by Kristen McElveen, ND
A lot of people have been asking me about the new female libido pill and frankly, I have a lot to say about it.
First, there doesn't seem to be much research behind it. They tried to pass it through twice before and it was denied due to the fact that it didn't really work very well and the company pushing it through has a bit of a shady past when it comes to marketing ploys and getting the FDA to approve things.
Second, it was a small sample size (just over 400 women finished the study, who were taking the actual pill) and it was limited to heterosexual women with an average age of 36, so pre-menopausal.
Now, in my experience, most women seeking libido support are women who are post-menopausal. Not always of course, but if that's your target population, wouldn't you want to mostly study that?
Third, the side effects don't seem to be worth the slight improvement compared to placebo - somnolence (drowsiness), dizziness, nausea, fatigue and upper respiratory infection. What? Yup...upper respiratory infection. All of which could be severe if the woman drinks alcohol, so alcohol needs to be avoided if you take this pill.
Fourth, I still don't understand the mechanism of action because it's both a serotonin agonist AND a serotonin antagonist, which means that it helps to increase serotonin receptors AND block them, similar to some anti-anxiety, anti-depression and anti-psychotic medications.
So, this isn't like the male medications that help to bring fresh blood flow to the area and give you a physiological response, aka "lady wood." Instead, this works on your mood to help calm you down and be more relaxed and potentially more open to a sexual encounter.
How many ladies reading this just cringed and thought, "don't you tell ME to calm down..."
...cuz I just did.
Fifth, the conflict of interest list is a bit long for my taste...you always need to read where the bias is and where the money is coming from and there's a lot going on here.
I recognize the perceived sexism in the fact that there are several medications for men when it comes to sexual function and there aren't any yet for women (and don't get me started on the fact that the little blue pill is often covered when female hormones for use other than birth control are not); but we have to also recognize that there's a lot more going on in the female brain when it comes to arousal and sexual response than just getting more blood flow to the area (although, that doesn't hurt either...more on that below).
Here's a great article from New York Magazine on the skepticism of this new pill, plus a nice breakdown of spontaneous arousal versus responsive arousal, responsive arousal being what many women can relate to ("I'm ok once we get started, but it's getting in the mood and getting started that's the hard part").
So, what's a woman to do?
I'll tell you what I've seen get the best results, naturally:
1. Stress Management
Women in particular are usually running around filling several different roles in the household whether they have a job outside of the home or not. Stress management is essential, not only for sexual health, but also for mental health. The bottom line is, so many women are so busy taking care of everyone else that they often put themselves last and if you're one of those women, I want you to remember this (and tweet it here):
You can't effectively take care of anyone else unless you take care of yourself.
If you get sick or otherwise incapacitated, who's going to take over all your roles? This is why it is so important to schedule your self care. Actually put into your schedule a walk outside or a pedicure or a massage or just a block of time where you can do whatever the heck you want AT LEAST three times per week, but work up to daily. Do it now. Seriously. I can wait...
Exercise is an essential key to any stress management treatment plan. There have been endless studies comparing the effectiveness of exercise to anti-anxiety and anti-depression medications. Not only that, but it also gets your circulation pumping, gets you some much needed vitamin D and vitamin N (nature) if you're outside, helps you to clear your mind easier, helps you sleep better, gives you more energy, helps give you body confidence...need I go on? Oh, and also it can make you feel damn sexy when you look good AND feel good.
This has helped so many post-menopausal women in my clinical experience and it requires no pill, no gimmicks and is completely free to any woman with access to hot and cold water and a couple washcloths.
Simply fill two bowls, one with hot water (not scalding - test on the inside of your forearm first to be sure it's not too hot) and one with cold water (no ice) and put a washcloth in each. Then, alternate the cloths, holding the hot one to your clitoris and labia for 3 minutes, then immediately switch to the cold cloth for 30 seconds and repeat two more times. You can do 2 to 3 rounds of 3 each day and what this does is brings fresh blood flow to the area, which in turn can bring more circulation, sensation and most importantly, intention. Take this time to bring awareness to your genitals and remember that they are there for pleasure as well as function.
Quick tip: if you don't have time for the washcloths, you can do a 30 second spritz with cold water to your genital area at the end of your shower or bath. This is not as effective as doing 3 rounds of 3 with the washcloths, but it's better than nothing.
