SIMON SAYS

Check out what Dr. James Simon says about the lack of an HSDD treatment!!

https://www.youtube.com/watch?v=CmWBu6BnPKo

In support of HSDD

THANK YOU Dr. Streicher, Dr. Parish and Dr. Kingsburg for your support in response to the NYT Op-Ed last week!

http://www.nytimes.com/2015/03/08/opinion/sunday/a-sexual-desire-drug.html?mwrsm=Email&_r=0

Sexual Empowerment

Thanks Dr. Krychman for helping pave the way for a pharmacologic treatment for HSDD.

By Michael Krychman, MD 

 

As a sexual medicine physician and sex counselor, I’ve noticed a societal shift towards greater acceptance and awareness of   female sexual empowerment and expression.  More and more women are owning their sexuality and speaking out about it -- sometimes in a way that is considered risqué --  but, at least they are talking. 

 

Do not get me wrong, many women I see in my practice would rather keep their sex lives behind closed doors for a variety of reasons. And some women do not have much in the way of sexual interest based on religious or cultural beliefs, or, in some cases, due to psychological issues or problems in their relationship. But what about those women who feel left out of sexual empowerment not because of their own set of personal beliefs or treatable psychological issues, but rather a biologically driven lack of sexual desire that is out of their control? 

 

According to a recent article   published in the journal Menopause, the rate of low sexual desire is high, reaching 43 percent, while an estimated 10 percent of women experience low sexual desire with the hallmark characteristic of distress, a condition called hypoactive sexual desire disorder, or HSDD.

 

Hypoactive sexual desire disorder is defined in medical literature as a “persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty, and which is not better accounted for by a medical, substance-related, psychiatric or other sexual condition.” Research has shown that women with HSDD are more likely than women who have “normal” desire to experience feelings of frustration, hopelessness, anger, loss of femininity and decreased self-esteem. And they feel there is nothing they can do about it. Even with the new classification system and lumping HSDD and arousal disorder together, the tenets of HSDD remain true and real.  Yes, Virginia, there is such a condition called lowered sexual interest. 

 

Hypoactive sexual desire disorder was first characterized as a medical condition in the Diagnostic and Statistical Manual of Mental Disorders in 1987. There are no FDA-approved pharmacological treatments available for women. Erectile dysfunction was first characterized in 1992. There are 26 FDA-approved treatments for either erectile dysfunction or low testosterone. 

 

While the etiology of erectile dysfunction and HSDD certainly differ, their regulatory pathways seem to have more distinction than would be expected – especially in a time when much emphasis is placed on women’s rights to an active and healthy lifestyle. 

 

As research into female sexuality has advanced, the element of desire has come into focus. We now know that desire is a complex interplay of social, psychological and biological components. If neither social nor psychological components are causing low sexual desire and biology is at play, science now understands that there can be an imbalance of key neurotransmitters, or chemicals, in the brain that affect sexual drive. With this direct correlation between chemical imbalance and desire, there is no reason why, in 2015, a treatment option for women should not be available. 

 

While the science has finally caught up, there remains a disparity in available options to treat sexual dysfunction between genders. The need to equalize this disparity and make a solution available for the millions of women who suffer from HSDD is clear. Men have had proven, FDA-approved treatment options available to them to treat their sexual issues for decades. It is time we have the same for women. 

 

As a medical physician, sex therapist and counselor it is fascinating to me that there still is much hostility between the   camps of sexual medicine and sexual psychology.  We do share one commonality- the concern for the patient and her distress and suffering.  Certainly we meet in the middle ground and embrace science, clinical research and most importantly listen to the patients’ voice.    Both medical sexual pharmacology and counseling will endure as importance facets for the treatment of sexual problems. A true collaborative approach between sexual medicine and sexual psychology, with mutual respect for science, data and facts,  will not only help women regain a lost and vital aspect of their sexuality but will offer an opportunity for solidifying and advancing the field of human sexuality through a team of professionals.  

 

Be Strong. Be Healthy. Be in Charge!

