Addyi: The drug designed to boost female libido
Lately it seems as though everywhere you turn, people are talking about sex. It’s due, in part, to the FDA approval of flibanserin, brand name Addyi, aka pink Viagra (although it’s actually not very Viagra-like at all, but we’ll get to that). If nothing else, the arrival of Addyi south of the border has sparked a conversation about sex that we should have had a long, long time ago ‘ because it turns out we actually don’t know that much about sex or, to be more specific, about women and sex.
‘There are a lot of myths out there about how women’s libidos work,’ says Dr. Lori Brotto, a psychologist and associate professor in the department of obstetrics and gynaecology at the University of British Columbia. ‘Even though research on female desire has increased slightly in the past 10 years, we still know a lot more about men’s sexuality than we do about women’s.‘ A lack of research isn’t the only problem. ‘Women don’t talk about their sexual concerns, even to their doctors,’ says Dr. Brotto. ‘And our medical schools aren’t doing a good job of teaching healthcare providers how to ask questions about sexuality. My own family physician has never asked me about my sexuality ‘ ever.’
Small wonder that we don’t know what’s ‘normal’ when it comes to our ever-fluctuating levels of desire. And what we see on the big (or small) screen isn’t helping our sexual self-esteem either. ‘Even though we say to ourselves ‘that’s not reality’ when faced with different media portrayals of sexuality, we’re completely inundated by messages that sex should be easy, spontaneous and multi-orgasmic,‘ says Dr. Brotto. ‘Then, when we don’t experience it in that way, we feel really broken.’
Understanding the ebb and flow of your libido
Until recently, most people thought that desire was the first step in any sexual encounter, but the latest research suggests that women’s sexual desire may not be all that spontaneous after all. ‘Women’s sexuality can be more responsive and more contextual than their biological drive years,’ says Dr. Teesha Morgan, a sex therapist in Vancouver. For instance, some women often report that they don’t consider the idea of sex or intimacy until their partners make a move (like planting a kiss on their necks).
Because that initial physical desire isn’t necessarily around at the outset, many women assume there is something wrong, says Dr. Morgan. ‘Many women have little idea how their sex drives work. They’ll come into my office and say ‘Something is wrong with me: I have low libido.’ And when I tell them desire often comes after arousal, their faces light up and they say, ‘Yes, that sounds like me!” Women experience desire in different ways, adds Dr. Brotto. Even at the start of a sexual encounter, they may not necessarily feel desire, especially in a long-term relationship. ‘They might have reasons to engage in sex ‘ they want to be close, they want to feel arousal and they want to have an orgasm ‘ but they’re not necessarily feeling a high libido in that moment. Then, as the encounter continues, they start to connect with their bodies and their desire emerges after that.’
Of course, there may be times when sexual desire simply refuses to kick in at all ‘ and that’s completely normal too, says Dr. Brotto. But, contrary to popular belief, it’s not necessarily something we can pin on our hormones. ‘Many studies that have looked at hormonal contributions to sexual desire show they’re really not that significant. It tends to be more relationship-related, psychological or emotional factors that predict women’s sexual desire, whereas testosterone plays a stronger role in men.’
This distinction is especially important for post-menopausal women. Yes, hormones do cause problems after menopause, when ovaries stop producing estrogen, but they’re more often physical issues, such as discomfort or dryness. ‘A number of large, longitudinal studies confirm that menopause doesn’t affect sexual desire,’ says Dr. Brotto. But, she adds, pretty much everything else does. Here’s a list of a few of the things that can affect your libido: medications (especially antidepressants, cardiac pills and anti-seizure drugs), mood (women with low desire have three times the level of depression), pregnancy, fatigue, stress, long work hours, a messy house, you didn’t have time to shave your legs, resentment toward your partner, children running around’. ‘Pretty much everything,’ says Dr. Brotto, although some studies rank stress and fatigue at the top.
‘Many women say that even though they’d like to engage in sex and are attracted to their partners, they’re just so tired and stressed that it’s the last thing they want to do in that moment,’ she says. Interestingly, men are a lot less likely to be worried about unwashed dishes. ‘Men’s desire may be more immune to the external insults that tend to dampen women’s sexual desire.’
