News

25-08-2015

Flibanserin ( Addyi) is the first drug in the world to be licensed for the treatment of low sexual desire in premenopausal women. There has been no announcement from the manufacturer as to whether an application will be made to allow the medication to be available for Australian women.
Despite comparisons with sildenafil ( Viagra), flibanserin has different pharmacology, having been developed as an antidepressant. The manufacturer says the mechanism of action is through the serotonin neurotransmitter system, claiming the drug raises levels of dopamine and noradrenaline to
increase sexual excitement. Women taking the drug reported between half and one more sexually satisfying event per month. The medication is taken daily and is said to require several weeks of regular use to assess effectiveness.

Versions of the medication have been submitted previously, but have been rejected in 2010 and 2013 on the basis of modest effect and significant side-effects . On this occasion, a loud feminist campaign called Even the Score established itself on-line. The
campaign claimed it was " time to level the playing field"  by getting the FDA to license drugs to treat sexual dysfunction in women as well as men. The group is said to be backed by the manufacturing pharmaceutical company, other pharmaceutical companies, US Women's
Groups and some Medical Organisations. Even the Score lobbied Congress and argued that the FDA had approved 26 drugs for treating male sexual dysfunction compared to zero for females.

Estimating the prevalence of sexual desire problems in women vary widely in medical literature. An Australian led study of 741 heterosexual women aged 18-71 found that the prevalence ranged from 3% to 31% depending on the definition and diagnostic tools used. These statistics give numbers of women ranging from 240 000 to 2.5 million women in Australia who suffer from the problem ,( from the Australian Bureau of Statistics population data.)
(Archives of Sexual Behaviour 2013;42:1073-78)
Even the Score claims that 43% of women have sexual dysfunction and 1 in 10 have " the most common form", hypo active sexual desire disorder. This diagnosi is controversial , with critics labelling it disease-mongering and over medicalisation . In studies released, 21% of women taking Flibanserin experienced CNS depression ( fatigue and sedation), and 11% experienced dizziness, sleepiness or nausea. Other side-effects noted include increased risk of fainting,accidental injury, depression and interactions with alcohol and some medications such as antidepressants and the oral contraceptive.

Controversy has surrounded flibanserin for several years. The diagnosis of low libido is complicated, reduced desire can be linked to physical causes such as fatigue, pain or medication;  psychological causes such as stress, guilt and depression; sexual causes such as poor technique and relationship difficulties. There is concern that flibanserin will create unrealistic expectations about women's sex drives and increase pressure to have sex or even allow another avenue for coercion to those in abusive relationships. Sexual difficulties in a relationship are not a simple problem that is easily repaired by taking a medication There is considerable stigma, ignorance, high expectations, influence by social media and pornography.

The drug may be of benefit to a small group of women, but should be combined with psychological therapies and relationship counselling.

Research does suggest female sexual dysfunction is prevalent, affects quality of life and has a negative impact on relationships and wellbeing. If the " blockbuster" "female Viagra" drug causes discussion, opens research and pharmaceutical company interest in the area , and creates demand for effective, safe strategies to assist women with sexual dysfunction concerns, then the release by the FDA has been a positive for women's health.

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