"Female Viagra": How the new drug works to treat sexual dysfunction in women

More and more issues related to women's sexuality and libido have been gaining ground in the social and scientific spheres. Proof of this is the new drug approved in the United States known as "Viagra Feminino". The substance, in fact, is called flibanserin and will be marketed as Addyi.

Even before being available on the market, the product has been causing shock in Brazil and the world, being the first active to treat female sexual dysfunction and also (male Viagra) for women.

However, it is important to remember that the sexuality of men and women does not work in the same way, so it is a mistake to establish some similarity between the two drugs , especially in relation to the arousal of the woman. "Female desire is multifactorial, that is, it is not a single element that will cause a lack of libido," says Carmita Abdo, a psychiatrist who coordinates the Sexuality Studies Program (ProSex) at the University of São Paulo (USP). This means that the absence of sexual desire in the woman can be linked to the couple's poor harmony, depression, problems at work, other diseases, use of certain medications, as well as several other factors or a combination of them. Differences between medicines?

Flibanserin (female) and sildenafil (male) drugs work in different places in the body, and in different ways. However, they were the first drugs to aid in the treatment of sexually transmitted diseases, both female and male, approved for use. "Sildenafil (viagra) is a substance that acts by causing a dilation of the vessels located at the extremities of the body, especially the penis," says Carmita. In addition, the specialist explains that the remedy will only be effective if the man who uses it has the desire preserved, that is, if he gets excited but can not maintain the erection.

Female

With flibanserin, which is an antidepressant, the action is central and not peripheral. With the use of just one tablet, it is possible to feel the positive action of the drug. This means that it "will act in the brain and cause a series of changes that are not local, influencing the behavior as a whole, including sexual behavior," warns Carmita. Another difference is that "the action of the drug will occur in the desire, and do not need it to manifest itself, it acts on the desire and not on the presence of the desire."

What is the periodicity of the medication?

With regard to dosing, a woman needs to take one tablet daily for about three weeks to begin to notice an increase in sexual interest. "The remedy begins to act in three weeks, and will usually reach the peak of action by the fourth or fifth week. If no effect is noticed by the eighth week, the chance is that this woman has no response to this medication" , says Carmita.

How does it work in the body?

The way the drug works in the body and if it really would be effective are points that are still being discussed and studied. "I do not believe in its isolated efficiency, so little that it is a magic pill. My clinical experience states, even in male cases, what desire is treated with sexual therapy, that is, with the help of a psychoanalyst or psychologist with a specialization in sexuality "says the sexologist and psychoanalyst Lelah Monteiro, a member of the Brazilian Association of Physiotherapy in Women's Health and the International Society of Sexual Medicine.

According to Carmita Abdo, who is also a psychiatrist who specializes in sexuality, the medication has the ability to release dopamine, modifying the levels of circulation of this neurotransmitter through the body. The substance is responsible for making the woman look for more rewarding rewards, enabling her to be more willing to have sex. In addition, flibanserin also helps to control the hormones that inhibit the manifestation of sexuality, such as serotonin.

When is the remedy indicated?

Before talking when and for whom flibanserin ("female viagra") is indicated, it is necessary to understand that "the female libido is complex, because it is related to several factors like the hormones, feeding, physical exercises, besides the presence of some substances that act in the central nervous system. "said Heloisa Ferreira Brudniewski, a specialist in gynecology and obstetrics for the Brazilian Federation of Gynecology and Obstetrics Associations." It's a very simple procedure and requires not only medication but a change in the habit of living and also a psychotherapeutic treatment of the woman or the couple, (FEBRASGO). Therefore, "medication is not recommended to increase a woman's sexual performance," says sexologist Lelah Monteiro.

Likewise, the idea is not to completely change a woman's sexual profile, but rather to increase her libido. Therefore, flibanserin is indicated for women with pre-menopausal hypoactive sexual desire where the cause is not:

Depression

Hormonal deficiencies

Physical diseases such as cardiovascular

• Psychiatric disorders, such as anxiety
• Conflicts of relationship
• Use of medicines that lead to lack of libido
• To do so, "the doctor will first make an extensive anamnesis and then may need some tests to check for any physical cause. In these cases, the lack of desire is secondary and can be resolved when the previous problem is treated or after the drug is exchanged, "says Carmita." Of course, the search for new medications that help is always important and it brings new resources for treatment, but often it is necessary to take other measures as well.When the woman feels the problem, she should always discuss it with the gynecologist, to seek the best treatment, "says Heloisa. The major concerns about flibanserin, the female "viagra", are the side effects, since in the clinical trials 13% of the women decided to stop taking the medication for this reason. Among them are dizziness, dry mouth, hypotonia and fainting. A woman may be more difficult to maintain consciousness, weakness, fatigue, and this is potentiated under the effect of alcohol.
• In the United States flibanserin will only be sold with a prescription and will also be checked if the doctor who applied for the drug has the ability to evaluate this issue, since it should take responsibility for each patient and monitor the side effects very closely. " Without a doubt the number of people who had the side effects is quite significant. , each case is a case, and depending on the degree of desire change, women will not experience any symptoms. side effects are as intense as they are at the beginning or decreasing, or whether the cost it is having or not supplies the benefit and also whether the prescription is adequate, "comp
• What is the role of depression in the lack of female libido?

Depression is an important factor in compromising a woman's sexual desire, but why? What happens is that depression possibly compromises the performance of brain gratification systems. They are nerve cell pathways responsible for motivated behaviors such as drinking, eating, and seeking sex. ? The systems are influenced by several neurotransmitters, but it seems that the final route always involves the dopamine hormone, the main of the gratification areas. Thus, impairment of the functioning of these sites would be related to decreased motivation, including that of sexual behavior, "explains Ivan Mario Braun, a psychiatrist and behavioral therapist at the Institute of Psychiatry at the University of São Paulo Medical School's Hospital das Clínicas (USP) ).

In addition, some of the medications also play a role in decreasing libido. According to Braun, this is especially true when using antidepressants that increase the amount of serotonin present between nerve cells. Examples of antidepressants that have this action are fluoxetine, sertraline, paroxetine, citalopram, escitalopram, venlafaxine, desvenlafaxine, duloxetine, imipramine, amitriptyline and clomipramine. This effect is non-existent or very minor with antidepressants that do not have this action on serotonin. such as trazodone, bupropion, mirtazapine and agomelatine.

What do we have in Brazil?

Although we do not yet have any approved female sexual dysfunction medicine in Brazil, ANVISA has not yet been consulted about flibanserin, women who feel uncomfortable with the way their sexuality is can and should seek medical help. "Currently, the use of some natural substances or hormones to try to stimulate sexual desire in women is used, but it is worth remembering that the use of drugs alone may not be sufficient to solve the problem, and it is necessary to approach the subject in a multidisciplinary way, with changes in lifestyle and psychotherapeutic treatment accompanied by professionals specialized in the subject, "says gynecologist Heloisa Brudniewski.

About medication approval in the United States, ProSex coordinator Carmita Abdo says:" The positive side is not is intrinsic to the substance itself, but it brings two good possibilities at its coming in. The first is to inaugurate a stage of further research in the area of ​​feminine sexuality and other new formulations for this purpose, and the second is that the subject be more debated and known to women, physicians and the population as a whole - even for the diagnosis and prescription of drugs. Suddenly we can say that we are seeing the sexuality of women from another perspective. "

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