Is Addyi the answer?
The FDA’s approval of Addyi (which is not, as yet, available in Canada) has created a great deal of discussion about women’s sexuality, says Kelly Suschinsky, a post-doctoral fellow in the department of psychology at Queen’s University in Kingston, ON, who studies arousal and sexual response. This is a good thing, she says, because sexuality is such a vital part of our lives that it’s important to understand it better. However, a pharmaceutical approach may not be the best option. ‘The fact that Addyi must be taken daily, unlike Viagra, is concerning because of its potential negative interactions with alcohol,’ she says. ‘Then there’s the fact that the actual effect seems to be relatively minimal compared to a placebo.’ While Viagra is just about increasing blood flow, Addyi is about changing brain chemistry and, although it might be helpful for some women who experience low desire, it’s not for everyone, adds Dr. Brotto.
‘Addyi will not make a woman like her partner any more. It won’t teach her partner how to evoke arousal or orgasm, and it won’t address the layers of taboo, myth, shame or anxiety that many women have wrapped up in their low desire,’ says Dr. Brotto.
So what’s a girl to do? Dr. Brotto recommends starting with some lifestyle changes. First, get more sleep. Research in the Journal of Sexual Medicine shows that women with sleep apnea (when your breathing repeatedly stops and starts) have higher rates of sexual dysfunction, while a recent study by researchers in the U.S. shows that women who sleep an extra hour are 14 percent more likely to have sex the next day. ‘Look at your energy levels and plan sex for times of the day when you’re awake and at your best,’ says Dr. Brotto. ‘It’s good, healthy and fun to plan sex ‘ it doesn’t have to just happen spontaneously.’ Planning can be as simple as logistically removing distractions, or imagining what an encounter will be like and fantasizing about it ahead of time, she says.
Dr. Brotto also recommends mindfulness meditation. In a study she co-authored and published last year, Dr. Brotto found that mindfulness-based group therapy (non-judgmental present moment awareness) significantly improved sexual desire in women. ‘It can help women be really present in their bodies during sex and help them notice the arousal and connect with their partner’s touch,’ she says. ‘It also gives them the ability to give feedback to their partner, to communicate and get into a nice, mutually reinforcing cycle of focused arousal.’
It takes two to tango
Dr. Morgan says that often the first time a woman comes to see her about a lagging libido, she comes alone. The second time, she will sometimes bring her partner. ‘It’s a dual dynamic ‘ it’s not just her issue and she needs to fix it,’ she says. ‘Often it’s just about improving emotional intimacy between two people. And sometimes all it takes is a little introspection.’ Too often, Dr. Morgan says, it’s social comparison that can lead to negative emotions about the relationship between a woman and her partner; they will feel like they aren’t normal. (Just because your girlfriend is having sex three times a week doesn’t mean you should be, too.) ‘Comparison is the theft of joy,’ she says. ‘If frequency isn’t a problem for you and your partner, it’s a moot point.’
Iris Krasnow agrees. She spent two years talking to women ages 20 to 90 about how sex and intimacy change as life changes for her book Sex After’. ‘One of the biggest takeaways for me was that there is no normal when it comes to sexuality,’ says Krasnow. She spoke to women in satisfied, committed relationships who were having no sex, but that was normal for them. Then there were women in their 70s and 80s who ‘were giddy as teenagers and excited to still be experimenting with their sexuality.’ Sex ebbs and flows in the best of relationships, and sexuality is unique to individual couples, says Krasnow. ‘Women get saddled by their emotions and obligations and busyness. And couples forget to have sex, they forget to give each other a kiss, they forget to say ‘hello’ or to be cordial with each other.’
Krasnow’s main recommendation is to keep things fresh. (A little hotel sex is never a bad idea, she says.) One woman she spoke to told her she and her partner schedule sex every Wednesday ‘ the exciting part is they never know what time on Wednesday it might happen. The key, says Krasnow, is to make time for intimacy. ‘It’s never too late. And considering that women in their 90s is the fastest growing segment of our aging demographic, it’s good to know you can be 75 and still look forward to a full life of intimacy and sexual pleasure.’