Bergner, who discovered while researching his book that, perhaps surprisingly, women are much less suited for sustained committed relationship than men are. “We live by old notions that women are somehow better made for long-term monogamy and those notions — so comforting to men — hold our society together.”
 
Bergner’s controversial conclusion — that the most effective cure for female HSDD is a new partner — isn’t comforting to women or men, which is why he’s hopeful about “medical aphrodisiacs that tinker with the mind.” If Lybrido and Lybridos can stimulate our genitals and our brains, he says, “they could be “a cure for women from long-term monogamy.”
 
Jennifer Berman, while not categorically opposed to the new drugs, believes they would only be another tool that could work in conjunction with talk therapy, exercise, meditation and dietary changes. “There are issues that affect feelings and behaviors, especially about sex, that are not going to be fully dealt with or completely enhanced pharmacologically,” she says.
 
Before anyone can hang their hopes on Lybrido and Lybridos, the drugs have a ways to go. The next step is FDA approval, which requires larger clinical studies. Hearings have yet to be scheduled, but the world will be watching. If Lybrido and Lybridos can successfully address emotional and physical barriers to female desire, they could be the drugs of the century.
 
Robyn Griggs Lawrence is a writer and regular contributor to Next Avenue based in Boulder, Colo.