\t\tRead: 5 min<\/p>\n
On Mother\u2019s Day, articles about women often centre on pregnancy, childbirth and caregiving.\u00a0<\/p>\n
Less often discussed is women\u2019s sexual wellbeing.<\/p>\n
Over a million Canadian women are estimated to have hypoactive sexual desire disorder (HSDD), a condition of low or non-existent sexual desire.\u00a0<\/p>\n
But the condition is under-diagnosed and under-treated, clinicians say.<\/p>\n
\u201cA lot of women will assume that low libido is an inevitable consequence of aging, perimenopause and motherhood,\u201d said Dr. Jennifer Wider, a New York-based women\u2019s doctor, author and radio host.<\/p>\n
In Canada, the only drug specifically approved to treat HSDD is Addyi. The drug is the subject of a new documentary, The Pink Pill: Sex, Drugs and Who Has Control.\u00a0<\/p>\n
In the film, numerous women claim Addyi reinvigorated their relationships.<\/p>\n
\u201cYour whole relationship \u2014 at least mine, with my husband \u2014 was stressed or strained,\u201d Barbara Gattuso, a woman who participated in clinical trials for Addyi, said in an interview on the film.\u00a0<\/p>\n
\u201cOn the medication, I chase him. It is unbelievable. I love my husband tremendously, but with this drug, I love him even more, and our sexual experiences were incredible.\u201d<\/p>\n
Desire disorder<\/p>\n
Hypoactive sexual desire disorder (HSDD) is defined as \u201ca persistent or recurrent absence of sexual fantasies and desire for sexual activity, causing marked personal distress or interpersonal [relationship] difficulties,\u201d a 2021 medical paper<\/a> says.<\/p>\n Addyi was first approved in Canada in 2018. The prescription medication is taken as a once-daily pill.<\/p>\n Addyi is sometimes compared to Viagra, the blockbuster Pfizer drug introduced in 1998 that treats erectile dysfunction by increasing blood flow to the penis.<\/p>\n But Viagra acts on blood vessels, while flibanserin \u2014 the active ingredient in Addyi \u2014 works in the brain.<\/p>\n \u201c[Flibanserin] specifically works on the dopamine, norepinephrine and serotonin systems,\u201d said Dr. Lori Brotto, a professor at the University of British Columbia and executive director of the Women\u2019s Health Research Institute.<\/p>\n Addyi must be taken every day for weeks before its effects become noticeable.<\/p>\n \u201cThis is why it shouldn\u2019t be referred to as a female Viagra,\u201d Brotto said. \u201cViagra acts peripherally \u2026 [and] gets metabolized through the system within four hours.\u201d<\/p>\n Wider says low sexual desire is harder to define than erectile dysfunction. \u201cErectile dysfunction is really a vascular and physiological issue, so it\u2019s very easy to measure,\u201d she said.<\/p>\n Desire, by contrast, is subjective and shaped by multiple factors, which may contribute to it being dismissed in clinical settings.<\/p>\n \u201cA lot of people say, \u2018Well, it\u2019s in your head\u2019,\u201d said Wider.<\/p>\n That perception, experts say, reflects broader attitudes toward women\u2019s sexual health.<\/p>\n \u201cWomen\u2019s [pleasure] is an afterthought or a nuisance or inappropriate,\u201d said Brotto, who also holds a Canada Research Chair in women\u2019s sexual health.\u00a0<\/p>\n According to a 2015 Canadian study<\/a>, about one-third of Canadian women report lower-than-desired levels of sexual desire.<\/p>\n But no national or provincial health survey directly measures HSDD. International research<\/a> suggests HSDD may affect about 10 to 15 per cent of all adult women.<\/p>\n \u201c[A] lot of women do have distressing[ly] low desire. Many have never been formally assessed or diagnosed,\u201d said Brotto.<\/p>\n Thank you for being a paid subscriber. Your support makes our original and Canadian-focused journalism possible. \ud83c\udde8\ud83c\udde6 <\/p>\n Subscribe to Editor’s Picks. Receive our free Saturday newsletter featuring our best stories from the week.<\/p>\n Low uptake<\/p>\n Despite the believed prevalence of HSDD, Addyi is rarely prescribed in Canada.<\/p>\n \u201cThe awareness [of Addyi] by both patients and doctors is pretty low \u2026 compared to the male side of the spectrum with medications like Viagra,\u201d said Wider.