One Writer Takes the New Female Viagra for a Spin.
I can think of no possession more thrilling—one I have coveted for months. Now it’s tucked away in my purse, close enough for my fingertips to graze its contours throughout the day. Back at home, I twist the lid off the pink-and-gray pin-striped bottle and admire its contents, each tiny oval a potential golden ticket.
Such is the mystique of Addyi , a peach-colored pill that offers women the possibility of eros regained. Its arrival marks the culmination of years of trial, development, and controversy. The first medication ever approved for female sexual dysfunction in premenopausal women, Addyi has been called the “pink Viagra.” The label is erroneous. Viagra is a tool designed for a man’s faulty hydraulics. Addyi aspires to the metaphysical, targeting a woman’s brain chemistry in order to boost her desire.
A lackluster libido is the most prevalent female sexual complaint, and one that affects women across the age spectrum. Sheryl Kingsberg, Ph.D., chief of behavioral medicine at University Hospitals Case Medical Center in Cleveland, is fielding requests for Addyi from patients in their 20s and 30s. “They say, ‘I’m 25 years old; what’s the matter with me?’ ” she tells me. “ ‘How can I enter a relationship with somebody if I don’t have any sex drive?’ ” Later I experience this phenomenon firsthand after a routine doctor’s visit, when a young nurse who has seen my chart follows me out of the examining room. “How is it?” she whispers. “Does it work?”
Any physician can write a prescription for Viagra. Addyi, which first became available in October, can be maddeningly difficult to obtain. Getting mine required several visits to New York’s (aptly named) Maze Women’s Sexual Health center, whose associate medical director, Melissa Ferrara, F.N.P., was among the first clinicians certified to prescribe it. Ferrara asked me a battery of questions about my relationship, current medications, and psychological and physical health. A nurse checked my blood pressure, hormone levels, and kidney and liver functions. My hard-won prescription could be filled only by a specialty pharmacy in Pennsylvania, 200 miles from my home—and then only after an Addyi-certified pharmacist had called to review a list of warnings and possible side effects.
“The biggest risk is dizziness—possible fainting—which is why they want you to stay away from alcohol completely,” the pharmacist said. I had already signed a consent form vowing not to drink and promising to lie down if I felt light-headed (nausea, sleepiness, and low blood pressure are other risks). “Do you have any questions?” she asked.
“Can you ship it overnight?” I replied.
In my case, sexual desire had become elusive—less a basic instinct than a distant place on a map that had been rolled up and locked away. I was still having sex with a man I loved, after four children and many years of marriage. I enjoyed it, but I didn’t crave it; I couldn’t reach the place that Tennessee Williams wrote about where you “get the colored lights going.” I wanted to find my way back there, to recapture even a fraction of the headlong lust of the days when my future husband and I could spend the entire day in bed, the same CD playing over and over on repeat.
Long before I got my hands on Addyi, my yearning to yearn led me to a sex therapist named Bat Sheva Marcus, Ph.D., who advised me to set aside time each week for “conscious coupling” with my husband. She also recommended small doses of supplemental testosterone—a hormone that fuels sex drive—and Wellbutrin, an antidepressant that some doctors prescribe off-label to stimulate arousal. It all helped, though the boost I got from testosterone was slight. The Wellbutrin enhanced my excitement in bed but made me anxious once I was out of it. With Addyi, I was to take one pill every night for a month. The effects would not be immediate, I was counseled, and the drug doesn’t work for everyone: A full half of the women who took it in clinical trials reported no boost in desire.
And so begins my Addyi adventure. For the first two days, I feel queasy. On the evening of the third, I experience a moment of dizziness that quickly passes. For the rest of the week: nothing. I do have sex with my husband that weekend because he asks and it seems unkind to refuse. It is a friendly commingling.
At the same time, something odd is happening: I’m suddenly thinking more about sex. I am not obsessed, just newly alert to erotic possibility, scanning the world around me for any sign of it. I study my husband’s body. Not bad. Has he been working out? I scrutinize each woman I pass on the street. Does she still want it? At yoga class I stretch on my mat and try to quiet my thoughts. The instructor places her hand on my back. Her skin feels warm. . . . Do I smell bergamot?
What does the brain look like in the grip of desire? A landmark 2009 study gave us our first picture, when a team of scientists and doctors mapped feminine erotic response by tracking neurological and physiological changes in 36 women. Although most were in stable relationships, 20 reported a healthy libido, and sixteen complained of a lack of desire. Each woman was shown a variety of videos: nature scenes, sports, and erotica. As participants watched, researchers tracked their brain activity and blood flow.
