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FDA Expands Access to Pill for Low Libido
More women can now use a medication approved to treat low or no sexual desire
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Health officials have expanded access to a libido-boosting pill for women, approving its use beyond menopause. Flibanserin, sold as Addyi and first cleared by the U.S. Food and Drug Administration (FDA) in 2015 for premenopausal women, can now be prescribed to women up to age 65.
Low libido is prevalent, health experts say; it affects between 40 to 70 percent of women. “Frankly, when you look at sexual issues throughout the lifespan, even 20s, 30s, 40s, low libido is the most common sexual complaint,” says Dr. Lauren Streicher, clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and host of the Come Again podcast series.
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Reasons run the gamut, doctors say. Low libido can result from medication side effects, stress, fatigue, pain during sex, mental health or mood. Biological changes, such as menopause, can also affect a woman’s sex drive.
“Any of those factors may be contributing to decreased libido; it’s rarely just one thing for a woman, so it’s complex,” says Dr. Selena Zanotti, an obstetrician and gynecologist with the Cleveland Clinic. And it’s “very different” for women than for men, she adds.
Health conditions such as diabetes, high blood pressure and heart disease, which become more common with age, can also affect libido.
Treating low libido
The wide variety of contributing factors makes treating low libido difficult.
“When you see anybody for sexual health concerns, you really have to go through their complete medical history,” Zanotti says.
“There needs to be some detective work,” adds Streicher, author of a forthcoming book from AARP on menopause.
For women whose lack of libido isn’t caused by another medical issue or a relationship issue, medication may be able to help.
Flibanserin was initially approved in 2015 to treat hypoactive sexual desire disorder — long-lasting or recurring lack of interest in sex — in premenopausal women. Its approval was expanded 10 years later to include postmenopausal women under the age of 65. Zanotti says research is ongoing for women over 65.
Flibanserin is a nonhormonal medication that acts on key neurotransmitters, or chemical messengers in the body, that affect sexual response.
The injectable medication bremelanotide (Vyleesi) is another FDA-approved treatment for premenopausal women with low libido. And while there is no FDA-approved testosterone therapy for women with libido issues, some doctors prescribe it off-label. Streicher says the therapy is particularly effective in older women.
Flibanserin is not for everyone, including women who take certain medications, including some blood pressure medications and certain antibiotics. It also requires caution with alcohol use. Still, the expanded approval has been welcomed by many women’s health experts.
“It’s taken a long time for us to get research into women’s health concerns, especially women’s sexual health,” Zanotti says. “It’s finally showing that this is important for women who are postmenopausal. I think for so long, people just didn’t want to think about it; they thought that after menopause, sex isn’t important to a woman. And it’s very important to women.”
One hurdle to treatment, however, is cost. Insurance coverage is not universal, and the list price is more than $1,000 per month, though the manufacturer offers copay programs and coupons to offset the cost of the medication.
Talk to your doctor
If you experience low or no sex drive and want to get it back, start by talking to your primary care physician or gynecologist. “They can start looking at some of these other factors and refer you to the right place,” Zanotti says.
Your doctor will most likely want to know when your dip in libido started and whether it was sudden or gradual, Streicher adds.
However, if you feel that your concerns are being brushed aside or that your provider doesn’t appear to have expertise in this area, know that there are professionals who do, “and it’s important to seek out one of those people,” Streicher says.
Both Zanotti and Streicher say a sex therapist can also help with libido issues.
Editor's note: This story has been updated to include more information on pricing.
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