Sexual dysfunction can occur in women in a wide range of ages and in many different phases of life, it can impact personal relationships and affect self esteem.
Often times sexual dysfunction is dismissed or avoided by providers and women are left wondering what they can do to improve this disorder on their own. Dr. Amy Brenner and Dr. David Schwartz OB/GYN focus on hypoactive sexual desire disorder & a possible solution that is non-invasive for women. Some attribute this pill as being the female version of the medication men have used for years for erectile dysfunction!
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Transcripts
Episode 8 Female Viagra
Narrator: Welcome to the HealthiHer Podcast. Your host, Dr. Amy Brenner is a board certified OB-GYN, with additional certifications in functional and integrative medicine. This podcast is meant to help women find reliable, relevant information to help them feel better, look better and live better. Here you will hear in depth information about hormones, sexual medicine, aesthetics, cosmetic gynecology and functional medicine.
AB: Hey thanks for joining us for another episode of HealthiHer and today I have one of my very good friends and colleagues and mentor. He’s also been my personal physician for endometrial ablation and some other things, we have Dr. David Schwartz today who’s board certified OB GYN who specializes in women’s health in Cincinnati, Ohio. Thank you for joining us today.
DS: Thank you for inviting me.
AB: Yeah, so today we’re going to talk about something really fun and probably smoothing women don’t even know that out there. Something called the little pink pill or the female “Viagra®” and this new medication called Addyi. I know you’re an expert in this and have been teaching & educating Doctors on this medication.
DS: So Addyi is for women who just aren’t interested in sexual activity with their partners. I think if we go back to the beginning, we should talk about the disease called hypoactive sexual desire disorder “HSDD”. And HSDD is when the average woman is just not interested in having sexual intimacy with her partner or any partner. It is not normal and it is due to a change in certain chemicals in the brain. Fortunately for women nowadays there is medication called Addyi, the generic is called Flibanserin and it is a pill they would take once a day, usually they take it before they go to bed. It’s not like Viagra that you take it and an hour later it relieves the difficulty and you can have sex. It takes about a month to work.
AB: Yeah, so even though it’s called the female viagra , it doesn’t work like viagra.
DS: It doesn’t work like viagra, well what it does is enables the pt to want to have intercourse. Where viagra enabled the male to be able to have intercourse due to anatomy. A woman’s always able to have intercourse, but she may not want to or she may not be interested in it or she may not be able to have an orgasm so she may just be doing it for her partner and not enjoying it. It. The beauty of this medication is that it changes the chemicals in the brain such that women are interested in intimacy. She wants to be intimate with her partner. She wants to have sex. And in doing so it’s a more enjoyable and fulfilling experience.
AB: And you & I both know this is a super common problem. I hear this 10-15 times a day from seeing patients in the office.
DS: There’s no question about it. And we as physicians have to remember to ask the pts about it because most of the time a w coming in2 the office is not going to say hey I’m really not interested in sex and she just goes on through the next 10 or 15 years not fulfilling that part of her relationship. Fortunately w this new medication & its not really that new it’s been around for a couple of years but it’s becoming more prevalent because we are asking pts more about HSDD Hypoactive sexual desire disorder & we’re finding that many women do have it to some degree and when we provide this med for them they have a much more fulfilling sexual relationship
AB: I think a lot of doctors dont ask the question because in the past there was nothing to do about it. We didn’t have anything. So why ask the question, if you don’t have a solution. Kind of like ordering tests, i don’t like to order blood tests unless it’s going to change my managemens.so dont you think that’s a big reason why a lot of drs dont even ask the question?
DS: You’re absolutely right, that’s part of the reason, that’s one of the biggest parts of the reason. The other is since the patients are uncomfortable with the question, some of the drs may be uncomfortable asking the same question too. We also are dealing w women who are post menopausal and have vaginal atrophy or the lining of the vagina is dried up and you want to ask them about that because there are medications there are products that we can use to make the vagina healthier so that couples can have a fulfilling sexual intimacy throughout their lives.
