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Will A Pink Pill Make Me Horny?

September 20, 2015
It depends what kind of sexual problem you are having

It depends what kind of sexual problem you are having

By Susan Kolod, Ph.D.

Flibanserin or “Addyi” is the first drug approved by the FDA to treat Hypoactive Sexual Desire Disorder (HSDD) in women. The drug will become available on October 17th. There has been much discussion in the media over whether the drug is pro or anti-feminist. But the really important question is, “does it make you horny?”

How Does Flibanserin Work?

Flibanersin treats desire, unlike Viagra, which improves performance. Flibanserin is not “female Viagra”–Viagra is taken before sex and it pretty much assures an erection. Flibanserin must be taken every day and is being marketed as a drug to increase desire. So how does Flibanserin actually increase sexual desire?

To find out, I spoke to the expert on rat sexuality, James Pfaus, Ph.D., and learned how Flibanserin affects female rats with the hope this might shed some light on how it affects women.

Pfaus, Professor, Concordia University and President Elect, International Academy of Sex Research, gave me a crash course on the sexual behavior of female rats. Female rats love sex and make their desires known very clearly. They pursue sex actively with partners they find attractive and avoid sex with rats they don’t find attractive. They love to have their clitorises stimulated with a paint brush. No slut-shaming among rats.

In Pfaus’ lab, rats whose ovaries had been removed were administered a low dose of estradiol and then Flibanserin. The low dose of estradiol created a sex hormone scenario similar to women going through menopause. Usually, a female rat whose ovaries have been removed and is given a low dose of estradiol will not initiate or “solicit” sex. After a

two day trial, Flibanserin restored these rats to their normal rate of solicitations. Impressive results!

However, human sexuality cannot be observed so easily, nor is it so straightforward. In the drug trials, some women were given Flibanserin and others a placebo. All were asked to keep a diary of their sexual experiences. They also met with a psychologist once a week. Self-report, especially about sex, is notoriously subjective and often inaccurate.

Diary responses were analyzed for SSE’s or Satisfying Sexual Events. An SSE can be anything from masturbation to multiple orgasms with a partner to intimate touching. It is a broad and somewhat vague concept–it just measures how many times you “did it,” the “it” being something defined as sexual. So an SSE doesn’t really capture the experience of desire.

Flibanserin appears to be a lot more effective with female rats than with women. The increase in SSE’s was only .7 per month for women as compared with an increase in sexual solicitations of 3.94 per month in the rats!!

However, human SSEs and rat solicitations may be two different things.

Appetitive and Consummatory Motivation

Pfaus makes a distinction between “appetitive” and “consummatory” motivation in sexuality. Appetitive motivation is the first phase of a sexual encounter and involves the initiation and anticipation of sex. Appetitive behavior moves the animal (human and non-human) towards an attractive potential sexual partner and is more indicative of spontaneous desire. For example, female rats will press a bar to get access to a male sex partner. This is appetitive behavior.

In humans, appetitive motivation includes such behavior as flirting, planning for a date, fantasizing about a date.

Consummatory motivation, on the other hand, leads to actual physical interaction and completion of the sex act. In female rats, lordosis–arching the back and sticking out the buttocks so the male can mount her–is a consummatory behavior. In humans, foreplay, touching and actual sexual contact, and orgasm are consummatory.

It is possible that different drugs help with problems in one phase, but not another. Pfaus suspects that Flibanserin increases appetitive motivation. In other words, it might help a woman to feel sexual desire towards a partner, to anticipate sex with that partner, and to be motivated to initiate sex.

Three other drugs, still being tested by the FDA, Lybrido, Lybridos and Bremelanotide, may effect the consummatory sytem by maintaining excitement throughout the sexual encounter and facilitating orgasm.

Who Will Flibanserin Help?

Flibanserin, Pfaus suspects, will be most effective with women who are highly organized and always planning ahead. They may find it difficult to be “in the moment.”

For example, Stacey and Linda have been together for 18 years and married for the last 5. They have 2 small children. Stacey is highly organized both in terms of the household and at her job. She often feels overwhelmed by all of her responsibilities. Although she is very attracted to Linda, she is unmotivated to initiate love-making because she is always planning the next thing. This is exacerbated by feelings of resentment towards Linda who is not helping enough with the kids and the housekeeping.

While the interpersonal issues need to be addressed, Flibanserin might help Stacey to feel spontaneous desire and to be “in the moment.” The drug could be a good adjunct to couples’ therapy.

Flibanserin might be less helpful for a woman who can experience spontaneous desire but can’t sustain her excitement. Some of the other drugs to treat HSDD such as Lybrido, Lybridos or Bremelanotide, still being tested by the FDA, could be more helpful with difficulties maintaining excitement and reaching orgasm. These three drugs do not need to be taken every day—only before having sex, like Viagra.

The best outcome would be that a number of different drugs will become available as adjuncts to psychotherapy, couples therapy and sex therapy. And that women will be comprehensively informed about the risks and benefits. Women are entitled to make the best choices for themselves about what makes them horny and helps them to enjoy sex!

Susan Kolod, Ph.D., is a Supervising and Training Analyst, member of the Faculty, co-Editor of the blog, Contemporary Psychoanalysis in Action and on the Steering Committee of the Eating Disorder, Compulsions and Substance Abuse Program (EDCAS) (link is external) at the William Alanson White Institute (link is external). She has lectured and written about the impact of hormones on the psyche with a particular focus on sexuality, menopause and the menstrual cycle. She is in private practice in Brooklyn and Manhattan.

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