Practice Your "O" Face — Female Viagra Is Here to Stay

Heck, no!

About 1 in 3 American women report having a low sex drive, and about 40 percent of women will have some type of sexual dysfunction between ages 18 and 60, says Dr. Paul Gittens, a board certified urologist who works with men and women at the Centers for Sexual Medicine in Philadelphia and New York.

“Sexual dysfunction” can refer to vaginal dryness, issues with sustaining or achieving orgasm, and/or issues with libido.

“It’s high time that women had something that affects libido or our ability to sustain sexual intimacy,” says Shepherd. As of 2020, there are two pharmaceutical options — Vyleesi and Addyi — that are approved by the FDA to treat female sexual interest/arousal disorder (FSAID), also known as hypoactive sexual desire disorder (HSDD).

“These issues are really underaddressed,” says Gittens. Thankfully, he adds, there are more options than ever!

Addyi

Addyi is a prescription drug that’s taken orally every evening before bed. It’s FDA-approved to treat premenopausal HSDD/FSAID.

Although Addyi (flibanserin) is sometimes called “female Viagra,” it doesn’t work the same way, explains Gittens. While Viagra increases blood flow to the penis, Addyi is believed to “work by stimulating the sexual neurotransmitters in the brain.”

Does it work? Yes, for some people. After three 24-week clinical trials (which led to Addyi’s FDA approval), about 1 in 10 participants said their symptoms were “much” or “very much” improved from weeks 8 to 24.

There’s definitely room for improvement, says Shepherd.

“This is how we get better, by allowing things to come on the market so we can improve it,” she says. And Addyi, she adds, helps put “female sexuality in the forefront.”

Addyi shouldn’t be taken with certain drugs (including alcohol) or by people with liver conditions.

The most common side effects are:

• dizziness
• dry mouth
• fatigue
• low blood pressure or fainting
• nausea
• sleep issues

Vyleesi

We could make a Khaleesi joke here, but we’ll spare you.

Vyleesi is an injection you give yourself 45 minutes to an hour before you plan to be intimate… kinda like the dragon queen walking naked into fire and emerging as a fully realized goddess (sorry — we had to).

Bremelanotide (the drug’s generic name) has been FDA-approved since June 2019. The FDA trials reported that 25 percent of users felt an increase in sexual desire (17 percent said the same about the placebo). While researchers aren’t completely certain how it works, it does work in a good number of patients, explains Gittens.

“It likely stimulates dopamine neurotransmitters in that area of the brain, which stimulates sexual function,” he says.

You can take Vyleesi only once every 24 hours, and it comes with a limit of eight uses per month, says Shepherd

While the idea of giving yourself an injection might make some folks squeamish at first, Shepherd encourages her patients to consider what they’re trying to accomplish. Usually, the tiny needle becomes less of a barrier when they think of the big picture.

The most common side effects are:

• nausea or vomiting
• fatigue
• flushing of the skin
• headache
• skin reaction at the injection site
• tingling

You shouldn’t use Vyleesi if you have uncontrolled high blood pressure or heart disease.

Viagra

While Viagra isn’t FDA-approved for women, that doesn’t mean women can’t — or don’t — take it.

What would happen if a woman took Viagra? It’s not like what you see on TV. Results are mixed. A 2014 review of trials on women found Viagra could modestly help with physical arousal in some women (although many didn’t report any benefit).

Gittens uses it “off-label” for certain patients, and some have reported that it can help them reach orgasm faster or increase vaginal lubrication. (Using a drug off label is common — it simply means the drug is FDA-approved for a different purpose than the one your doctor recommends.)

The penis and clitoris start out as the same embryonic tissue, and both contain sensitive nerve endings and become engorged when blood vessels dilate during arousal. Viagra works on both, to some degree.

“It’s a safe drug,” Gittens says. “Side effects are temporary.”

People who have cardiovascular issues that make sex unsafe should not take Viagra. And if you take certain medications, called nitrates, for heart disease, you absolutely cannot take Viagra.

The most common side effects are:

• headache
• flushing of the skin
• upset stomach
• muscle pain
• nausea
• vision issues

Topical treatments

For patients looking for something they can use more spontaneously, Shepherd recommends pharmaceutical-grade clitoral serums, which are available over the counter.

“It’s the same concept as Viagra, causing engorgement of the clitoris,” she explains. “It allows you to boost arousal and sensitivity on the fly.”

These serums can be used with Addyi or Vyleesi, she adds.

Plasma-rich platelet treatments

Then there’s the O-Shot procedure, which uses a patient’s own blood to extract plasma-rich platelets. The PRP are injected into vaginal tissue to stimulate cell turnover.

“It’s highly restorative and increases sensation and arousal,” says Shepherd. While not FDA-approved for vaginal tissue, PRP treatments have long been used for hair loss, joint issues, and more.

“It can be used at any stage, even in women who just recently had children,” Shepherd says.

Low-intensity shock or sound waves

Another off-label treatment is the use of low-intensity shock or sound waves. Performed in a doctor’s office, the treatment involves a series of painless 20-minute treatments.

“A low-energy laser stimulates the vagina and causes a minute amount of injury to promote healing and increase vascularization,” explains Gittens. It’s the same technology that’s used to break up kidney stones. He compared it to getting a peel on your face, with similar risks and side effects.

If you’re dissatisfied with your sex drive — regardless of your age — you might benefit from one of these “lady V” options.

“Sexual wellness is more than ‘I’m just having a problem,’” says Shepherd. Having these options “dials down into who we are by not allowing sexuality to be something embarrassing or shameful — and letting it be a natural part of life.”

Symptoms of low sex drive include a reduction in or lack of:

• interest in sexual activities, including masturbation
• sexual thoughts and fantasies
• lubrication
• ability to achieve or sustain orgasm

Talking about sex with your doctor might not be high on the list of things you want to do, but remember that you’re not alone. Start by finding a doctor who can put you at ease.

Don’t be afraid to be your own advocate, says Gittens. And don’t let anyone tell you a low sex drive is “normal” or something you have to accept.

“I have so many patients that have been told to go read a book or ‘you’re too young’ or ‘it’s part of getting older,’” he says. “I think of all these as medical problems first. In my mind, we are treating it just like any other symptom.”

Shifting your perspective might make it easier to open up to your doc, who can also help you address or rule out psychological causes.