The truth about female Viagra ‘Addyi’: DR BRAD McKAY

If you’ve been active on social media lately, you’ve likely noticed more women discussing their experiences with menopause and the impact lower libido has had on their sex lives. 

You may have also heard about women trying to fix their low libido by taking ‘Female Viagra’ – Addyi (Flibanserin) – a prescription drug that is now available in the United States and Canada, but not yet approved in Australia.

Conversations about female libido are long overdue, but is ‘Female Viagra’ the wonder drug we’ve been waiting for, or is it a bit of a fizzer?

Is low libido normal?

It’s common to worry about a loss of libido, discomfort during sex, relationship stresses, and a fear of losing their sex life altogether. Many women feel their health issues have been brushed off in the past, or were told their symptoms were just part of the ageing process and to get used to it. However, women deserve clear information, good advice, and appropriate medical care.

Fortunately, GPs around Australia are increasingly seeing women asking for assistance to help guide their way through menopause.

Here’s a basic guide about libido, hormonal changes, and the ‘Female Viagra’ that has been attracting so much attention lately.

What low libido actually is

Low libido simply means a reduced interest in sex. It may be a temporary change related to stress, relationship issues, illness, or medication. It can also last a lot longer and begin to cause emotional distress.

Low libido is far more common than people realise. Australian research shows that sexual desire varies throughout adulthood, with about 27 per cent of women in their early 20s experiencing low libido, increasing to more than 90 per cent of women reporting low libido in their late 70s.

Some women naturally have a lower sex drive and feel perfectly content, while others find their lack of libido frustrating and desperately want it to improve. If your low libido doesn’t bother you, then it’s not an issue. However, it becomes a clinical concern when it begins to bother the person experiencing it.

How perimenopause and menopause affect desire

Perimenopause is the time when a woman’s ovaries start to run out of eggs and produce less oestrogen. 

This phase of life can last several years before menopause eventually occurs and is often associated with symptoms like hot flushes, night sweats, trouble sleeping, joint stiffness, mood changes, and vaginal dryness. 

These changes happen as oestrogen levels drop, affecting sexual comfort and desire for sex.

Menopause occurs when a period hasn’t happened for 12 months in a row, usually around age 51 years for women in Australia.

Hormone therapy, with oestrogen and progesterone, can be very effective for treating these symptoms during perimenopause, but for many years, women were discouraged from using hormone therapy due to concerns about cancer risk and blood clots. Fortunately, we now have better knowledge, more clear information, and safer ways to use hormone therapy.

Women who were previously warned against using Menopause Hormone Therapy (MHT) may find that safe and effective options are now available. New formulations are now available that weren’t previously available.

When low libido is considered a medical condition

Reduced sexual desire, fewer sexual thoughts, difficulties with sexual arousal, and a loss of pleasure during sexual activity are all aspects of a condition known as Female Sexual Interest and Arousal Disorder (FSIAD). For a diagnosis, these symptoms must persist for more than six months and cause significant distress.

About one-third of Australian women experience these symptoms in their early 40s, and that number remains consistent into their early 60s. Unfortunately, many women avoid discussing these issues due to embarrassment or because they don’t feel their concerns will be taken seriously.

It acts on receptors in the brain that influence motivation, reward and desire. It reduces the activity of serotonin, increases the effects of dopamine and also affects noradrenaline. These neurotransmitters influence mental desire rather than physical arousal.

What the so-called ‘Female Viagra’ actually is 

Flibanserin is approved in some countries and is also known by its American brand name Addyi. It’s often referred to as ‘Female Viagra’, but this nickname is misleading. 

The tablets are pink, contrasting with the blue tablets of (male) Viagra, and they have a distinctive angular shape, similar to Viagra’s characteristic diamond appearance.

Viagra (sildenafil) works in men by selectively increasing blood flow to the penis to help get and maintain erections. It only works when someone is sexually aroused and doesn’t increase libido.

Flibanserin does not work this way at all.

It targets receptors in the brain that influence motivation, reward, and desire. It lowers serotonin activity while increasing dopamine and noradrenaline levels. This results in a psychological impact on libido and sexual drive rather than triggering a physical response to sexual arousal.

Flibanserin tablets are taken once a day and may take four to eight weeks to show any benefit – whereas Viagra is taken as needed and typically begins to work within half an hour.

Flibanserin (Addyi) is not available in Australia and has not been approved by the Therapeutic Goods Administration.