The latter increased for all the women when they watched the erotic videos—their bodies were showing signs of arousal, even if they weren’t conscious of it. But the MRI scans told a different story. When the sexually healthy women watched, a little comma-shaped hub in the brain called the entorhinal cortex lit up. This is where emotional memories—including the happy ones created during satisfying sex—are captured and processed. When the women with low desire watched, the comma barely flickered.
That was the game changer, says Leah Millheiser, M.D., a lead author of the study and director of the Female Sexual Medicine Program at Stanford Health Care. “One of the areas of the brain that is typically associated with desire and arousal is not functioning in the same way,” she tells me. For decades, women who suffered from persistent low sex drive could expect to be told to try new lingerie or a week in Lake Como. Here, at last, was proof that diminished libido was a true neurobiological condition.
These findings were among the key pieces of evidence cited by proponents of Addyi, then known by its generic name, flibanserin, at an FDA hearing last June. Although Addyi’s mechanism is not completely known, it’s designed to put the brakes on serotonin, a neurotransmitter linked to inhibition, while promoting the release of sex-friendly neurochemicals such as dopamine and norepinephrine. Initially developed as an antidepressant, the drug caused a curious side effect: increased libido. It was promptly retooled as a medication for female sexual dysfunction, only to be twice rejected by the FDA before finally winning its approval last August, after a full-throated public campaign accusing the agency of gender bias. “Men have multiple treatments for sexual dysfunction,” Marta Hill Gray, a women’s-health advocate, testified in June. “Many women have not caught up with men in claiming their right to have a fulfilling, satisfying sex life.”
My second week on Addyi passes very much like the first, until I feel a legitimate stirring one quiet afternoon. Random fantasies distract me from my work. Perhaps that other, more sensual incarnation of myself has not gone missing for good. That night I pick up where I left off in Elena Ferrante’s The Story of a New Name . The novel is even better than I remember. Her prose is so fierce. . . . Am I feeling turned on?
The following weekend my expectations are high as I set off on a date night with my husband. There has been no time or space for intimacy in a week, and it takes effort to shift gears. We try not to talk about our children and flirt, tentatively, over a bottle of Saint-Émilion. (Despite the pharmacist’s warnings, I decide to drink; none of Addyi’s worst side effects have materialized, and my husband is driving.) At home, I take my nightly pill and get into bed, wondering if desire will strike at last. Unfortunately, I fall asleep almost instantly—it turns out that Addyi taken with half a bottle of red wine can, indeed, result in extreme sleepiness.
But when I wake up the next morning, I feel like having sex with my husband. Simple as that. I’m not overwhelmed with passion, just . . . up for it. I find him making coffee in the kitchen and suggest he return upstairs. The following week, my husband nudges me in bed—on a school night. Reflexively, I tell him I am tired and turn off the light. Then I reconsider and find myself staying up after all.
My desire is improving, as is the quality of the sex. I’m more enthusiastic, less distracted. The color commentary that usually runs through my mind during the act— This is nice, but am I enjoying it enough? Is that a paint chip on the ceiling? —has fallen silent. The sharp edges of daily life melt, just a bit.
Has the Addyi flipped a switch in my entorhinal cortex? More likely, the drug is helping to create “a good neurochemical environment” for desire, according to Jim Pfaus, Ph.D., a scientist in the pharmacology of sex, based at Montreal’s Concordia University. Mindfulness training, sensate exercises, and talk therapy could probably achieve the same result, given enough time and energy. But as Pfaus points out, “You can’t take a trip to Cozumel every weekend.”
Women’s sexual problems can be complicated, and Addyi is not a magic bullet. The drug’s signal achievement may be that it has opened a window onto a new frontier of research into better sex through neurochemistry. One drug in development is Lybrido, a testosterone-coated pill containing sildenafil—Viagra’s active ingredient—which triggers arousal in both the body and the brain. Another, bremelanotide, uses a synthetic hormone to activate neurological receptors linked to sexual response. You take it only when you want to have sex, and you can even have a cocktail. Compared with Addyi, says Pfaus, who has experimented with all of these drugs on his lab rats, “bremelanotide produced a much greater effect on spontaneous desire.”
Four weeks into my own experiment, a distinct shift has taken place. It is mild, yet unmistakable—less a crashing wave of desire than an easy swell. Sex seems less dutiful, more fun, and a virtuous circle has begun to take hold: I want it more often because I’m enjoying it more, which makes me want it more. I’ve already called in my refill.
Sittings Editor: Phyllis Posnick.
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One Writer Takes Addyi, the New Female Viagra, for a Spin
