In this segment Dr. Somi Javaid and a co‑host discuss the multifactorial nature of low sexual desire in women, emphasizing that hypoactive sexual desire disorder (HSDD) affects roughly one in ten women at some point. They outline contributors such as relationship dynamics, neurochemical imbalances, hormonal changes (including declining ovarian testosterone), lifestyle stressors, medications, and illness. The conversation highlights the recent availability of two FDA‑approved, non‑hormonal medications—Addyi (flibanserin) and Vyleesi (bremelanotide)—detailing their mechanisms (modulating excitatory and inhibitory neurotransmitters), dosing regimens (daily nightly for Addyi, on‑demand injection for Vyleesi), efficacy evidence from female sexual function index (FSFI) data, and side‑effect profiles. A referenced neuroimaging study showed that women with HSDD exhibit reduced activation in brain regions associated with approach/desire and heightened activity in inhibitory regions when viewing erotic stimuli. Dr. Javaid also mentions adjunctive testosterone use, the need to set realistic patient expectations (e.g., delayed onset for Addyi versus rapid effect for Vyleesi), and critiques the lengthy FDA approval process for women’s sexual dysfunction drugs compared to men’s, noting the stark disparity in treatment options (26 for men vs. 2 for women).
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There's some other things that happen if you over fast or if you just are going through aging in women. Low libido. Talk to me about why that happens.
So many reasons. So low libido is multifactorial. I tell people, imagine walking into a cockpit of a, of a plane and looking at all those buttons and dials. So it can be relationship. If you don't like your partner or you're not attracted to your partner, that has a lot to do with it. Neurochemistry. If we have too many inhibitory signals in our brain and not enough excitatory signals, hormones. As we age, our ovaries produce less and less testosterone. There was a consensus statement two years ago that testosterone is key and vital for women in all the domains of sexuality. Our lifestyle. You're working third shift, he's working second shift. You have young babies in the bed. Medications, illness, stress. You know, you're stressed about money, you're stressed about the pandemic. There are so many things that can interfere with sexuality. And the truth is that one out of every ten women struggle with something called hsdd. Right. We changed impotence to erectile dysfunction. We call low libido, which I feel like blames women. Hypoactive sexual desire disorder. And one out of every 10 women suffer from it at some point in their lifetime. And we have to decide, you know, when they need treatment. And as of 2015, there were zero treatments on the market, none for women. And now we have two that are FDA approved and then we have a few that are off label treatments. Right. Meaning they're indicated for something else. But there's FSFI data, female sexual function index data, proving that libido does increase if you prescribe these medications.
And these are they, they've stopped naming medications that you can pronounce ady, a D, D, Y, I and vi lisi, who names these things? So I can say by Lisi, Adi. What is that?
Addie?
Addie. Is that how you say it?
All right, Addie.
So I have never experienced the effects of these drugs because Lana doesn't, doesn't use them. What are they? How do they work?
So they work on different neurotransmitters in the brain and basically they increase excitatory signals and decrease inhibitory signals. And they did a fascinating study where they took women who were struggling with hsdd, women who weren't, showed them erotica, I. E. Porn, and then put them in MRI machines and watched the neurochemistry and what they saw with women who were struggling with HSDD is the parts of their brain that say, yes, I want to have sex, or, yes, I'm going to eat that cake, were very quiet. And the parts of their brain that told them no were very active. And the opposite pattern, women who weren't struggling with their libido. Yeah. So these medications work on neurochemistry, and they're non hormonal, which is really nice for patients who can't have hormones. ADDI is every night regardless of whether or not you want to have sex. So it is a female Viagra. It's not on demand. Vi lisi is an injection given at least 45 minutes before you want to want to have sex. And it is on demand. So they both work, you know, differently.
Can you take them together?
No, that's okay.
It's one or the other.
Yeah, it's one or the other. And then I oftentimes will add testosterone, depending, but the side effects are both different. Some are contraindicated for certain patients. But basically, Addie met clinical guidelines or endpoints as far as increased number of sexually satisfying events. So no more checking a box sex or keeping the peace sex in the marriage. You know, decreased distress about your sexuality and increased desire. So that's really, really nice. And some of my patients who are like, Dr. Debate, you have to fix this now. Abby can take six to eight weeks to work. No, I'm serious. They'll come in and be like, listen, I'm having a save the marriage weekend. And we're like, okay, well, then I can't give you this medication because it'll take too long. And so I'll prescribe by Leesy because that works immediately. Both drugs have side effects. Both drugs have non responders. So it's just setting expectations for patients. But, you know, it's a travesty because Addi took six years to get FDA approved. Viagra took six months. You know, men have 26 options, women have two. And so it's been an interesting journey with the FDA and to even get solutions out there that, you know, you can prescribe for patients.
