A little pink pill for women; A little blue pill for men

By Susan Burke March, MSEd, RDN, LDN, CDE

There’s a little blue pill for boys, and a pink one for girls. Both are marketed to adults suffering from sexual dysfunction, but they work in completely different ways.

Men can choose from a variety of drugs to treat erectile-dysfunction (ED).  The first, that “little blue pill” Viagra (sildenafil), was approved by the U.S. Food and Drug Administration in 1998. Levitra and Cialis followed — these three are all “PDE inhibitors” and work by relaxing tight blood vessels, allowing more blood to surge into the penis and cause an erection. They all have potential side effects including headaches, flushing, dizziness and indigestion, but despite this, they’re some of the best-selling drugs on the market. You can’t watch American television without seeing advertisements featuring gorgeous, vital couples getting all snuggly — and being sternly warned that if that erection lasts longer than four hours, call the paramedics!

These are prescription drugs in North America but are sold over the counter in Ecuador. The generic version of Viagra, sold under several labels, costs between 5% and 10% of the name brand in Cuenca (For more, click here).

The most common cause of ED in men older than age 50 is type 2 diabetes. In my previous column about sexual dysfunction in men, I wrote that diabetes doubles or triples the chance of suffering ED, because uncontrolled or poorly controlled blood sugar leads to nerve damage and damage to both large and small blood vessels, namely the capillaries that bring blood to the heart, eyes, kidneys, and to the penis.

But people with Type 2 diabetes often have complications and take medications that address high blood pressure and heart disease. NBC News reports that “pharmaceutical nitrates”, used to treat or prevent chest pain (angina), dangerously interact with these types of ED drugs. “For men with diabetes, heart disease, high blood pressure or high cholesterol who already take pharmaceutical nitrates to combat those conditions, unknowingly taking sildenafil to increase their sexual potency may cause ‘dangerous’ blood pressure drop”. They also report that taking any pharmaceutical form of Viagra could actually kill — by a sudden heart attack. And they report that the active ingredient in Viagra, sildenafil, is also found in a variety of tainted over-the-counter “male sexual enhancement” supplements. As we know all too well, in the USA, dietary supplements are not regulated or tested for safety or efficacy. Men see ads for “natural Viagra” and gamble with their health. What’s supposedly in the supplement may not be in the supplement — and more importantly, there may be ingredients that are not listed.

As I’ve written in a previous column, the consumer takes all the risk when they purchase supplements. Only if there are adverse events reported will the manufacturer be taken to task. But that is often too late to help the consumer.

All things are not equal…in treatment for sexual dysfunction

Someone said that for women, the largest sexual organ is between the ears. Unlike men, whose performance is more easily measured, the new “pink pill” addresses the assessment that women’s inability to reach orgasm results mainly from psychological problems — either depression, or emotional issues, or both. Although pharmaceutical companies have been feverishly working to find a Holy Grail to rival men’s drugs financial success (addressing the physical aspects of sex), until just recently the drugs tested for women lacked studies that showed that any were better than a placebo. If you thought the drug would work, it would work.

Going back to 2004, The Economist reported on one women’s topical drug, Alista (alprostadil), reported to increase blood flow and vaginal lubrication and so improve sexual function. However, although approved by the U.S. Food and Drug Administration (FDA) in 2004, alprostadil failed to demonstrate any meaningful benefit greater than the placebo. At this time they were also testing the administration of testosterone on women, with the thinking that since testosterone is the primary hormone responsible for libido in men, supplementing in women would be effective too. With age, women’s testosterone levels drop, but side effects of synthetic testosterone could include masculinization — hair growth in unnatural places, deeper voice, and acne are just a few unwanted side effects. According to DrugWatch.com, anyone considering testosterone therapy should know that adverse effects are possible, both in men and women undergoing treatment and family members for whom accidental exposure may be a risk with today’s topical testosterone products. For example, two testosterone replacement gels, AndroGel and Testim, carry a black-box warning — the FDA’s strongest warning — for secondary exposure in children. Because the gel is applied to the skin, children may come in contact with leftover gel by contact with adults or on unwashed clothes or towels.