Meditation is essential, not only for stress management, but also to help you with your goals and intentions. We are ruled by a mind-body balance and if your mind is overwhelmed, it's not going to make time for things that may have a lower priority, like sex. As with anything, you have to practice to really be able to quiet the mind, but it will be SO worth it once you can (psst...this is one of those things that should be in your schedule DAILY, so add it now).
I was one of those women who thought I would never be able to meditate, but with so many resources available nowadays to help those of us who are meditation-challenged, there's really no excuse. Remember, it takes 21 days to make something a habit, so you literally can't say it didn't work unless you stick to it for at least 21 days.
My favorite resources are:
Deepak Chopra's 21-Day Meditation Challenge - these are free and offered every few months (and there's an app so you can put it on your phone or tablet).
Headspace is also a great app to help to teach you to meditate.
4. Counseling and/or EFT/tapping
Some partners aren't able to connect sexually because there are issues that they need help communicating about. There is no shame in getting couple's counseling to be better communicators. If you ask any couple who have been together for decades, they will all say the same thing - learn to communicate and recognize each others cues and triggers. Sometimes, it can be super helpful to have a little help with that from someone who is completely objective.
Another technique that I found extremely helpful in my practice for just about anything, including sexual stressors, is EFT or Emotional Freedom Technique, sometimes just referred to as "tapping." I did a YouTube video on it - EFT with Dr. McElveen - and you can watch my entire playlist on EFT here, but basically, you tap on specific acupressure points that help with specific emotions like guilt and fear and shame and when you tap on those and say an affirmation and acknowledge and accept your emotions, you are able to move on and not have those emotions hold you back as much. I've seen this work for deep emotional traumas as well as for physical symptoms like chronic pain and even allergies.
5. Bioidentical hormones and/or hormonal support
For some women, it may not be an issue of arousal, but in fact a biochemical imbalance of hormones. This is where naturopathic medicine really excels because there are so many safe and effective options from herbs to supplements and even bioidentical hormones, which tend to carry less risk than synthetic hormones. Keep in mind, naturopathic medicine treats the whole person, not just the symptoms, so treatment may not seem focused on your sex hormones. Adrenal dysfunction or fatigue can weigh heavily on the libido and energy in general and once that is balanced, often time the sex hormones can balance themselves.
I'm not going to go into specifics here because it's best that you discuss your options with your doctor. Even when you are taking natural hormonal support, like herbs and supplements, you still need to be monitored with blood and/or saliva hormone testing, even if you are just treating the adrenals. I've met so many people who have taken adrenal support on their own for years and therefore put themselves into adrenal fatigue. The adrenals think, "hey, if she's getting it from that pill, I don't have to do anything! I can sit back and relax!" And exhaustion ensues...
The take-home is this: don't ever take any supplement or medication that affects your hormones without doctor supervision. It's just too complex a system and if you get in over your head, it can take years of treatment to get out of it.
If you don't know of a licensed naturopathic physician (ND) near you, you can find one here or by googling "[your state] naturopathic physician association."
6. Intention and responsive arousal
I really love this article on arousal by Pamela Madsen, where she says:
"In large part, the biggest speed bump many women face, especially in midlife, is this myth: if you are not walking around turned on and wanting sex, then you have "low sexual libido" and you are in some way sexually broken. But what if their sexuality does not work that way? My experience working with hundreds of women at my "Back to the Body: Sensual Retreats for Women" is that for most women, it doesn't. What these women eventually learn is that this belief they and perhaps their partners, have been holding about their sexuality is hogwash. And even more, that their erotic potential can be quite enormous once they figure out their own key to turning themselves on."
So...how I interpret that is, it may not be a libido issue at all, but simply that you aren't getting aroused in the way your brain wants to be aroused.
If you are one of the many women who respond to responsive arousal rather than spontaneous arousal, you need to express to your partner that you need to feel wanted, and not just in the 15 minutes before sex. Some women respond to erotica or sexy talk, some women prefer more physical arousal like sensual massage, kissing or other foreplay.
Either way, many women, whether they are spontaneous or responsive arousers, eventually get turned on once they start going through the motions, so scheduling sex and not having an orgasm as a goal can really take the pressure off and make sure that you just have a fun, intimate experience with your partner.
The ultimate takeaway: the big tip that no drug company wants you to know is...
you aren't broken
There's a LOT of junk out there and marketing can be tricky and try to make you compare yourself to others as if you need to "fix" yourself. My opinion is to save your money and focus on what would be most effective and safest for you. You don't want to take anything that could potentially mess with your hormones without doctor supervision - trust me, I've fixed a lot of grocery-store-advice-gone-bad!