What is the approach to managing hypoactive sexual desire disorder (HSDD)?

From the Guidelines

The most effective approach to managing hypoactive sexual desire disorder (HSDD) involves a comprehensive assessment of physical, psychological, and relationship factors, with treatment options including psychosocial and/or psychosexual counseling, lifestyle modifications, and medications such as flibanserin or bremelanotide, as recommended by the most recent guidelines 1.

Key Considerations

• A thorough evaluation by a healthcare provider is essential to identify underlying causes of HSDD, including hormone level testing and review of medications that may affect sexual desire 1.
• Psychosocial and/or psychosexual counseling can be beneficial in addressing elements of sexual response, such as desire, arousal, or orgasm, with no single type of counseling proven superior to another 1.
• Lifestyle modifications, including regular exercise, adequate sleep, stress management techniques, and limiting alcohol consumption, can naturally boost libido.

Treatment Options

• Flibanserin (Addyi, 100mg daily at bedtime) may be offered to premenopausal women with HSDD, with approximately 1 additional satisfying sexual event every 2 months 1.
• Bremelanotide (Vyleesi, 1.75mg subcutaneous injection as needed) is an option for premenopausal individuals with HSDD, with statistically significant increases in sexual desire and reductions in distress related to low sexual desire compared to placebo 1.
• Off-label use of bupropion and buspirone may be considered for survivors with HSDD, despite limited safety and efficacy data 1.

Important Notes

• The use of oral phosphodiesterase type 5 inhibitors (PDE5i) is not recommended for sexual dysfunction in cisgender females due to limited data on their effectiveness 1.
• Vaginal laser therapy is not currently recommended for the treatment of vaginal dryness and other genitourinary symptoms in postmenopausal individuals due to limited data on safety and effectiveness 1.

From the FDA Drug Label

ADDYI is a prescription medicine used to treat hypoactive (low) sexual desire disorder (HSDD) in women who have not gone through menopause, who have not had problems with low sexual desire in the past, and who have low sexual desire no matter the type of sexual activity, the situation, or the sexual partner. Women with HSDD have low sexual desire that is troubling to them Their low sexual desire is not due to: • a medical or mental health problem • problems in the relationship • medicine or other drug use

The approach to managing hypoactive sexual desire disorder (HSDD) is to use ADDYI (flibanserin), a prescription medicine, in premenopausal women with acquired, generalized HSDD, as characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance 2.

Key points to consider when managing HSDD with ADDYI include:

• Indications: HSDD in premenopausal women with acquired, generalized low sexual desire
• Contraindications: Postmenopausal women, men, and women with HSDD due to a medical or psychiatric condition, relationship problems, or medication effects
• Dosage: One tablet at bedtime, with no use of alcohol until the following day 2
• Precautions: Increased risk of severe low blood pressure, fainting, and sleepiness with certain medications or liver problems 2

From the Research

Approach to Managing Hypoactive Sexual Desire Disorder (HSDD)

The approach to managing HSDD involves a biopsychosocial approach, considering biological, psychological, social, and contextual components of women's sexual desire 3.

• Screening and Diagnosis: HSDD screening can be accomplished during an office visit with a few brief questions to determine whether further evaluation is warranted 3.
• Treatment Options: Treatment options for HSDD include:
  • Office-based counseling
  • Psychotherapy
  • Pharmacotherapy, such as flibanserin, a postsynaptic 5-hydroxytryptamine 1A agonist and 2A antagonist 4, 3, 5
  • Hormone therapy, such as transdermal testosterone 3
  • Non-hormonal medical therapies, such as bupropion 6, 3
  • Herbal therapies, such as Avlimil(R), Arginmax(R), Zestra(R), yohimbine, and Ginkgo biloba 6
• Lifestyle Changes: Lifestyle changes, such as treatment of coexisting medical or psychiatric disorders, switching or discontinuing medications that could impact on sexual desire, and marital therapy, may also be recommended 7.
• Medications: Flibanserin is the only FDA-approved treatment for HSDD, and bremelanotide, a novel melanocortin receptor agonist, was recently approved by the FDA for the treatment of acquired, generalized HSDD in premenopausal women 4, 5.

Pharmacologic Treatment Options

Pharmacologic treatment options for HSDD are limited, but include:

• Flibanserin, which has been shown to cause statistically significant increases in the number of satisfying sexual events and in sexual desire scores on standardized/validated measures while reducing FSD-related distress of premenopausal women diagnosed with HSDD 4
• Bremelanotide, which is indicated for acquired, generalized HSDD in premenopausal women 5
• Off-label use of other agents, such as transdermal testosterone and bupropion 3