An article last month in Time magazine is headlined “This CEO is Pushing a Pill for Female Sex Drive. But Does the Science Hold Up?” The story is about Cindy Eckert and her long-time advocacy for a prescription drug named Addyi, which I’ve been watching for years as it made its way through FDA approval and into the market.
What was disappointing to me about the article is that it doesn’t follow through in answering the question its headline posed. Yes, it shares opinions about hypoactive sexual desire disorder (HSDD). But it doesn’t include information like I saw presented at this fall’s annual meeting of the North American Menopause Society (NAMS). And it pokes holes in the notion that desire is only in the brain, which I don’t hear claimed in venues like NAMS. In fact, I hear the opposite: that women’s desire is complex, including but not limited to activity in the brain. Let me break it down.
The first question is whether there’s brain activity associated with desire, and whether there’s a difference between a “typical” woman (who among us will claim that title?) and a woman who is distressed by a lack of desire. Dr. Irwin Goldstein is the director of San Diego Sexual Medicine, Director of Sexual Medicine at Alvarado Hospital, and Clinical Professor of Surgery at University of California at San Diego. He presented data at the NAMS meeting in the form of magnetic resonance imaging (MRI) of women diagnosed with HSDD compared with other women. There’s a clear and observable difference, and his explanations of the underlying details went beyond what I can make clear in a brief blog post.
Irwin also talked about the “plasticity” of the brain, which is its ability to change and adapt. The research that he presented showed, essentially, that with treatment over time, the brain of a woman with HSDD can change so that it is no longer a contributor to a lack of desire.
But his presentation did not assert that the brain is the only ingredient for sexual desire for women, which is what I understand to be the second question. He introduced psychosocial themes that were then expanded upon by Sheryl Kingsberg, a clinical psychologist and associate professor in the Departments of Reproductive Biology and Psychiatry at Case Western Reserve; she’s also the staff psychologist of the Department of Obstetrics and Gynecology at University Hospitals of Cleveland.
What both Irwin and Sheryl presented was desire resulting from a balance of excitation and inhibition, which are affected by brain chemistry, on the biological level, and also by psychosocial cues. Given her background and specialties, Sheryl emphasized the psychological and interpersonal contributions to an increase in inhibition (and a loss of desire), which can include depression, shame, lack of trust, childhood trauma, “ghosts of past relationships,” fear, and more.
Add changing hormones to the mix (the subject of yet other presenters at NAMS), and you begin to understand how complex is the sexual response of women, as we began describing with Rosemary Basson’s model when MiddlesexMD first launched.
So back to Time magazine: Yes, the science backs up the role of the brain in sex, and the role of Addyi for women who genuinely have HSDD. I’ve seen the data and the studies, and I’ve met the women in my own practice. Yes, for some women a glass of wine, a hot bath, a romantic movie, or a piece of dark chocolate is all it takes to get in the mood. If you’re among them, be grateful. No, Addyi isn’t the answer for every woman with sexual health issues--even for every woman with HSDD. But for those for whom it works, it’s life-changing. Who would deny them that experience?
And, by the way? Cindy Eckert looks great in pink. (And I’ll be keeping an eye out for similar commentary on male entrepreneur wardrobe choices.)
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.