Yesterday, the FDA approved flibanserin under the brand name Addyi. Flibanserin was rejected twice before, for its “modest” effect and potential for unwanted side effects. But its newly won approval makes it the only drug available to treat low sexual desire in women—a win for many, no matter how modest. Here’s what you need to know about the libido-booster: How does it work? Flibanserin was developed as a potential antidepressant by a German company called Boehringer Ingelheim. “It’s a neurotransmitter reuptake inhibitor, like many other approved antidepressants,” says John Thorp, Jr., MD, who was the principal investigator for flibanserin studies in North America under Boehringer Ingelheim. The drug increases dopamine and norepinephire and decreases serotonin in the brain, thought to lower feelings of inhibition. However, it turned out not to work all that well as an antidepressant, says Thorp, “but people did report an increase in libido,” he says. The rest is hisherstory. But how well does it work? It’s not like there’s a blood test for female sexual desire; how much you desire sex is a purely subjective measure (compared to Viagra, which changes measurable factors like strength and duration of an erection, Thorp says). But even if the effects are small by the FDA’s interpretation, they could make a world of difference to the right woman, says Leah S. Millheiser, MD, clinical assistant professor in obstetrics and gynecology and director of the Female Sexual Medicine Program at Stanford University School of Medicine. “If I said to her, ‘I can improve your libido by one to two sexual events per month,’ that’s already tremendously impacted her self-esteem in her relationship,” she says. This hasn’t always convinced everyone on advisory panels, Thorp says, namely men who consider one to two additional satisfying sexual encounters a month to be pretty trivial. MORE: 15 Secrets Of Seriously Sexually Satisfied Long-Term Couples How do you know if you need it?Not feeling in the mood isn’t always something to pop a pill for. One of the major criticisms of flibanserin “is that this is not a disease but a phenomena of aging, and this drug is trying to jazz up women’s sexuality to meet the hypersexual world in which we live,” Thorp says. “After all, aerobic fitness at 40 isn’t what it was at 20.” Flibanserin is intended for women with what’s called hypoactive sexual desire disorder, or HSDD. HSDD is not your run-of-the-mill “Not tonight, honey.” “It’s normal to have a libido that waxes and wanes based on psychosocial surroundings,” Millheiser says, whether it’s thanks to your relaxing Caribbean vacation or your kids driving you up the wall. Those women may not spontaneously feel in the mood, but they’ll usually still have what’s called responsive sexual desire, meaning they start having sex with their partner and get into the mood during the deed. This is not the case with women with HSDD, Millheiser says. “They will get in the act and nothing will happen. This is a chronic, persistent problem.” Can it still improve your libido if you don’t have HSDD? Maybe—but don’t expect fireworks, Millheiser says. Because flibanserin affects your brain chemistry, it’s not going to have the same impact on everyone. “Women with HSDD don’t have the same neurobiological response to arousal or the same neurotransmitter response in the brain,” she says. “Experts in the field very clearly state this drug is not for all women. Clinicians need to make a point of understanding who it’s for and who it’s not for before they prescribe it.” If you don’t think you meet the criteria for HSDD but still feel like your libido’s been lacking, it’s still smart to bring it up to your doctor, she says. “Now that there’s this potential treatment out there, libido is on everyone’s radar. Whether or not the drug is deemed appropriate, women shouldn’t suffer in silence.” If flibanserin’s not right for you, there may be other options, like therapy, she says. MORE: 7 Ways To Feel Like Having Sex Tonight Why is it getting support now after being rejected before? There’s been some some progress in better understanding female desire since the FDA’s last rejection of flibanserin. Since then, the FDA assembled a panel of real women living with HSDD, Millheiser says, to gather some personal intel about how the condition truly affects women. The FDA also requested more safety and side effect information about the drug, specifically looking into whether flibanserin-related drowsiness affects women driving in the morning (it doesn’t). It’s being backed now, Millheiser says, for both of these reasons: a better understanding of the condition that needs treating and more favorable data on the pill’s safety. Of course, we can’t discredit the power of a very vocal group of lobbyists who called foul play after the last rejection. Flibanserin-enthusiasts pointed to the fact that there are more than 20 FDA-approved drugs to treat male sexual dysfunction and a whopping 0 for women. “They criticized the FDA for being insensitive to women by not approving it,” Thorp says. An FDA official said that there is no drug currently approved for treating low sexual desire in men or women, the New York Times reported, since the meds for men deal with the mechanics of erectile dysfunction rather than brain chemistry. What if you’re taking HRT or hormonal birth control?ReutersThe Natural Menopause Solution Flibanserin doesn’t have any interactions with hormonal medications, Thorp says. It does seem to interact with the original libido helper, though: some panelists recommended a warning against drinking alcohol while taking it, reported. (Interested in natural alternatives to hormone replacement therapy? has everything you need to tame symptoms and trigger rapid, healthy weight loss in menopausal women.) Are there other side effects? In clinical trials, dizziness, nausea, and sleepiness were reported. There are also some reports of low blood pressure, particularly upon standing up after sitting or lying down, called orthostatic hypotension, Thorp says. But all drugs have side effects, Millheiser says. “The concern for many people is do the benefits of the drug outweigh the potential risks, and for a woman with HSDD who is thinking of ending a 30-year marriage because she feels guilty she can’t provide her husband with what she thinks he deserves, I would say that drug is well worth it.” Updated August 19, 2015
