NEW FEMALE VIAGRA PILL

In the United States are ongoing clinical trials of a new remedy that promises to return and increase the desire for women who have lost interest in sex: something like a female Viagra.But the sexual desire of women is more complicated than erectile dysfunction. Recent studies suggest that follows a very different pattern than men and that the lack of desire is not a disease to be cured. Will it serve a pill?

1132. Paula Saturday 12 October, 2013.

There was once a laboratory called Pfizer who synthesized a compound called sildenafil to treat patients with hypertension and angina. Clinical trials concluded that it was not very effective but which produced a remarkable side effect: prominent erections in male patients, due to the compound increased blood flow to the penis. The drug was patented in 1996, the sale was approved in 1998, Viagra became one of the most popular drugs in history. Only in 2008 worldwide sales reached almost two billion dollars.

Meanwhile, the other side of the bed, things have not changed much. In recent years they have sought unsuccessfully remedies with the same ease and immediacy increase sexual desire and arousal in women: injections of testosterone to increase libido in women with hormone therapy (causing side effects such as increased facial hair and voice changes, were withdrawn from the market); regulators of neurotransmitters that stimulate or inhibit sexual arousal (the FDA, the agency that approves all drugs in the United States, rejected in 2010); and a synthetic hormone supposedly aphrodisiac whose investigations were discontinued in 2008. A long list of drugs that use any of these three -testosterone, vasodilator or regulator of neurotransmitters methods have been tried, or are still being tested, without much success.

The latest attempt is the Dutch laboratory Emotional Brain with two drugs that promise, within hours of being ingested, increase libido in women who have a dysfunction called inhibited sexual desire: that is, before responding to stimuli and not now. The lack of desire may be due to insensitivity to sexual stimuli (for them is Lybrido) or inhibitory mechanisms bad experiences (for them, Lybridos). Lybrido contains testosterone and compound similar to sildenafil (the active ingredient in Viagra, which stimulates blood flow to the genitals), while Lybridos combined testosterone and an anxiolytic whose intake, in low doses, can elevate dopamine (associated with pleasure ) and decrease the inhibition. Clinical trials are already in its second phase and were conducted between 2011 and this year, 420 women in the United States. And although recent results have not been officially released, and the FDA requires complete third phase of testing for approval, the company says are very promising: that these pills do increase the urge to have sex, enhance the experience, and even rates rise orgasms. They could be on sale in 2016.

Meanwhile it has sparked a heated argument. Why decreasing desire in women? And why it is considered a disorder to be cured with a remedy?

WHAT I WISH WE TALKING ABOUT?
The hypoactive sexual desire or inhibited sexual desire is included since 1980 in the broad category of statistical sexual dysfunctions famous diagnostic manual and mental disorders (in English DSM) of the American Psychiatric Association, which also Chile used. It is described as missing or prolonged absence of desire for sexual activity, and is considered a disorder if it causes a high stress level and interpersonal difficulties, and can not explain any medical condition or another psychological disorder. So you should be evaluated by a clinical expert.

However, this definition has several reviews. The feminist organization New View Campaign (www.newviewcampaign.org) acknowledges that pathologizes as "dysfunction" something that can be normal and due to many factors: for example, ignores the cultural, social and economic context in which a woman develops their sex life. Since lack of education and limited access to contraception, family violence or religious precepts that conflict with sex.

Several experts reject the idea of ​​treating female desire decreased with medications, including drugs that are being tested now. They say there is no need to take a remedy for something that is normal: the spontaneous desire decreases in women in a long-term relationship.

There is also criticism from female sexuality experts say that the definition of disorder is based on masculine parameters. The psychologist Lori Brotto is a professor in the Department of Obstetrics and Gynecology, University of British Columbia, Canada. Together with a team of researchers developed a new model of female sexuality: nonlinear, but circular. Instead of thinking that a woman always respond the same way: first desire, then arousal and orgasm finally;They concluded that a woman's sexual response cycles can occur in stages that overlap each other, and can vary in order. For example, you may want to have sex without feeling desire but for other reasons: emotional closeness with your partner, increased personal, want to feel attractive. Or you can have an orgasm without reaching the point of maximum excitation. Therefore, the study of Brotto (published in 2005 in the Journal of Sexual Medicine) speaks of a different "subjective desire" that spontaneous desire and urgent-followed by one or more orgasmos- movies have taught us that we should feel. That is, while the response is a physiological arousal, desire is a subjective experience.

