There have been few moments in the history of pharmaceuticals as night-and-day as the launch of sildenafil tablets.
Before the advent of Viagra, the only proven treatments for erectile dysfunction were awkward, complex and filled with potential dangers, but the release of the little blue pill launched a conversation that turned erectile dysfunction into a very treatable and manageable condition.
However, for as long as there has been a conversation about PDE5 inhibitors and ED medication, there has been a debate about the possibility of a ‘Viagra for women’, a drug that can restore confidence and reinvigorate someone’s sex life in the same way ED medication does for many men.
Whilst there are two competing drugs available, the history of both is somewhat complex and controversial, in no small part because ‘the little pink pill’ is treating a very different and more complex sexual disorder.
Hypoactive Sexual Desire Disorder
One of the biggest misconceptions about erectile dysfunction is that it is intrinsically connected to sexual desire, which is a myth that has existed for centuries. In practice, ED is somewhat more complex than this, as it is as much a symptom as it is a condition in itself.
As a result, PDE5 inhibitors work by addressing the physiological aspect of ED, such as by opening the blood vessels and allowing blood to flow and stay in the penis, and do not work without sexual desire.
This is why certain ED medications such as tadalafil can be taken with special daily dosages and why there are separate treatments for men with low sexual desire.
The closest female equivalent to ED is hypoactive sexual desire disorder, which is the most common form of sexual dysfunction in women pre-menopause and is caused by a mix of psychological and physiological factors that are still currently being researched.
Regardless, in 2015 flibanserin, sold under the brand name Addyi, was approved by the FDA in the United States (although notably not by the MHRA in the UK) as a potential treatment, albeit under somewhat controversial circumstances.
Flibanserin, much like sildenafil, is a repositioned drug that was formerly developed as an anti-depressant but during testing was found to have more potential as a drug that increased libido.
Controversially, the research into its effectiveness found it was only slightly better than placebo, and there has been some criticism of its marketing and positioning as a simple solution to a condition that is complex and not completely understood, although others have credited it with helping their relationship.
As well as this, safety risks, both when the drug was first approved and concerns about hypersensitivity in 2021 have made it somewhat controversial, and since its release, another competing drug called Vyleesi has also been approved for sale in the US.
Unlike Addyi, which has had its reputation tainted by safety concerns leading to a Black Box warning as well as issues between its original manufacturers Sprout and Valeant (now Bausch Health), Vyleesi benefits from fewer safety red flags (although there are still warnings) and can be taken as needed.