-Michael Krychman MD

 

 

My VOICE My WISH

I am so appreciative of all the national organizations who have spoken out against this ridiculous op-ed that appeared in the NYT last week.  

http://www.nytimes.com/2015/02/27/opinion/nothing-is-wrong-with-your-sex-drive.html?_r=0

Here are my personal thoughts as a woman who has been diagnosed with HSDD.

First, Nagoski's claim that the FDA rejected flibanserin because " ...the drug doesn’t work and isn’t safe." is insane.  Having been on the trial, I am here to tell you it DOES work and it IS SAFE!  Read the data and you will see. The FDA didn't say flibansering "didn't" work and wasn't "safe".

More frustrating is Nagoski's claim that "...its backers are attempting to treat something that isn’t a disease."  Really?  Where have you been and from where does you get your information?  I was diagnosed with HSDD three years ago so unless my physician, and others across the country are all misguided, you are absolutely mistaken.

Yes, "Flibanserin purportedly treats a condition called hypoactive sexual desire disorder in women".  Finally, something I agree with only it doesn't "purportedly" treat, it DOES treat!

Here's where I really get offended.  "The new diagnosis is intended for women who lack both spontaneous and responsive desire, and are distressed by this. For these women, research has found that nonpharmaceutical treatments like sex therapy can be effective."  I'm not sure what research you are referring to but sex therapy DOES NOT help me.  I lack both spontaneous and responsive desire but have no arousal disorder. ( see my earlier post )

For the record, I don't "assume that because their desire is responsive, rather than spontaneous, they have “low desire”; that their ability to enjoy sex with their partner is meaningless if they don’t also feel a persistent urge for it; in short, that they are broken, because their desire isn’t what it’s “supposed” to be."  I don't think I am "broken" but I am "distressed" and know exactly how my distress disappeared when I was taking flibanserin!

The icing on the cake, or perhaps, better stated, the straw that broke this camel's back was your matter of fact statement that "What these women need is not medical treatment, but a thoughtful exploration of what creates desire between them and their partners. This is likely to include confidence in their bodies, feeling accepted, and (not least) explicitly erotic stimulation. Feeling judged or broken for their sexuality is exactly what they don’t need — and what will make their desire for sex genuinely shut down."

Let me set the record straight, Ms. Nagoski.  My husband and I are very thoughtful with regards to what creates or fuels desire between us.  When he is "in the mood" and initiates, my body responds appropriately (physically )as I do NOT HAVE an arousal disorder.  What is lacking is the DESIRE to respond.(the brain half of the equation)

 I do NOT feel judged or broken.  I am confident in my body, (we work out regularly and I am quite proud of my fairly sculpted body) and I could not possibly feel MORE accepted than I do. Furthermore, we are active participants in erotic stimulation!  And trust me, my body physically responds appropriately to my husbands touch, stimulation and praise. All of this, of course, if HE initiates.  If he waits for me to initiate, he will be one lonely man.

With reference to Dr. Heath and Sprout "trying to call “diseased” what is simply different.", I would ask you if you consider ADHD simply "different"? Will "therapy" treat ALL patients with ADHD?  I'm assuming you think so but knowing several who suffer with ADHD, I would argue that while therapy MAY help some, it most certainly does NOT help all and most incorporate a combination of treatment options - therapy and prescription medicine.

Trust me, I do WORK with my sexuality and that is part of the problem.  With all I have on my plate, it is nice to not HAVE TO WORK at it.  When I was taking flibanserin, I didn't have to!  

Don't get me wrong.  I am not saying I walked around in a state of desire, but I recaptured what I once had and that was a sometimes "spontaneous" desire to have sex and others a "responsive" desire to have sex.  Either way, it felt natural, unashamed, not forced and non-obligatory.  I got my desire back!  One less thing in a day to have to work at.

So my question to you is, why are you so adamantly trying to block the approval of a medical option for me and others suffering from HSDD?  

Could it be to further your own agenda and keep a flow of patients in your office??

Were you so vocal when all the ADHD medicines were approved?  Chemical imbalances in the brain are often considered medical disorders.  Why do you try and separate HSDD?

It is my "desire" that you and your peers who continue to try and block FDA approval and write such offensive editorials with regards to a condition from which you clearly do not suffer and about which you are not fully educated, will stop and consider your words before you offer them publicly.  

