Sex therapists' phones have been ringing off the hook since the publication of a New York Times magazine story last Sunday touting two new pills in the pipeline to boost a woman's low libido -- making it seem as if they were on the verge of hitting the market.
"My patients who read the story have been asking me about these drugs," said Lorri Brotto, a psychologist at the University of British Columbia who was quoted in the magazine story. "But the study data so far have found that the pills aren't effective for everyone with low desire -- only a subgroup of women." These women tend to have trouble experiencing sexual pleasure due to a lack of sensation, rather than simply a lack of desire.
The two new experimental drugs -- Lybrido and Lybridos -- contain small amounts of the libido-boosting hormone testosterone and have each been tested in about 200 women. Both need to be tested in longer studies containing 1,000 or more women to even be considered for approval by the US Food and Drug Administration. (Other companies abroad are testing nasal sprays.)
And, if previous experience is any guide, FDA approval is likely to be very tough. Three years ago, the agency's group of expert advisors resoundingly rejected the desire-booster flibanserin -- dubbed the "female Viagra"-- over its modest effectiveness and risk of side effects such as dizziness, nausea, anxiety, and insomnia.
Any libido-heightening drug, if approved, would be indicated only for women with a psychiatric condition -- newly named sexual interest/arousal disorder -- just like sildenafil (Viagra) is suppposed to be prescribed only for men with erectile dysfunction.
The low-desire condition was more broadly defined for women in the new psychiatric diagnosis manual called DSM-5 to reflect not just a lack of interest in sex or sexual fantasies but also difficulties with the mechanics of sex such as reduced pleasure during intercourse or a lack of arousal when touched in a sexual way.
"This change was based on a fair bit of research showing that sexual fantasies aren't necessarily a good indicator of a woman's level of desire," said Brotto, who helped develop the new definition. She and her colleagues declined to broaden the definition in men because of a lack of research on men and low sexual desire.
In addition to testosterone, Lybrido contains sildenafil, which works to dilate blood vessels and increase blood flow to a woman's genitals, which could help those who have nerve damage due to diabetes, multiple sclerosis, or previous cancer treatments. The other drug, Lybridos, contains an anti-anxiety agent that could boost arousal in those who lose their sex drive due to specific medications such as the most popularly prescribed antidepressants.
Brotto said for these subgroups of women, a desire-boosting drug may offer real solutions for problems that are likely physiological.
Far more women, however, may simply have lost interest in sex because of boredom with their partners, which Brotto doubts can be fixed with a pill.
(Men seem to be less bothered by boredom, likely because of their higher levels of testosterone, which can trigger arousal several times a day without much prompting.)
"Some experts see monogamy as the ultimate killer of desire," Brotto said, especially when parenting and household responsibilities take center stage over sexual pursuits. "Distance, intrigue, mystery, and romance all dramatically decline as two people become more familiar and secure."
Couples could try setting up separate e-mail accounts that they use only for flirtatious messages, Brotto suggested, or they could experiment with having sex in unusual places "to introduce mystery and novelty." Depending on a couple's proclivities, she might even recommend that they flirt with other people or consider having an open relationship.
"Those who are successful at this," she said, "already have a secure and honest relationship. I would not recommend it to anyone with marital discord."
Other sex therapists, however, disagree with this approach and with the notion that security dulls passion. "Both men and women crave intimacy and secure attachment," said Dan Pollets, a psychologist and sex counselor who has a private practice in Medford. He said he hasn't seen open relationships work in the couples who come to him for counseling.
"Men need to respect that women need novelty and experimentation" to fuel their desire over time, he said. "But there has to be a reservoir of safety and attachment in that relationship in order to overcome any sexual inhibitions."
Another important element that can heighten a woman's sex drive: being present in those moments of foreplay. "Their minds may be elsewhere during sex," Brotto said, "thinking that it's just something they want to get over with."
She teaches them to tune into their bodies by practicing mindfulness exercises. It could be as simple as giving them a raisin to eat slowly. "I guide them through noticing its texture, shape, and smell," she said, "how it feels resting on their lips or sitting in their mouth, and how it tastes."
Eventually, women learn to redirect that focus onto their own bodies' feelings and sensations.
Pollets often recommends yoga to increase libido via body awareness. "It puts you in the moment, regulating the thrust of your body, and noticing how it behaves." He says a growing body of research has convinced him that the practice enhances sexual response.
And women don't need to wait for FDA approval to try it.