Not in the Mood? You Could Have Hypoactive Sexual Desire Disorder

 Not interested in sex? Perhaps you have a condition called hypoactive sexual desire disorder, caused by a brain chemical imbalance. That's the message conveyed in a new "educational campaign" launched last week by the Society of Women's Health Research with actress Lisa Rinna as a celebrity spokesperson talking about "the brain's potential role in desire." On the campaign's new website, you might conclude that if you're not fantasizing about sex a lot you should definitely talk to your doctor.

You won't, though, learn about any medications for HSDD—because there are no approved drugs for it. A new drug, called flibanserin, may be approved by the Food and Drug Administration after its advisory committee meets to discuss the drug next month. In the meantime, flibanserin manufacturer Boehringer-Ingelheim has funded an HSDD educational campaign to create demand for the drug, some experts say. And, yes, Rinna is a paid spokesperson.
"It's like priming the market," says Lisa Schwartz, an associate professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H. "Disease awareness is a very important part of [preparing for] an upcoming ad campaign" for any new drug—which will no doubt occur if and when flibanserin is approved. (I previously reported on the over-medicalization of low sexual desire in women.)
Unfortunately, the website doesn't provide much useful information about the low sex drive condition, which was first identified in the 1970s and is included in the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorder. You wouldn't learn from the website, for example, that certain medications—including antidepressants, birth control pills and antihypertensives—can dampen your sex drive. Nor would you learn about the usefulness of psychological treatments like psychotherapy or mindfulness training. And the website doesn't differentiate between "situational" HSDD, caused by lifestyle factors like lack of sleep, breastfeeding, stress, and relationship issues, and "generalized" HSDD, which may arise from some sort or physiological problem, like low testosterone levels or a brain chemical imbalance. In this interview with Fox News, Rinna said she lost her sex drive soon after her second child was born, which, according to experts, means she probably had some explainable reason like excess fatigue or low sex hormones due to nursing.
[Here are 5 natural ways to boost your sex drive.]
"Will the drug help if you're tired and have young children? Probably not," says psychologist Stanley Althof, executive director of the Center for Marital and Sexual Health in West Palm Beach, Fla. He's been testing flibanserin in the manufacturer's clinical trials and says he sees a real need for an effective medication to treat women who have been carefully screened and diagnosed with generalized HSDD, where sex drive suddenly disappears without any explainable cause. "These are women in good relationships, generally happy in life but who describe their loss of desire as a mystery," he adds.
The drug is being considered for approval only in premenopausal women who have a low sex drive and isn't meant to treat other forms of sexual dysfunction, like an inability to achieve orgasm or painful intercourse. Clinical trial results presented at a recent medical conference have found that women taking flibanserin had an average of 1.7 satisfying sexual events each month beyond their baseline measurement of 2.7 events; those who took a placebo had just a 0.8 event increase. Flibanserin users also reported feeling more desire and lower levels of distress related to their sexual functioning compared to placebo takers.
Whether the FDA will deem the drug effective enough to be approved remains an open question. In 2004, its advisory committee voted against approval for a desire-boosting testosterone patch called Intrinsa that had produced clinical trial results very similar to flibanserin's. The panel said it was concerned about a lack of long-term safety data and that the drug would be overprescribed to women who didn't really need it. After all, primary care doctors may not take the time to tease out the real causes of a low sex drive and may simply prescribe it to any woman who asks. (Manufacturer Procter & Gamble is still testing the Intrinsa patch in postmenopausal women and already has it on the market in Europe.) The FDA might make the same call with flibanserin given that, as with any medication, it's not free of side effects. It causes fatigue, nausea, and dizziness in about 10 percent of users, according to Althof—which underscores the need for doctors to use caution when prescribing it if the drug, indeed, gets approved.