AB: That’s a whole other issue, you and I will have to talk about that on another occasion because I know you have a nice device that can help with vaginal atrophy and dryness
DS: That is correct and that is vaginal rejuvenation but we will talk about that at a later discussion. But right now going back to hypoactive sexual desire disorder. This medication called Addyi, women should take before they go to bed at night . One of the side effects is it makes you a little tired, so if they take it before they go to bed , they have a great night’s sleep. Wake up feeling refreshed in the morning. There is a little bit of weight loss associated with it. We do not give patients this medication to lose weight but that’s one of the beneficial side effects .If you have low blood pressure there may be some issues with it causing low blood pressure again that’s why we give it to you before you go to bed at night . but the beauty of it is that all of the studies show an increase in satisfying sexual events such as sexual intercourse and the like .
AB: I know when it came out, we had to have patients sign a release that they would never drink alcohol and we had to get special training. And then that went away, can you explain the deal with the alcohol issue. That was the big reason when it first came out, is you couldn’t ever drink alcohol, you couldn’t have a glass of wine out to dinner and so it just limited a lot of use.
DS: So this was originally about 3 or 4 years ago when the drug was first released and approved by the fda. And unfortunately the company at the time did the initial studies, having women take the pill w alcohol . Literally with a couple of [unintelligible] of alcohol and the pill at the same time. And it caused them to be dizzy. If I took that much alcohol that they took, whether I took the pill or not , I would have had the same side effects. Well what the FDA required was that they could not take the pill with alcohol . Subsequent to that other studies have come out and the FDA has erased that warning and like any med you’re not going to take it with alcohol. But if you’re having a couple of drinks and then you’re going to take your Addyi 3 hours later, that is perfectly safe and perfectly normal. So no longer do we have any issues with alcohol and taking this pill
AB: Gotcha, so who is not for? I know you mentioned it’s really for anybody that has decreased libido that they are bothered by, which is the definition of HSDD. But are there any patients that you wouldn’t give it to?
DS: Well if patients are on other medications that may decrease their desire for intercourse. If they’re on different types of antidepressants and antianxiety pills, they need to discuss those meds with their physician . Now originally this med came out for premenopausal women, women who were under the approximate age of 50 – somewhere between 50- 60 is when they go into menopause -and it was approved by the FDA for premenopausal women. Currently studies are under review for postmenopausal women. It’s important to know that it works for postmenopausal women too. So in my practice I use it off label for postmenopausal women. And though it’s not approved by the FDA, we’re waiting for that approval and it should be coming soon. There are a number of trials out there showing its effectiveness. Just going back for one second, we are scientists, we look at evidence based medicine and for me there is evidence based medicine there that works for both pre menopausal and postmenopausal women.
AB: Yeah I think that’s important, I like to document and tell ppl this is what it’s approved for but as physicians we use a lot of things “off label”. Like birth control pills,we use birth control pills for heavy bleeding painful periods but they are FDA approved to prevent pregnancy.
DS: That is absolutely correct. So physicians do use meds off label, it is perfectly appropriate and because we are scientists and we’re going to look at the evidence based medicine that’s what’s going to make the most improvement and the best process for our patients.
AB: So you mentioned that one of the contraindications is using antidepressants like Prozac®, Zoloft®, Pristiq®, that kind of thing, have you ever switched, cause one of the downsides or one of the biggest downsides of those medications is those decrease your libido and interfere with orgasms. One of the things I’ve done is just getting ppl off those drugs, cause what I found is sometimes people are put on those drugs or women are put on those drugs, maybe they went through a divorce or they had a death in the family and then no one ever looks to take them off of those drugs. And that could be, that alone could be the reason why they have decreased libido. But sometimes ppl are really nervous to come off of those drugs, if you’re not replacing it with something else. So have you ever weaned people off one antidepressant and put them on Addyi?
DS: You know Dr. Brenner, you’re brilliant, because you’re absolutely correct. And yes, I have weaned them off. Yes I have switched them to other ones. Sometimes they’re on certain medications and they can take the Addyi at the same time. My point is they need to let their physicians know what medications they are on and then the physician, like you have already done, can decide to cut the dose in half or wean them off or put them on Addyi instead of that medication . Or there are other medications, for example, Wellbutrin® has an increase in sexual desire, vs Prozac or Celexa®? Or things like that, But if my point is the pt has to let their physician know what medications they are on. And then we as physicians can use the evidence based medicine that’s out there to help them with their problem.