The “Little Pink Pill”

Which brings us to the “little pink pill” for women. According to HealthDay.com, recently approved flibanserin (Addyi) is the first FDA-approved drug designed to help women with low libido.

Quoted in this article, Dr. Holly Thacker, a women’s health specialist at the Cleveland Clinic, said the FDA’s approval of Addyi, “Provides an additional, helpful option for women across the country who experience sexual dysfunction.” She also said, “It doesn’t treat all sexual dysfunction, it won’t help all women with sexual problems, but it will have a role in the therapy, and just like with any medication — adult women in conjunction with their physician can make an informed decision about whether this is an appropriate therapy for them.”

Addyi is not a women’s version of Viagra. Instead, it acts selectively on brain receptors to restore to women what they consider their previously normal level of sexual desire. Instead of describing it as a “sex pill”, the experts advise consumers to consider this drug restorative. As reported in , “A good analogy is that people don’t take antidepressants to experience a euphoric, elevated mood. They just want to return to a normal mood response. In fact, an antidepressant won’t elevate mood in a person without depression.”

Currently, Addyi is approved only for pre-menopausal women who do not drink alcohol…at all. In fact, the FDA has issued a pretty clear warning. “Addyi can cause severely low blood pressure (hypotension) and loss of consciousness (syncope). These risks are increased and more severe when patients drink alcohol or take Addyi with certain medicines that interfere with the breakdown of Addyi in the body. The use of alcohol is contraindicated while taking Addyi. Health care professionals must assess the likelihood of the patient reliably abstaining from alcohol before prescribing Addyi.”

Is it in your head? Or is it type 2 diabetes?

Which brings me back to sexual dysfunction and diabetes. When it comes to sexual dysfunction and diabetes, both men and women suffer equally. Remember, more than 50% of the time, men with erectile dysfunction are suffering from nerve damage and impeded blood flow due to poorly controlled blood sugar — from type 2 diabetes. In a similar way, women with diabetes can have sexual problems related to their control — or lack of control — over their blood sugar.

Many women aren’t willing to talk about their lack of response — they may have a desire, but they don’t have the response necessary to achieve orgasm. In the same way that diabetes affects men by damaging their nerves and capillaries that help them achieve erection, women whose blood sugars are chronically high may suffer lack of response — complications may also be due to lack of sensation in that important area — just like men.

WebMD.com quotes board-certified endocrinologist Spyros G. Mezitis, who says, “When blood glucose is uncontrolled, it impacts the tiny blood vessels that feed our nerves and allow a woman to experience the full spectrum of intimate sensation. When microcirculation is impaired in men, erectile dysfunction happens — so the impact is obvious to both partners. In women, the effect isn’t as apparent. It’s all about arousal and sensation in the genital area, which frequently no one but the woman herself must acknowledge.”

Besides nerve damage, women with diabetes are also susceptible to yeast and urinary tract infections — no doubt, these can decrease libido. And chronic high blood sugar can lead to vaginal dryness, which can make sex uncomfortable and painful.

Good Health = Good Sex

We women are complicated creatures and often women’s sexuality needs to be addressed on many different levels. A lack of desire can be connected to health issues but also to the stress that these issues bring to the bedroom.

And depression can be a side effect of many medications! Hormonal contraceptives (pills, implants, patches, rings) may lower libido. Alcohol is a depressant and trying to get “into the mood” by drinking can have the opposite effect. Other recreational drugs can also lead to a loss of sex drive.

Are you at risk for type 2 diabetes?  Take this quick quiz from the American Diabetes Association.

It’s important to understand your own unique situation, and try to achieve as many healthy behaviors as you can — and hopefully restore libido, naturally.

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Susan Burke March, a Cuenca expat, is a Registered and Licensed Dietitian, a Certified Diabetes Educator who specializes in smart solutions for weight loss and diabetes-related weight management. She is the author of Making Weight Control Second Nature: Living Thin Naturally—a fun and informative book intended to liberate serial dieters and make healthy living and weight control both possible and instinctual over the long term. Do you have a food, nutrition or health question? Write to me at SusanTheDietitian@gmail.com