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'Viagra' for females: Types, how they work, and side effects

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In the United States, two medications have been specifically sanctioned to manage female sexual interest/arousal disorder (FSIAD): Vyleesi (bremelanotide) and Addyi (flibanserin). Many might commonly refer to these innovative treatments as “Viagra for females,” which highlights their intended purpose of enhancing sexual desire and arousal in women experiencing these challenges.

The Food and Drug Administration (FDA) has given its stamp of approval to two primary medications — flibanserin (Addyi) and bremelanotide (Vyleesi) — designed to address the issues surrounding low sexual desire or arousal in females. It is crucial to note that the FDA has limited the use of these medications strictly to individuals who have not yet reached menopause, emphasizing their targeted demographic.

This comprehensive article outlines the FDA-approved medications aimed at alleviating low libido in females. It delves into how these drugs function within the body, outlines potential side effects, and discusses alternative approaches to managing low sexual desire.

As previously mentioned, the FDA has approved two medications specifically for the treatment of FSIAD: Vyleesi (bremelanotide) and Addyi (flibanserin), both aimed at restoring sexual interest and arousal in women.

Addyi (flibanserin)

Addyi holds the distinction of being the first medication approved for the treatment of FSIAD. This drug is specifically designed for premenopausal individuals and is available in pill form.

A person prescribed Addyi is advised to take the medication daily, ideally before bedtime, regardless of their sexual intentions for the day. The treatment may require a maximum of 8 weeks before many users notice an increase in their sexual desire; however, some individuals may experience the positive effects much sooner than this timeframe.

Vyleesi (bremelanotide)

The FDA has classified Vyleesi as a medication that can effectively treat FSIAD in premenopausal females. This drug is unique as it is administered through injection into the thigh or stomach. Patients should inject Vyleesi at least 45 minutes prior to engaging in sexual activity. The effects of the drug can linger for up to 24 hours, but it is imperative that users refrain from self-administering the medication more than eight times within a single month.

Comparison table

The table below provides a concise comparison between Vyleesi and Addyi, illustrating their distinct characteristics and applications:

It is essential to understand that Viagra is not FDA-approved for use in females. To grasp the reasoning behind this, it is beneficial to explore the original purpose for which Viagra was created concerning male physiology.

Typically, upon sexual stimulation in a male, there is a release of nitric oxide, which subsequently raises levels of a regulatory component called cyclic guanosine monophosphate (cGMP) within cells.

This cGMP increase results in the relaxation of smooth muscles, which allows for enhanced blood flow to the penis, leading to the attainment of an erection.

In males, an erection subsides when an enzyme known as phosphodiesterase type 5 (PDE-5) begins to break down the cGMP.

Sildenafil, the active component of Viagra, blocks the action of PDE-5, which results in increased blood flow to the penis and ensures a longer-lasting erection.

In certain situations, healthcare professionals may prescribe sildenafil as an off-label treatment for FSIAD. A 2024 study discovered that topical sildenafil cream improved sexual function in individuals with FSIAD.

Any individual interested in exploring the possibility of using Viagra should consult with a healthcare professional, who can determine if the drug is an appropriate off-label option for their specific situation.

Research has indicated that Addyi alters the brain’s serotonin system, which indirectly influences dopamine levels as well. When low sexual desire or arousal can be traced back to serotonin imbalances in the brain, Addyi may demonstrate efficacy. Dopamine, an important neurotransmitter, plays a significant role in motivation and the experience of pleasure.

On the other hand, Vyleesi targets melanocortin receptors, which are intricately associated with sexual function. This unique medication modulates the brain pathways that are critical to the sexual response.

The FDA has outlined two placebo-controlled trials that demonstrated statistically significant increases in sexual desire and arousal among premenopausal females who utilized Vyleesi.

Addyi maintains its effects for approximately 11 hours, although this duration can extend to 26 hours in individuals with mild liver issues. Notably, the presence of food during ingestion can enhance the drug's absorption into the system.

After three days of consistent medication intake, a stable level of the drug can be achieved within the body. Nevertheless, some individuals may have difficulties metabolizing CYP2C19, an enzyme-based protein, which could lead to elevated drug levels and subsequent side effects.

In contrast, Vyleesi typically lasts around 2.7 hours, while the average clearance time from the body is approximately 6.5 hours. The use of Vyleesi may slow the metabolism of other medications, posing potential complications for those on additional treatment regimens.

Both Vyleesi and Addyi are intended to treat FSIAD exclusively in premenopausal individuals, and there remains a lack of research on their effects in individuals who are undergoing or have completed menopause.

The medications may be advantageous for premenopausal individuals who:

  • are taking other medications that may negatively impact sexual desire
  • are experiencing boredom in their sexual life
  • suddenly notice a decline in their interest in sexual activity

Several factors correlated with a decreased sex drive in females include the following conditions:

  • vaginal dryness
  • difficulty achieving orgasm
  • experiencing pain during sexual intercourse
  • mental health challenges, such as stress, anxiety, and depression
  • specific health concerns, including diabetes and heart disease

The FDA-approved medications for FSIAD may lead to several side effects.

Addyi

Common side effects associated with Addyi can encompass:

  • experiencing drowsiness
  • dry mouth
  • nausea sensations
  • feelings of dizziness
  • general fatigue
  • insomnia challenges
  • individuals who have pre-existing liver conditions
  • those on oral contraceptive pills
  • patients taking CYP3A4 inhibitors
  • nursing mothers
  • those who consumed alcohol within the previous 2 hours

This medication may provoke severe hypotension and fainting episodes in users who combine it with alcohol or have underlying liver issues.

Vyleesi

Side effects for Vyleesi may include:

  • nausea and vomiting
  • hot flashes and flushing
  • skin irritation or rashes at the injection site
  • headaches
  • flu-like symptoms
  • fatigue
  • dizziness
  • darkening of the skin, leading to hyperpigmentation on areas like the gums, face, and breasts
  • elevated blood pressure
  • reduced heart rate
  • tingling sensations

Vyleesi can slow down the absorption of oral medications, thus diminishing their effectiveness due to delayed gastric emptying.

Furthermore, it may interfere with drugs that contain naltrexone, commonly used for alcohol and opioid dependence, making it crucial for anyone on such medications to avoid Vyleesi.

As with any medications, Vyleesi and Addyi carry the risk of causing allergic reactions. Individuals should seek immediate medical assistance if they experience symptoms indicative of an allergic reaction or anaphylaxis.

The FDA issues a strong warning against the use of over-the-counter products that are marketed as libido-enhancing supplements. These products may contain hidden ingredients that are similar to those found in prescription medications, yet are not listed on the labels.

It is essential for anyone considering taking supplements to enhance libido to consult with a healthcare provider. They can provide guidance regarding the safety and appropriateness of the products, along with recommending evidence-based medications such as Addyi and Vyleesi where necessary.

Vyleesi (bremelanotide) and Addyi (flibanserin) represent significant advancements in the treatment of female sexual interest/arousal disorder (FSIAD) specifically for premenopausal individuals. It is important to note that the FDA has not authorized the use of Viagra among females. Moreover, caution is advised against over-the-counter supplements that claim to enhance libido.

It is crucial to understand that medication may not rectify every underlying cause of diminished sexual desire. Individuals seeking assistance are encouraged to discuss potential treatment options, including medication and alternative therapies, with their healthcare provider to determine the most suitable approach for improving their libido.