AB:Yeah, certainly I feel like there’s a role for antidepressants for somebody who has true anxiety disorder, depressive disorder, maybe they’ve been hospitalized for one of those conditions in the past. But it amazes me how many ppl are just put on those meds for just some mild mood changes that might have been life related, perimenopause related and those drugs definitely come with their own side effects. So, you’re right, I use a lot of wellbutrin or you know other things that help w mood, supplements and testosterone because those SSRI’s, although they might help w mood, they just squash libido and orgasms.
DS: And as you’re saying we can lower the dose, because maybe they needed them when they had some lifecycle event, whether it was a divorce or a death in the family and now they don’t need the med and you can wean them off of it or get them on a lower dose for 6 months and then wean them off it. So there’s many ways of helping them with this issue.
AB: One of the things that I like about you and why I think you and I are such good friends is we haven’t stopped learning and we’re always looking for the next thing or what else is on the horizon. But it takes a lot of time and effort to learn these new things. Why do you think other drs aren’t using this or switching to wellbutrin or lowering the dose, why haven’t pts even heard of this medication?
DS: Well the first part of your question is the doctors have a certain amount of time to do the physical exam. So a patient comes in and the doctor has 15 mins to get through heart and lungs and menstrual periods and contraceptives and everything. And then to start a whole conversation about hypoactive sexual desire disorder is just going to wreck that drs schedule, so a lot of times they’re not going to bring it up . It may also be that the dr either a male or a woman is uncomfortable talking about that and if the pt doesnt bring it up , then the dr isnt going to bring it up . In addition some drs are stuck in their ways and aren’t interested in learning new things. As you and I have talked about in the past, I’ve always described when I was in medical school, you take a loaf of bread and I learned that that first piece of bread, that first slice in medical school. And I learned that second slice in my residency, the rest of that loaf of bread, as we slice it, I’m learning during my whole career. They didn’t even have hypoactive sexual desire disorder discussed when I was in medical school and it’s something that is very common now. And so we need to learn new things , all physicians need to learn new things and like you do, I think that’s the way we can provide better care for our patients
AB: Yeah, so, one thing that I like is, I think one of their campaigns of this medication is evening the score because up until this point, was this the first FDA approved medication for women? Or was this the second?
DS:There’s another one out called vilessi, which is an injection, in which the patient gives herself a shot & an hour later has an increased desire to have intercourse. I’m not comfortable giving myself a shot to increase my desire for activity. I’d rather take a pill, and that’s why i’m more comfortable with Addyi. But as you asked Addyi is the first med that is approved by the fda for hypoactive se
AB:Well thanks for joining us to talk about the first medication to kind of open the gates to talk more about women’s sexuality. Anything else you want to talk about before you get on to seeing patients?
DS:Just I would encourage your patients, my patients and all patients out there to ask their physician about these issues. Bring it up. You should be able to talk to your OB-GYN about any issue relating to your sexuality, and if you’re not you need to find a new physician.
AB:I think that’s great advice. You really need to have this open relationship. But you’re absolutely right, I think as OB-GYNs we’re taught [to ask] how many partners do you have sex with, are you having sex w males, females or both? What are you using to prevent pregnancy? But at least when I went through medical school and residency we weren’t taught to elaborate on sexuality – are you happy? Are you having pain? Are you satisfied? All of those types of things. You’re absolutely right, if you don’t feel comfortable talking to your dr you probably need to find a new dr. So on that note, because I know you are comfortable talking with your patients -how can ppl find you?
DS: I am, again David Schwartz, my office number is 513-241-4223, my website is https://cincinnatiobgyn.com/ and I’m also happy to talk to somebody on the phone if they have some ?’s. Thank you again for inviting me to be part of the show today.
AB:Yeah! We’ll talk soon.
DS: Bye now.
Narrator: Thank you for listening to this episode of HealthiHer . You can find us on Instagram, Facebook and the web. Go to www.dramybrenner.com to learn more. This podcast is for general information only and does not constitute as medical advice , the practice of medicine, nursing or other health care services. No patient-physician relationship is formed. The information in the podcast and any references, material or links are at the sole discretion of the listener and not meant to be a substitute for professional medical advice, diagnosis or treatment. Listeners should not delay or disregard obtaining medical advice for any medical issues or diagnosis they may have, and should seek medical advice from their healthcare provider for any such conditions.