Why has it not been approved in Australia

For the TGA to approve a medication, it needs to be both effective and reasonably safe. Flibanserin has had difficulty meeting these expectations.

Let’s start with its effectiveness: Studies show a small improvement in desire. On average, women taking the medication every day experienced only one additional satisfying sexual experience every two months.

This result may seem underwhelming to most of us, but it’s important to recognise that the significance of sex differs greatly from person to person. Some women might see taking a tablet every day for two months to achieve just one extra enjoyable encounter as a waste of time and effort, while others might cherish each additional sexual experience as adding more fulfilment, meaning, and value to their lives. 

How do the side effects stack up 

Flibanserin commonly causes side effects such as dizziness, low blood pressure, drowsiness, nausea, sweating, blurred vision, confusion, and fatigue. It also interacts with a wide range of other medications, including antibiotics, blood pressure drugs, and antiretroviral treatments for HIV. 

Additionally, combining flibanserin with alcohol significantly increases the risk of a rapid drop in blood pressure and fainting.

The medication is quite expensive, costing anywhere from several hundred to over a thousand dollars each month.

Current research suggests that if it were to be approved for use in Australia, it is unlikely to qualify for funding through the Pharmaceutical Benefits Scheme (PBS). As a result, Australian women would need to cover the full out of pocket cost.

The combination of minimal benefits, significant side effects, potential interactions with other medications and alcohol, and a high cost raises concerns about its overall value.

Why a single pill is unlikely to be the answer

Sexual desire is influenced by physical, emotional, hormonal, and interpersonal factors.

Sex often plays second fiddle to various stressors, such as feeling tired, being pressed for time, caring for kids, work demands, relationship issues, sleep problems, medications, trauma, concerns about body image, and low self-esteem.

Many women find that these factors greatly impact their sexual desire, making it extremely challenging for a small pink pill to provide substantial relief.

What doctors look at when assessing low libido 

When women raise concerns about low libido, doctors usually assess several key areas. These include stress levels, sleep quality, medications, relationship dynamics, signs of anxiety or depression, and symptoms related to hormonal changes during perimenopause and menopause.

Blood tests can assess hormone levels and rule out other possible causes of low libido. Menopausal hormone therapy (MHT) can offer relief for many women, and in specific cases, low-dose testosterone may be prescribed under the guidance of a specialist.

Additionally, lifestyle changes—such as increasing exercise and enhancing sleep quality – can lead to significant improvements. Counselling or sessions with a sex therapist can also be beneficial, especially when emotional or relationship factors are at play.

Overall, medication might be helpful, but it’s just one component of a comprehensive treatment plan.

Could Flibanserin help some women?

Possibly.

When used safely and under careful medical supervision, some women may be lucky enough to respond well to the medication while not experiencing significant side effects.

However, Flibanserin comes with strict alcohol restrictions, careful monitoring requirements, and a comprehensive understanding of potential drug interactions. These factors make it unsafe for women to bypass their doctors and order unapproved medications from online pharmacies. Furthermore, there is a significant risk associated with online clinics offering ‘Female Viagra’ without fully understanding their patients’ medical histories.

Many women learn that there are far more treatment options than they were originally told, especially as medical understanding continues to evolve.

There is nothing embarrassing about wanting a healthy sex life. Sexual wellbeing is an important part of overall health, and women deserve respectful, evidence-based care.

What women should know before taking any libido medication

Many treatment options are available that don’t include a little pink pill.

It’s important to speak openly with your doctor about your concerns. If you feel uncomfortable, misunderstood, or not taken seriously, it’s essential to seek a second opinion. Some general practitioners have a special interest in menopause and women’s sexual health, while endocrinologists and gynaecologists can be particularly helpful in managing complex cases.

The bottom line

Low libido is common, and there’s no need to feel embarrassed. Hormonal changes during perimenopause and menopause can significantly impact sexual desire, but there are many ways to address these symptoms and enhance your sex life.

The medication known as ‘Female Viagra’ provides only modest benefits and comes with significant risks, which is why it hasn’t been approved in Australia. If you’re concerned about low libido, please consult your doctor.

With the right support, many women can improve their sexual lives and have more meaningful sexual experiences through lifestyle changes, personalised hormone treatments, and open conversations – often leading to far better outcomes than a single pill could ever offer.

Dr Brad McKay is a medical practitioner, author, TV host and media commentator. This article contains general information only and is not a substitute for medical advice. Always consult your doctor for guidance tailored to you.