If you're a woman, it likely feels like your body is in constant flux — oftentimes we're left wondering, "What TF is going on here?!" Women have a delicate balance of hormones and other chemicals that can get upended from the slightest touch, a complex reproductive system that is confusing at best, and — to top it all off — a host of stigmas about our bodies that are forced on us from the moment we emerge from the womb. We're taught to suffer in silence and not speak up about our health issues — it can be easy to feel ashamed or embarrassed when it seems like our bodies are failing us in some way.
It's time to break down those walls and destigmatize women's health issues, once and for all. Here, we're diving headfirst into a disorder that many women have that you've likely never heard of: hypoactive sexual desire disorder, or HSDD. One survey showed that 72 percent of premenopausal women didn't know anything about HSDD, even though about 10 percent of premenopausal women in the US experience it.
We spoke with Dr. Lisa Larkin, a women's-health specialist and CEO of women-focused concierge medicine practice Ms. Medicine, about the warning signs, causes, and treatment of HSDD. She also gave us some much-needed information about treatment options.
HSDD is defined as low or absent sexual desire for several months (including thoughts and fantasies) in women that causes frustration. The key here? The lack of sexual desire should not be due to another medical issue or relationship problems. "In other words," Dr. Larkin said, "people with low desire who are not bothered by it do not have HSDD." The common diagnosis is "acquired, generalized" HSDD, meaning you were happy with your level of sexual desire in the past and now you're not — no matter the sexual activity, situation, or sexual partner.
Let's break down the actual symptoms. HSDD shows itself when you've stopped feeling spontaneous desire for any kind of sexual activity, or you actively avoid situations that could lead to sex because you're just not interested. All of this can cause a variety of emotions like frustration, sadness, and anxiety.
"If a woman has low desire that is bothersome and does not improve with a change in environment (vacation to the beach, for example), stress levels, or a new partner, and is not caused by another medical issue, she should seek medical care and be evaluated for HSDD," Dr. Larkin said.
The complexities of female sexual desire are widespread and certainly don't come in a one-size-fits-all model. Sexual desire isn't always event-related (meaning in response to a specific person or situation) and can be shaped by a number of different factors, from your neurobiology to your cultural upbringing to past traumas. However, women who are thought to have HSDD have an imbalance of neurotransmitter (chemical messengers) activity in the brain, resulting in low sexual desire.
It's important to note that there are other factors that could impact an HSDD diagnosis. Be sure to mention the following to your doctor when discussing your low sexual desire: a recent operation, depression, injuries, other medical conditions, medications, drugs, alcohol, pregnancy, recent childbirth, menopausal symptoms, other sexual issues you may have (pain, decreased arousal, orgasm), your partner's sexual problems, dissatisfaction with your relationship or partner, and stress or fatigue.
HSDD has been a recognized medical condition for over four decades, and the FDA approved the first as-needed treatment for premenopausal women with acquired, generalized HSDD called Vyleesi® (bremelanotide injection) in 2019. Vyleesi® is believed to act on certain neurotransmitters, called melanocortins, to help improve sexual desire, although the exact way that Vyleesi® works isn't fully known.
That said, the Vyleesi® clinical studies showed that the women who took Vyleesi® experienced a change in HSDD symptoms including an increase in sexual desire and a decrease in related distress. So how do you use it? Take Vyleesi® as needed at least 45 minutes before anticipated sexual activity. Do not take Vyleesi® more than one time within 24 hours or more than eight times per month. The most common side effects are nausea, flushing, injection site reactions, headache, and vomiting.
Many people believe there's a major difference in how we talk about men's sexual health vs. women's. "Men's sexual health is accepted as a cultural and societal priority," Dr. Larkin said. "Sexual dysfunction in men is accepted as important to overall health. It's mainstream and talked about. As a result, men demanded treatments, and research led to drug development. Today, there are multiple therapies available — therapies that are advertised on radio and TV during primetime. In contrast, it remains culturally unacceptable to talk about women's sexual health."
"Sexual dysfunction in women — especially low desire — is not acceptable to discuss," Dr. Larkin said. "The longstanding bias against women's sexual health has negatively impacted research and development of treatments. Because of the pervasive implicit bias, women have been reluctant to raise concerns and clinicians have been uncomfortable and reluctant to query patients about concerns. Clinicians are also not trained adequately."
Even though we have FDA-approved treatments, women continue to feel like they can't speak up about their sexual health. "Women must be educated and empowered," Dr. Larkin said. "They need to start discussing sexual health concerns with their clinician, and seek experts if needed." It's time for women to take control of their sexual health and begin to prioritize themselves. With more treatments for women's sexual issues on the rise, the future of women's health is looking brighter by the day.
Want to learn more about Vyleesi®? Click here to read more and then talk to your doctor about your options.
Vyleesi® is not for use in postmenopausal women or in men, and is not indicated to improve sexual performance. Don’t use Vyleesi® if you have uncontrolled high blood pressure or known cardiovascular disease. The most common side effects of Vyleesi® include: nausea, flushing, injection site reactions, headache, vomiting. These are not all the possible side effects of Vyleesi®; please see Important Safety Information here.
Vyleesi® is a prescription medicine used to treat hypoactive (low) sexual desire disorder (HSDD) in women who have not gone through menopause, who have not had problems with low sexual desire in the past, and who have low sexual desire no matter the type of sexual activity, the situation, or the sexual partner. Women with HSDD have low sexual desire that is troubling to them. Their low sexual desire is not due to:
- a medical or mental health problem
- problems in the relationship
- medicine or other drug use
Vyleesi® is not for the treatment of HSDD in women who have gone through menopause or in men. Vyleesi® is not for use to improve sexual performance. Vyleesi® is not for use in children.