Ignorance Is Not Bliss: If We Don’t Understand Hypoactive Sexual Desire Disorder, How Can Flibanserin Treat It? Commentary

Abstract

Background Female sexual dysfunction (FSD) affects as many as 1 in every 3 women, with a significant portion of these with hypoactive sexual desire disorder (HSDD). These figures alone present significant psychological and pharmacologic challenges. Partly in response to this situation, in 2015 the US Food and Drug Administration approved flibanserin for the treatment of HSDD. This approval has drawn criticism on the grounds of efficacy and necessity. Aim To better inform potential consumers about FSD, flibanserin and other interventions for the treatment of HSDD, the importance of understanding the mechanism of FSD, and the efficacy of flibanserin and to review existing relevant knowledge. Methods A literature review of extant clinic studies and theoretical discussion articles was performed. Outcomes Efficacy of flibanserin for addressing symptoms associated with HSDD in premenopausal women. Results Extant literature and empirical evidence suggest that the efficacy of flibanserin for the treatment of HSDD in premenopausal women is at least questionable. Clinical Translation Clinicians considering the prescription of flibanserin would be well advised to appreciate some of the controversies concerning the efficacy of the drug. Strengths and Limitations The prohibitive usage guidelines, tenuous risk-benefit profile, and considerable cost of use of flibanserin are each worthy of consideration. Flibanserin thus far has been trialed in only a narrow patient range: premenopausal women in long-term relationships with acquired or generalized HSDD. Conclusions Although we acknowledge that the discovery and use of flibanserin constitute a compelling narrative, we conclude by questioning the specific efficacy and necessity of flibanserin in providing a treatment for HSDD in women.

Systematic Review of l-Arginine for the Treatment of Hypoactive Sexual Desire Disorder and Related Conditions in Women

“…In comparing L-arginine containing products to flibanserin, the only oral FDA-approved medication for the management of HSDD, adverse effects, population of study, and cost may be a consideration. Flibanserin carries a risk of hypotension, somnolence, syncope, fatigue, and carcinogenicity, and a REMS program has been enacted to ensure the safe use of flibanserin [41,42]. By contrast, limited adverse effects have been reported with L-arginine.…”

Modeling Female Sexual Desire: An Overview and Commentary

“…Thus far, flibanserin has been clinically tested in premenopausal women in stable cis-gendered heterosexual relationships who reported either generalized or acquired HSDD [37]. In the clinical trials of flibanserin, women self-reported moderate improvements to the baseline assessment of HSDD [38,39].…”

Hypoactive sexual desire disorders in women: ways to solve the problem

“…Считается, что флибансерин способен модулировать эти нейромеди аторы в определенных зонах мозга и тем самым восста навливать необходимый баланс. К сожалению, большин ство комментариев по поводу эффективности флибансерина при СПВ у женщин в научных журналах не являются научными дискуссиями, экспертными клиническими мне ниями и не содержат анализа и интерпретации клиниче ских данных, а в большей степени содержат элементы сенсационности [40]. К недостаткам его стоит отнести высокую частоту побочных эффектов.…”