Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

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Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

In response to a woman whose husband wants her to began taking the new  female “Viagra” pill, Addyi, Dr. Pat turns for expertise to Dr. Hilda Hutcherson, professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons. (Dr. Hutcherson and Dr. Pat have both written many articles for us as the “Sex Talk Team.”) Dr. Pat also turns to Dr. Cecilia Ford, clinical psychologist with a practice steeped in marriage and family counseling, and sex therapy.

Dear Dr. Pat

I am a 46 year-old woman who has been married for 20 years to a really great guy. I remember liking sex well enough in college with my second boyfriend then I met my husband, my third sexual partner and we were married when I was 26.  I never masturbated. I was finally able to be orgasmic when my husband bought me a vibrator but I only used it when we had sex together. He really liked sex and was thoughtful but truthfully I never found it to be such a big deal. However, I had sex twice a week most of our married life. We still have sex once or twice a week.  I never initiate. I never did. Then the news about the woman’s “pink viagra” came out and my husband is all over me to call a specialist and get this prescription. I don’t really want to take a pill every day and I am concerned about the possible side effects. And I like having a glass of wine every night with dinner. I don’t want to stop my wine and take a risk just to make my husband feel like I have made every effort to be waiting in lingerie when he comes in the door at the end of the day. Is there something really wrong with me? The only thing wrong with our marriage is his insistence that I see “someone.” Shouldn’t pleasant intercourse and sometimes a few surprises in the bedroom be enough?

Sad in Seattle

Dr. Hilda Hutcherson Responds:

Dear “Sad,”

Perhaps you’ve heard stories about how the “little blue pill” turned men into sex machines. Or you’ve watched your husband go from an anxious man who avoided sex for fear of failure to a highly sex-confident lover after ingesting Viagra. If so, the announcement of the “pink Viagra” might lead you to rush out to the nearest pharmacy and demand a year’s supply. But before you do, let’s talk a little about female sexual desire.

Female sexual desire is complicated, and full of ebbs and flows. Desire changes throughout the monthly cycle, and dramatically during major life stages. Desire may tank during pregnancy, the first year after giving birth, while breastfeeding, and during menopause. Desire can also take a dive when you are fatigued, stressed, coping with medical problems, taking some medications, or when your relationship with your spouse is suffering.

Unlike the typical male, most women do not think about sex or have sexual fantasies several times a day. In fact, many women never have spontaneous sexual thoughts and fantasies. And that’s normal. But when approached in the right way by the right partner, she may become interested in sex.  Some sex experts have determined that it is more common for women to experience arousal first in response to sexual stimulation, and the arousal then leads to sexual desire. Therefore, it may be normal for women not to have spontaneous sexual thoughts and fantasies. And the pressure for women to have a sexual response cycle that is similar to the male response, places great pressure on women and makes them feel inadequate and abnormal.

So since female sexual desire is complicated, normally ebbs and flows, and may not be spontaneous in most normal women, should women rush out to buy the new “pink Viagra,” Addyi, for “low libido?”

What Addyi Won’t Do:

It won’t compensate for a marriage to someone who is ungrateful and takes you for granted (or a bad marriage), a certain desire-killer. It won’t compensate for a man who can’t find your clitoris if it sat on the end of his nose and who doesn’t know his way around your body after 20 years of marriage. Nor will it compensate for lack of self-knowledge about how your body works and what brings you sexual pleasure. And it won’t compensate for guilt and shame stemming from negative sexual messages that you might have received during childhood that continue to make it difficult for you to relax and embrace pleasure.

What Addyi May Do:

It may lead to a modest increase in your desire. Some, but not all, women who took the drug every day had a slight increase in satisfying sexual events each month over that of women taking placebo. It will drain your wallet, as the drug will not be cheap. You will have to give up all alcohol. And it will place you at risk for side effects that may include decrease in blood pressure, dizziness and fainting.

Women who suffer from a complete loss of sexual desire and responsiveness deserve our concern and attempts to find appropriate treatment. The most significant effect of the FDA approval of Addyi for female sexual desire may be increasing sex education and opening an honest discussion about female sexual needs, desires and experiences, including what’s “normal” and how to make sex better. It may also peak the interest of other companies to investigate other ways to improve women’s sex lives.

 Next Page: Dr. Cecilia Ford Responds