So the psychologist says it is difficult to diagnose a lack of desire: "There is no easy answer to the distinction between natural response, for example, something stressful happened to a patient, or if a disorder," says . "There is a fundamental clinical judgment of an expert to rule out other explanations for why the desire is down".

Those other explanations are many as the study of Dr. Brotto: fatigue, stress, depression, drugs, fear of pregnancy, shame, hormonal imbalances, feeling unattractive, among others, may cause the urge to have sexual activity decrease.

Brotto joined a clinical team that worked precisely to reformulate the concept of "hypoactive sexual desire" in the DSM manual, which this year has just been upgraded to the new DSM-V version (not modified since 1984). The name was changed dysfunction: Although the manual is not available in Castilian, roughly translated as "disorder of interest / female sexual arousal." And, based on female sexuality circular model incorporates a new set of criteria for diagnosis: women should experience at least six months, at least three symptoms within six described. These include lack of sexual thoughts or fantasies and lack of arousal or pleasure in most or all sexual encounters. It should also experience significant stress having these symptoms.

"The biggest change is how we define a disorder of desire," Brotto explains. "We took into account factors such as whether the woman responds to the initiative of his partner, if she has initiative, or how it responds to erotic stimuli: this is important and can lead to different treatments.Instead of a pill that gives you desire to have more sex, "he adds.

Because to several experts, criticism of female desire uniform and rigid model is linked to rejection of the idea of ​​treating with drugs, including drugs that are being tested now. They say there is no need to take a remedy for something that is normal: the spontaneous desire decreases in women in a long-term relationship.

BECAUSE OF THE Monogamy 
What do women want? That journalist and writer Daniel Bergner asks. In May this year he published a book with that title that challenges what we thought we knew about female desire and arousal. His extensive research suggests that, contrary to popular belief, women are perhaps less inclined physiologically to monogamy. And maybe that explains the ISD syndrome occurs much more in them than in men.

Bergner analyzes dozens of expert studies, such as the German psychologist Dietrich Klusmann.After studying 2,500 people in stable relationships concluded that, at the beginning of the relationship, the desire of men and women is very similar. But for women who had been with their partners between 1 and 4 years, at some point began to decline. The experiment is also conducted separately and the psychologists Stephanie Both Dawson Samantha. They showed clips of porn men and women, monitoring blood flow to the genitals. As the clips were repeated again and again women are beginning to excite less, while the flow of men remained constant. But when introducing a new clip, the excitement of women increased again.

Laurie Mintz, an expert in sex therapy psychologist and professor at the University of Florida, agrees with these results. "Studies are extremely clear," says with Paula. "The women in stable relationships, especially when you are stressed, can lose that sense of spontaneous desire even after only one year of relationship. And they think, 'What's Up? ", Because they know it's normal".

In fact, tests are performed Lybridos Lybrido and only women in stable relationships. So one of the Bergner thesis is that perhaps the frantic search of female Viagra has more to save marriages that improve the sex lives of all women.

The gynecologist Andrew Goldstein is director of the Center for vulvovaginal dysfunction in Washington, and has conducted numerous clinical trials in patients, including those of Lybrido.Phone, says he can not comment on the results because they were not officially published and, in any case, the tests are designed so that even he knows what the patient is taking. "I've had women ecstatic with the medication they were taking, but do not know if placebo" he says. Make that it is normal testing occur only in women in long term relationships. "When a clinical trial is designed, you must delete variables. And we've all experienced the excitement of being with a new partner, then there could be attributed to increased desire a remedy if the patient is in and out of relationships. Not that the ISD will pass only for people in long relationships, but is a much more common problem in these cases. "

When asked Dr. Lori Brotto, who is also a sex therapist, if you believe that monogamy has any impact on female desire, says: "Yes, it is known that the desire decline in the context of a long-term relationship. So we do not want pathologizing low sexual desire in women. And so I think it is wrong to say that a drug can reverse that and make a woman feel like I was in a completely new relationship. "

This does not mean that women do not want to be in a stable relationship. "One of the most important things we have learned about female desire is that we can grow," he adds. "Most people think that once the desire is gone, you can not do anything. And one of the errors of this intense search for a remedy is not going to be any quick-relief medicine that works. People need to learn strategies and tools, and talk with your partner to enhance your sexual desire, "he concludes.