Ask those of us who are suffering, who were on the trial or not, and stop speaking "ON OUR BEHALF".  Instead, speak "TO US".  I will gladly discuss this with you as I have my medical doctor.I don't need you to speak for me...I have a voice and a wish and deserve to be heard, too.

No "One Size Fit's All" approach for HSDD

Another response to ridiculous NYT Op-Ed by Emily Nagoski.  Thanks to NAMS for supporting women and recognizing HSDD as valid medical condition.

NAMS Challenges New York Times Op-Ed

NAMS Challenges New York Times Op-Ed, Nothing Is Wrong With Your Sex Drive.

On Friday, February 27, the New York Times published the opinion piece, Nothing Is Wrong With Your Sex Drive, by Emily Nagoski. The NAMS Board of Trustees decided that the inaccuracies and biased messages of this piece could not go unaddressed. On February 27, the Board emailed a response to the New York Times editor, signed by the NAMS Executive Committee. To not respond would be to send a message of tacit agreement to our patients and further the misinformation that we know to be detrimental to the health and quality of life of all women. NAMS’ response is below:

The claim in Nothing Is Wrong With Your Sex Drive that hypoactive sexual desire disorder does not exist invalidates the experience of the 9.5% of American women who are currently living with this condition.
As an organization devoted to promoting midlife women’s health, The North American Menopause Society (NAMS) wants to ensure the dissemination of accurate information. The FDA recognizes that low sexual desire with distress is an accepted disorder and among the top 20 unmet medical needs for women. As a testament to the importance of this problem, the FDA recently held a 2 day workshop to hear directly from women and experts in sexual medicine. There is not a ‘one size fits all’ treatment for sexual problems in women or men. While sex therapy may help some women, science has shown us that low desire is best understood from a biopsychosocial perspective. Women deserve a range of treatment options, and the distress they voice regarding their sexual problems should be respected.

The Executive Committee of The North American Menopause Society
Margery Gass, MD, NCMP
Andrew Kaunitz, MD, NCMP
Pauline Maki, PhD
Peter Schnatz, DO, NCMP
Marla Shapiro, MDCM, NCMP
Jan Shifren, MD, NCMP
Lynnette Sievert, PhD

From LA to NYT, #WOMEN DESERVE

Excellent visual of all the inaccuracies of recent OP ED in NYT...ridiculousness!!

http://eventhescore.org/wp-content/uploads/sites/49/2015/03/NYT-Nothing-is-Wrong-with-Your-Sex-Drive-Mark-Up.pdf

Let's CLEAR the air

Excellent response and factual information to offset the offensive, dismissive and belittling OP ED in last week's NYT.  Thanks, Dr. Snyder

NYC Sex Therapist Responds to New York Times Opinion Piece on Sprout Pharmaceuticals’ “Pink Viagra”

As a sex therapist who also happens to be a medical doctor, I’m used to disagreeing with a lot of what I read about sexual pharmacology.

But the recent New York Times opinion piece “Nothing Is Wrong With Your Sex Drive” — regarding Sprout Pharmaceuticals’ new FDA application for flibanserin (so-called “Pink Viagra”) — seemed especially in need of a systematic rebuttal.

For those of you who haven’t read the article, I encourage you to go take a look at it here.  I counted seven major errors. Here they are, in the order they appear in the text itself:

ERROR #1:  Misrepresenting recent changes in psychiatric diagnosis. 

NYTimes: Quoting from the Times article:  “Flibanserin purportedly treats a condition called hypoactive sexual desire disorder in women. But H.S.D.D. was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in 2013, and replaced with a new diagnosis called female sexual interest/arousal disorder, or F.S.I.A.D. Why the change? Researchers have begun to understand that sexual response is not the linear mechanism they once thought it was.”

Let’s clear this up:  DSM-5 didn’t get rid of HSDD.  Rather, it combined HSDD and Female Sexual Arousal Disorder into one new entity, FSIAD — since there wasn’t sufficient evidence that women’s desire and arousal disorders were in fact distinct. Yes, the new FSIAD diagnosis did for the first time mention responsive desire (item #3). But that was only one of several changes. See my articles, “Sex in the DSM” and “the FDA Wants to Hear More About Women and Sex” for more info on this.

