Dr. Goldstein recalls the medication currently available to help a woman treat her sexual health problem.
Eureka! We have a drug, hopefully, for the first time in history for women who have sexual health problems. Unbelievable that if you look at the epidemiology of sexual health problems in this society, more women have sexual health problems than men, yet the Food and Drug Administration has approved exclusively pharmacologic treatments for men who have sexual problems. We have not been able to get approval of pharmacologic agents for women.
The drug flibanserin is a novel, non-hormonal drug that has been studied in women with low interest and we have now called low interest, this condition, HSDD. So we sort of did the same with men who had impotence, little pejorative, so created this term ‘ED’ and women don’t like to be called, “You’re the woman with low interest or low libido,” so we have this term called HSDD – hypoactive sexual desire disorder.
So HSDD is a condition whereby we believe there’s an imbalance of chemicals in the brain, that there are chemicals that excite the sexual response and the chemicals that inhibit the sex response and then women with the HSDD, compared to women who don’t have HSDD, who go to tests called functional MRI or PET scans where we actually look at the blood flow to the various regions of the brain – those women with HSDD do not send blood to the important regions of the brain where sexuality is started.
So, it’s almost like in a weird way, erection problems where men who have erection problems don’t send blood to the important parts of the genitals; women who have HSDD don’t send blood to the important regions of the brain that regulate the onset of interest in sexual activity. So it’s a chemical determined blood flow phenomena, so if we can rearrange or rebalance the chemical imbalance then we can get more blood flow to go to regions of the brain that regulate interest.
It’s a common concept. Men with Parkinson’s disease don’t have dopamine in the specific part of the brain called the substantia nigra; giving them back dopamine will allow them to move and become mobile again. Otherwise they become sort of rigid.
Women and men who have depression commonly have low levels of serotonin and their drug is called SSRI that raise the serotonin and help with the sad and blue state of depression. So the concept that there can be chemical imbalances is now being applied to HSDD.
So flibanserin is a drug, which will stop the inhibition called serotonin and raise the excitation through noradrenalin and dopamine and fascinating new drug. It has been studied in almost 5000 women hereto for and the evidence is pretty strong that it improves libido, and because it’s non-hormonal, there is not the emotional response of hormones that hormones are going to cause cancer and all that.
So, we are really excited about the possibility that a drug will finally be available for women who have a sexual problem and that flibanserin will help women with, you know, breast cancer and all other kinds of low interest situations.
About Dr. Irwin Goldstein, M.D.:
Dr. Irwin Goldstein is Director of San Diego Sexual Medicine at Alvarado Hospital, the Secretary of the International Society for the Study of Women’s Sexual Health, a former President of the Sexual Medicine Society of North America and a Clinical Professor of Surgery at University of California at San Diego.
Dr. Goldstein has been involved with sexual dysfunction research since the late 1970s. His specialties include penile microvascular bypass surgery, surgery for dyspareunia, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women.