In researching his book What do women want ?, journalist Daniel Bergner interviewed women who were taking Lybrido as part of the clinical trial. They said they had sex five times a week and even still felt desire after having an orgasm.

LIKE DEPRESSION
Despite the suspicions against the pursuit of female Viagra, remains undisputed attractiveness to go to a pharmacy, buy a pill that dissolves on the tongue, and fix the problem in just a couple of hours. In their research, Daniel Bergner women interviewed claimed that thanks to Lybrido they were taking, as part of the clinical trial, had sex five times a week and still felt desire even after having an orgasm. Another argument: many women who complain of low sexual desire, one in three in the US alone. In fact, there are reports of doctors who claim that some patients, in the absence of a drug designed for them, prove testosterone patches and other remedies for men, which can have serious side effects.

The Dutchman Jos Bloemers is the director of scientific operations Emotional Brain and has written several articles published in The Journal of Sexual Medicine, about laboratory investigations: based on the firm belief that the emotions we experience are regulated by an intricate system structures and chemicals in our brain. "Not only our behavior depends on the chemistry," says Bloemers Magazine Paula. "It's a combination of biological, psychological and social factors. However, we believe that the libido does have an important biological component.The brain has a network of interconnected systems that are essential to produce an adequate response to sexual stimuli. "

The key finding of Emotional Brain, says Bloemers, and other laboratories have overlooked is that the ISD is not a homogeneous dysfunction, but is due to more than one cause. "We believe that there are two main factors: whether a mechanism in the brain unreceptive to sexual stimuli, or high sexual inhibitory mechanisms," he says. Therefore, drugs that are testing not just aimed at raising the desire (which Bloemers called the symptom of the problem), but the mechanisms regulating both low and high receptivity inhibition in the brain, hence the combination of testosterone Lybrido sildenafil for the former and testosterone with an anxiolytic in Lybridos, for the second.

Another peculiarity is that, like Viagra, these pills are not taken every day, but only when you want to have sex. Take between 3 and 6 hours to take effect. "We want to increase sexual desire on a daily basis," the scientist. "We want to stimulate the brain to the body more actively address and that sexual experience more pleasant."

So Bloemers ensures that the controversy over a female Viagra is based on misinformation. The pills are not designed for all women who experience a decrease in desire, only for those diagnosed clinically with inhibited sexual desire and have ruled psychological or relationship factors.

"These are women with biological differences in how they process sexual stimuli, and are extremely stressed by this problem. They have loving couples want to have sex, have tried everything; these women were sitting here crying as they tell their story, "he says. "And when taking these medications and feel that your body responds, become very happy. If you compare with depression, this is a dysfunction for which itself is considered to be good drug use, regardless of the cause of depression. But 30 or 40 years ago, psychologists said that nothing be remedies for depression. Because depressed people were not taken seriously. We now know that it is a very serious condition and relieved, in part, with drugs. "

* THE DESIRE OF CHILEAN
In Chile there are no population-based study on the prevalence of disorders of desire in women.However, psychologists and sex therapists agree that inhibited desire disorder is a common cause of consultation: 70 percent of the patients they serve the Nerea Ugarte and Renata Ortega sexologists consult for this cause and at least 50 percent of women attending psychologist and sex therapist Francisco Pérez Deney have the same difficulty. "Most are women between 30 and 45 years they have between 5 and 10 years of stable relationship," says psychologist Nerea Ugarte.

How to treat Chilean therapists? The first step is to rule out other causes affecting sexual interest, such as depression or imbalances of hormones involved in desire, such as testosterone. If there is any alteration, can be prescribed a testosterone gel or hormone replacement therapy.

The revival of sexual desire work in different ways according to the therapeutic power.Psychologist Francisco Pérez Deney apply a cognitive behavioral approach mixed with the coaching women to reconnect with your body and your emotions to make sexual practice eager to find something. This is coupled with the recommendation to extend the sexual repertoire.

For its part, the psychologist Nerea Ugarte created a treatment called cognitive stimulation program to hypoactive sexual desire, which applied in 50 patients and to be presented this month at the Chilean Congress of Neuroscience and Neuropsychiatry. "In the desire to participate cognitive abilities such as memory, attention, motivation and language and what happens is that the power of thinking about sex is lost if not used," he explains. Your program works with weekly tasks aimed at stimulating eroticism, like making lists of what they seduced the other at the beginning of the relationship. CT