ERROR #2:  Confusing “can be effective” with “is generally effective.”  

NYTimes: Again, quoting from the article:  “The new diagnosis is intended for women who lack both spontaneous and responsive desire, and are distressed by this. For these women, research has found that nonpharmaceutical treatments like sex therapy can be effective.”

Response:  Ah, that phrase: “can be.”  Anything can be effective. But how often?  And what about when it’s not?  Yes, sex therapy can be effective.  But it can also be quite useless at times.  That’s why there’s been a search for biological treatments.

ERROR #3:  Assuming that one subset of women with low desire is representative of all or most women with low desire.

NYTimes: Quoting again: “I can’t count the number of women I’ve talked with who assume that because their desire is responsive, rather than spontaneous, they have ‘low desire’; that their ability to enjoy sex with their partner is meaningless if they don’t also feel a persistent urge for it; in short, that they are broken, because their desire isn’t what it’s ‘supposed’ to be.” 

Response:  Yes, some women are helped by learning that their desire is just responsive rather than spontaneous, and that this is normal. But there are many women who lack both spontaneous and responsive desire, and are distressed about it.

ERROR #4:  Either/or thinking.

NYTimes: The author writes, “What these women need is not medical treatment, but a thoughtful exploration of what creates desire between them and their partners.”

Response:  Yes, women who have responsive desire but not spontaneous desire can benefit from this kind of thoughtful exploration. But how about women who lack both responsive and spontaneous desire? If experience with other conditions in sexual medicine is any guide, some of them might conceivably benefit from both medical treatment and psychological counseling.

For more on the perils of either/or thinking in sexual science, see my article, “Sex for Pleasure, for Profit, or Both?”

ERROR #5:  Implying that a pill to help women regain sexual desire is similar to barbaric gay-conversion therapies.  

NYTimes: “Apparently we still haven’t learned our lesson about what happens when we pathologize normal sexual functioning.  In one extreme example, medical professionals once took seriously the idea that homosexuality was a disease in need of a cure . . .”

The author goes on to describe a Frankenstein-like case published in 1972 of a gay patient with epilepsy who had neurosurgery to implant electrodes in his pleasure centers, after which his doctors tried to recondition him to enjoy heterosexual erotica.

Response:  Is this really supposed to be equivalent to a woman who’s distressed by a lack of sexual desire and wants to try a pill?  I think that’s kind of a stretch. There’s  a big difference between trying to change someone’s essential sexual nature, and simply helping them recover a part of their nature that they’ve lost.

ERROR #6:  Mislabeling sexual psychopharmacology as “outdated science.”

NYTimes: Again, I quote: “Outdated science isn’t going to improve our sex lives. But embracing our differences — working with our sexuality, rather than against it — will.”

Response: Science means being honest about what you don’t know, and being willing to correct yourself when you’re wrong. It’s hardly scientific to claim, “We know what’s good for all women, and what’s not.”

I don’t think it’s fair to characterize pharmacologically-driven sex research as “outdated.” It’s crude now, but it gets more sophisticated all the time. Desire is complicated, and it’s affected by an extraordinary number of things. No biological researcher would deny that. But complexity doesn’t mean that medical treatments for desire problems are of necessity invalid. (See item #4 – “either/or” thinking).

ERROR #7:  Intolerance of diversity.  

NYTimes: The article (quoted above, item 6) ends by exhorting us to start “embracing our differences.”

Response:  I’d like to see the anti-medicalization folks take this message seriously. Yes, let’s embrace our differences.  Let’s acknowledge that many women might reject out of hand the idea of taking a pill for desire, but that some others might want to give it a try.

Why not allow for differences, and let each woman use her own judgment?

If the FDA approves flibanserin for women, then we’ll find out whether it works in the real world — and for whom. Until then, let’s not pretend we know more than we do about the causes and best treatments for lost sexual desire. We still have much to learn.

© Stephen Snyder MD  2015
www.sexualityresource.com
New York City