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Female Viagra?

Addressing low sexual desire in women is more complicated than just taking a pill.

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The FDA has approved 26 sex-related drugs and treatments for men. Finally, women get one for themselves. But does it work?

As a psychotherapist who specializes in sexual health, I work with couples and individuals to improve their emotional and physical intimacy, and I have been asked this question since the announcement of "the female Viagra," Flibanserin, or Addyi. However, this drug works very differently than Viagra, which treats dysfunction by increasing blood flow to the genitals. Addyi, in contrast, works on neurotransmitters in the frontal cortex in the brain by increasing desire and decreasing sexual inhibition.

So what is the drug's effectiveness? According to the FDA, only eight to 13 percent of subjects were helped by the drug, reporting an average of one more sexual experience a month, compared to a placebo. Some medical groups felt like the benefits of the medicine didn't outweigh its side effects: possible low blood pressure and loss of consciousness, especially if consumed in combination with alcohol. Others advocated strongly for the drug, seeing the lack of FDA-approved sexual drugs for women as an issue of inequality.

Sexual response is often misunderstood, and therefore women may be mistakenly considered as dysfunctional. Female response is complex and related to a variety of factors that may impact desire. Many times, women are motivated to be intimate from a mental or emotional space, wishing to connect with their partners. As they proceed, they can feel physically aroused in the process.

A woman can feel shame when she doesn't feel overcome with desire prior to sex, and many hormone clinics capitalize on this anxiety. Addyi is also prescribed to elicit desire prior to intimacy, a response more likely to be consistent with males than females, but one that can vary from one individual to another.

Many women will be willing to take this pill, despite its side effects. Hopefully they will also address the other factors that impact desire. Some women experience barriers to connecting sexually because of past infidelity or other difficult relationship dynamics. One out of four women prior to age 18 has had some past sexual trauma, and that also plays into how they see themselves as sexual beings.

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Many women aren't comfortable with their body image, and this affects their desire and ability to orgasm. A University of Texas study showed that 70 percent of women cover some part of their bodies during sexual activity, rather than tuning into the moment. Researcher Thomas Cash found that body image impacted how women experience sex. Body-conscious women reported experiencing orgasms 42 percent of the time, compared to body-confident women, who experienced orgasms 73 percent of the time. It's clear we each need to feel comfortable when connecting intimately.

Often couples are presented with a desire discrepancy, where one person's drive is higher than the other's. The lower-drive person is labeled "the problem," while the higher-drive partner is often labeled the "sex addict." But are they really an addict? Do they have a history of substance use, gambling, or any other addictive behaviors, or is it just that he or she has a stronger sex drive? This asymmetry can create resentment with the higher-drive partner feeling rejected and the lower-desire partner feeling used. If the couple is still waiting for that initial desire in the woman to kick in, she will likely see sex as a task. The result is that both partners feel angry and resentful. It's certainly understandable why couples would hope there is a medicine to fix all of this. Sex offers a powerful, nonverbal way of communicating.

The question remains: Do women need a medicine to achieve what is a normal sexual response? Have drug companies had trouble creating a successful drug because desire in women is a complex issue, or do companies spend less money on women, seeing them as a marginalized population?

Seeing ourselves as sexual is deeply rooted in religious and cultural traditions. Taking a pill isn't likely to override them. Women may take the pill, wait for it to work, and then feel more inadequate when they don't feel overcome with desire. Individuals and couples who strive to examine and understand sexuality — and work on overcoming their problems — will more likely enjoy quality intimate interactions.

Dr. Jennifer Valli is a psychotherapist and sex therapist specializing in emotional and physical intimacy. She has a private practice in Germantown.

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