When Your Sex Drive is on Life Support

Low desire? No more orgasms? Is your sexual enjoyment a nonexistent priority in your partnership? Sex is such a physical/emotional chore that you’d rather be burning the calories in a Pilates class?

Part of our intake questionnaire at WholeHealth Chicago asks if you’re satisfied with your sex life and fully half of our newcomers either indicate no or leave it unanswered. This pretty much lines up with surveys on female sexuality: one quarter to one half of all women who are in a relationship fulfill the criteria of the once-named Hypoactive Sexual Desire Syndrome, now rechristened Female Sexual Interest/Arousal Disorder (FSIAD).

Before I go on, I want to mention a book that one of our readers alerted me to in the comments section of a previous Health Tip. It’s called Come As You Are: The Surprising New Science that will Transform your Sex Life, by Emily Nagoski, PhD.

Here’s a description via amazon:

“Cutting-edge research across multiple disciplines tells us that the most important factor for women in creating and sustaining a fulfilling sex life is not what you do in bed or how you do it, but how you feel about it. Which means that stress, mood, trust, and body image are not peripheral factors in a woman’s sexual wellbeing; they are central to it. Once you understand these factors, and how to influence them, you can create for yourself better sex and more profound pleasure than you ever thought possible.”

Because of the complexity of a woman’s libido, FSIAD is referred to by psychiatrists as a contested diagnosis, which is just what it sounds like. Men and women on both sides of the discussion ask (reasonably) “Is this real and needing pharmaceutical intervention and/or counseling?” or is this yet another diagnosis invented by Big Pharma (like getting Zoloft approved for social anxiety).

Women are complex
One thing’s for certain: when it comes to sexual pleasure, women are complicated. Men can travel through life armed to the teeth with an unwavering sense of sexual entitlement and generally are able to reach orgasm with anyone, female or male, live person or internet porn site, in a featherbed or a toilet stall at O’Hare. When men are in their 60s or so and testosterone levels fall, sex becomes mainly memory, though more men are working to jumpstart their libidos by getting a testosterone prescription from their doctors.

For women, when it comes to desire, there are so many factors in play that it’s hard to know exactly where to begin. Researchers into human sexuality use the term “sexual concordance” to describe the extent to which the body and mind are in synch. For many women, there’s a disconnect. Some women have a history of trauma, being objectified, or feeling socially unsafe. Others become preoccupied with their performance, worried about partner satisfaction or the appearance of their bodies.

Another group is simply bored with the whole process, feeling so little during sex that they start having thoughts about repainting the ceiling. Interestingly, one study showed some women treat their ennui by finding another partner, either on the sly or with the original partner’s consent.

Sometimes there are no concordance issues at all. A woman is genuinely fond of her partner and remembers really enjoying sex once, but now there’s not much of anything.

Yes, there are pharma options
For a while there was a flurry of interest in using the male hormone testosterone to jumpstart a woman’s sex drive. Sometimes it actually worked, others not so much.

A couple of years ago, Big Pharma introduced Addyi for enhancing female sex drive. Physicians like myself were reluctant to prescribe Addyi because of its side effects, which included fainting, dizziness, and nausea.

A second med, Vyleesi (bremelanotide), takes aim at the clitoris. In theory, this is a good idea, because scientists have concluded that the sole purpose of a clitoris is to convey pleasure to its owner. Unfortunately, having a clitoris doesn’t guarantee that it works. The best part about Vyleesi is, like Viagra, you only use it when planning sex, unlike Addyi, which has to be taken daily.

There are two–no, make that three–drawbacks to Vyleesi. First, you need to inject it into your skin (thighs, tummy), though it’s a very tiny, thin needle so really you don’t feel much of anything.

Second, the first dose (but interestingly not usually subsequent ones) can make you feel nauseated. This goes away quickly, but you’re having enough problems already. Who needs to add nausea? This is preventable by taking an anti-nausea med at the same time, in case you want another med for your pre-sex ritual.

The third is the price, which is enough to kill anyone’s sex drive, retailing at $3,600 for four syringes, discounted to a mere $2,900 with a goodrx card. Pondering the well-being of my partner’s clitoris at $725 a pop would likely trigger a permanent state of erectile dysfunction, even with Viagra, which recently went generic, the price falling from $78 a pill (!) to $1.02 a pill (yes, really).

But on the seriously plus side, because the generic Vyleesi (bremelanotide) existed years before anyone used it for clitoral stimulation, it couldn’t be patented. A small company, Tailor Made Compounding, which specializes in a group of substances called peptides, makes the same product but at a fraction of the price. Ten doses of this med, called PT 141, are about $300 ($30 a dose vs. $725 a dose).

Because bremelanotide works on cells that produce the pigment melanin, using more than eight doses per month has resulted in cases of hyperpigmented spots on skin and gums. This doesn’t occur with four doses or fewer, so try not to get carried away if you decide to try it.

Interestingly, stimulating melanin cells enhances sexuality for both genders and a common off-label use of PT 141 is for erectile dysfunction when Viagra is no longer doing its job.

If you or your partner are interested in trying PT 141, schedule an appointment with Katie McManigal, our nurse practitioner, who is most knowledgeable about peptides. She’ll order a vial for you from Tailor Made and teach you how to administer it yourself.

Finally, here’s a link to a decreased sexual desire screening tool designed for physician use. However it’s quite straightforward and you can DIY.

Be well,
David Edelberg, MD