Drug Improves Women's Sexual Desire

From the WebMD Archives

June 9, 2000 -- From her home in the San Antonio suburbs, 53-year-old Margaret Christilles reports that she and her husband are having sex three or four times a week. It's a big improvement, she tells WebMD. The last few years have been rough.

"It wasn't like overnight I noticed my sex drive wasn't great," she says. "It's one of those things that sort of comes on gradually, that I could take it or leave it." Her gynecologist suggested that diet and exercise might help. "I was a little disappointed," she says. "I wanted a little more help than that."

A blurb in the San Antonio newspaper caught her attention; it advertised a clinical study for women with decreased libido. she started taking bupropion hydrochloride -- better known by the trade names Wellbutrin or Zyban. After taking the drug, which is now prescribed for both smoking cessation and depression, Christilles gradually saw a change.

"Over maybe five or six weeks, I noticed it," she tells WebMD. "I felt a lot more excited about sex. I didn't sneak into bed anymore after my husband was asleep."

Researchers have pinned a name on this very common, and perhaps, very treatable, disorder: hypoactive sexual desire disorder (HSDD). According to psychiatrist and sex therapist Harry Croft, MD, who is in private-practice in San Antonio, it affects one in every five American women. "It's not clear what the cause is," Croft tells WebMD. Low testosterone levels are sometimes, but not always, at fault, he adds.

Loss of desire happens even in the best of marriages, and often occurs after the first child is born, Croft says. "She's just not interested anymore -- even though he is. He doesn't know what's wrong with her. And she starts thinking, 'It's his fault. He's a big clod. He doesn't know women. He never compliments me anymore. He doesn't kiss me anymore.'' She becomes resentful. So does he. And a once-great relationship begins to sour.

At this year's American Psychiatric Association meeting, Croft shared the results of a small, preliminary trial of Wellbutrin, which showed very promising results.

Continued

The study involved 66 women ages 23 to 65 (the average age was 41, and most of the women were pre-menopausal). Women with low testosterone levels were excluded from the study. Also, none of the women was depressed. But all were experiencing difficulty becoming aroused or having orgasms.

For the first four weeks of the 12-week study, all were given inactive placebo pills. Fifteen then dropped out, and the remaining 51 women were given Wellbutrin for eight weeks. A response was seen as early as two weeks after the drug treatment began, Croft says. By the study's end, 29% of the women showed a response, reporting a more than twofold increase in interest in sex. Frequency of sexual arousal nearly doubled. And the women who were responding had more than twice the number of sexual fantasies.

Overall, 39% of the women reported being satisfied with their levels of sexual desire by study's end.

Another finding was increase in "what we called, for lack of a better term, receptivity," Croft tells WebMD. "A number of the women ... while their [sex] drive level did not increase, said, 'But you know what, I didn't say no. And you know what else, when I did have sex, I enjoyed it more.'" While these results were not directly measured, Croft and colleagues have proposed a study looking specifically at this issue. "That may be as important as increased sexual drive," Croft says.

The theory is that Wellbutrin works indirectly on the brain's receptors for dopamine, the pleasure-reward chemical, he explains. He says that one of the big problems with many other new-generation antidepressants, especially the selective serotonin receptor inhibitors (SSRIs) such as Prozac, "is that, wonderful as they are, they may cause sexual dysfunction in the long run. In men, it's delay in reaching ejaculation or climax. It's been estimated that some of these drugs can delay orgasm or climax up to nine times."

"For a woman who may have problems reaching climax anyhow, a long delay may lead to nowhere."

In several studies, Wellbutrin has been shown to cause no sexual problems, Croft says. "In fact, one placebo-controlled trial last year showed that it causes no more sexual dysfunction than placebo, but that ... SSRIs caused sexual dysfunction in 40% or more patients. ... We noticed that [Wellbutrin] seemed to not only notcause sexual disorders, but it seemed to increase sexual drive levels; it had an almost aphrodisiac effect in some patients."

Continued

Female sexual dysfunction is a widespread, serious, and little-understood problem, Mark Ackerman, PhD, a psychologist specializing in sexual health at the Veterans Administration Hospital and Emory School of Medicine in Atlanta, tells WebMD. "When you talk to women who have the problem, they'll tell you it's a huge problem. It can lead, frankly, to the destruction of a good relationship."

"I think it would be hard to make a blanket statement to say that one drug in and of itself is the answer to hypoactive sexual desire in women," says Ackerman, who also counsels men and women as a private-practice sex therapist. Still, "whether it really boosts sexual drive or not ... certainly merits further attention," he tells WebMD.

Reduced sexual desire in women can have many causes, Ackerman says. "One, of course, is the nature of the relationship and another is their overall mental health. Another factor is whether there is any history of sexual trauma, sexual abuse. Psychosocial trauma certainly needs to be ruled out before you can prescribe any medication."

Suki Hanfling, MSW, LICSW, AASECT, founder and director of the McLean Hospital Human Sexuality Program in Boston, tells WebMD: "The most common thing we deal with is low desire in men and in women. The most common cause, aside from menopausal issues, is depression. Or there may be some people who are depressed and don't know it. The other is marital/relationship conflict. There are so many causes for it, but [Wellbutrin] is an exciting possibility."

She points to the "placebo effect" that comes with studies like this: just being part of such a study sometimes increases sexual desire. "But they didn't have a group that got just the placebo the whole time, so we don't know."

"I am skeptical that 40% were satisfied with their sexual desire," she tells WebMD. "If that's really true, that's incredible ... but I do believe that for a certain percentage, it may make a big difference. ... They need to have more studies with different ages of women separated, to see what happens.

Despite the drug study's promising findings, Hanfling says, psychotherapy for sexual dysfunction should not be overlooked. "I think that couples sex therapy can be quite effective for low desire in certain instances where the cause doesn't seem to be physiological," she says.

Continued

Some of the researchers involved in the Wellbutrin study were from the drug manufacturers Parke-Davis and Glaxo Wellcome.

WebMD Health News
© 2000 WebMD, Inc. All rights reserved.

Pagination