<\/p>\n As of 2024, there had been only 936 recorded pharmacy dispensation claims for Addyi across B.C., Manitoba and Saskatchewan, according to data from the National Prescription Drug Utilization Information System. These provinces are the only jurisdictions where complete pharmacy dispensation data reflect both public and private claims for Addyi.<\/p>\n Addyi is not covered by public drug programs in other provinces, so it does not appear in publicly funded claims data, a Canadian Institute for Health Information spokesperson said.<\/p>\n Coverage under private insurance varies and is typically limited. And Addyi can be prohibitively expensive if paid for out of pocket. In Ontario, for example, a 90-day supply costs $880.<\/p>\n The Pink Pill documentary traces the difficult journey to get Addyi approved in the U.S. \u2014 and argues the drug was subject to a much higher level of scrutiny than drugs that treat male sexual dysfunction.\u00a0<\/p>\n For example, when Viagra was approved by the U.S. Food and Drug Administration in 1998, it received priority review and reached the market in about six months. Addyi, by contrast, was rejected by the FDA on multiple occasions and took nearly two decades to be approved.<\/p>\n Brotto notes that the medical community had doubts about the drug\u2019s efficacy.<\/p>\n \u201cThe data were not that impressive,\u201d she said.\u00a0<\/p>\n \u201cWhen you look at the actual randomized clinical trials, there was a significant increase in sexually satisfying events of one per month compared to the placebo group \u2026 in the absolute sense, it\u2019s really not that big of a difference compared to placebo.\u201d<\/p>\n In the film, however, Addyi proponents note that even one additional sexual event a month can represent a meaningful shift.<\/p>\n \u201cThe studies show that there\u2019s an increase in, on average, one sexually satisfying encounter a month, and a lot of folks will hear that and say, \u2018One encounter a month. That\u2019s very little. What? How is that even worth it?\u2019\u201d Dr. Francisco Garcia, a urology consultant and sexual medicine specialist at Cypress Regional Hospital, said in the film.<\/p>\n \u201cMy response to that, typically, is, when we\u2019re treating somebody who has HSDD, they\u2019ll be lucky if they have sex once or twice a year. Typically once a month is a monstrous change for some of these couples.\u201d<\/p>\n Treating low desire<\/p>\n Although Addyi is one of the only treatments for low female sexual desire in Canada, it is not a miracle cure, says Brotto.<\/p>\n \u201cIt doesn\u2019t change how much you like your partner,\u201d she said. \u201cIt doesn\u2019t change your mood. It doesn\u2019t change your confidence in your body. It doesn\u2019t improve your ability to talk about sex or overcome trauma histories.\u201d<\/p>\n Brotto says psychological factors should be addressed separately. \u201cThere\u2019s also a ton of data supporting psychological treatments like mindfulness and [Cognitive Behavioural Therapy],\u201d she said.<\/p>\n She is also optimistic about an alternative treatment: testosterone therapy.<\/p>\n \u201cThe physicians that I work with, none of them prescribe flibanserin, but they regularly prescribe off-label testosterone,\u201d she said. \u201cThere\u2019s really good data to support testosterone, especially for postmenopausal low desire.\u201d<\/p>\n In Canada, testosterone is only prescribed for HSDD off-label. It is, however, approved for use in treating HSDD in Australia<\/a> and the EU<\/a>.\u00a0<\/p>\n Wider says topical testosterone can be more effective than Addyi for treating HSDD, but it can have unwanted side effects such as acne, hair growth and voice changes.<\/p>\n \u201cWomen deserve to know all the range of different treatments, including about flibanserin, including about testosterone and including about the role of even sex education,\u201d said Brotto.<\/p>\n Experts say women\u2019s sexual health has historically been under-researched and underfunded.\u00a0<\/p>\n \u201cWe\u2019re playing catch-up in women\u2019s health research,\u201d said Brotto.\u00a0<\/p>\n \u201cWomen were [historically] not routinely included in clinical trials \u2026 data in most medical studies were not disaggregated by sex, so we\u2019ve got lots of approved medications where the original trials either only recruited men or they didn\u2019t look at the data separately for men and women.\u201d<\/p>\n