Women claimed a victory in the summer of 2015 when the Food and Drug Administration approved the first prescription medication for the treatment of hypoactive sexual desire disorder (HSDD), the most common form of female sexual dysfunction. But thus far, it has turned out to be a rather hollow victory.
The drug in question — Addyi — has some very problematic side effects, an extremely modest degree of efficacy, and a high price tag. Making matters worse, most insurers have declined to cover the drug, putting it beyond the reach of many potential users. As a result, Addyi has posted disappointing sales and failed to live up to the hopes and predictions of its developers and most ardent supporters.
Women Looking for an Alternative
The apparent failure of Addyi to fill the burgeoning demand for some form of treatment for HSDD has left American women longing for an alternative one that really works. Neuroscientist Nicole Prause, Ph.D., thinks that the answer may lie in some form of electrical stimulation to the brain that could reinvigorate the sex drive in women as well as men.
After roughly a decade of research at UCLA’s Sexual Psychophysiology and Affective Neuroscience (SPAN) lab, Prause in 2015 founded Los Angeles-based Liberos LLC, a sexual biotechnology company. Prause’s research, both past and present, has focused primarily on the feasibility of using some form of electrical brain stimulation to modulate sexual desire.
‘Female Viagra’ Misleading
The term “female Viagra” has been used rather loosely to describe various forms of treatment designed to increase sexual desire in women. The term is misleading because the primary forms of male and female sexual dysfunction stem from altogether different psychophysiological problems. Viagra and the other oral ED drugs that have followed temporarily optimize blood flow to the penis, giving impotent men a window of time during which they can more readily get and keep an erection strong enough for sexual intercourse.
Addyi and Prause’s research into the science of sexual desire focus on the brain. Addyi is said to rebalance brain chemistry, suppressing neurotransmitters that tend to inhibit sexual desire while promoting those associated with increased desire. Likewise, Prause’s research has spotlighted the potentially curative effects of electrical brain stimulation as an alternative approach to the reinvigoration of sexual desire.
For a December 2016 article posted at the website of New York Magazine, writer Lilly O’Donnell interviewed Prause about her ongoing research and her hopes that it will lead to a more effective treatment for women who are suffering from a loss of sexual desire. Direct brain stimulation, Prause told O’Donnell, is similar in some ways to “electroconvulsive therapy, but much more targeted and not nearly so dangerous.”
Two Forms of Brain Stimulation
Prause is exploring the potential of two different forms of direct brain stimulation: transcranial magnetic stimulation (TMS) and direct current stimulation (DCS). Of the two, TMS uses a more powerful and more focused electrical current and is believed to have a more lasting effect. DCS involves a more diffuse electrical stimulation of the brain and produces only short-term changes, averaging about 30 minutes, according to Prause.
TMS has already been approved for use in the treatment of depression that has failed to respond to other forms of therapy. According to Prause, more than 60 percent of depression patients who have used it have gone into remission within three years. Unlike most antidepressant medications, which work by lowering all forms of emotional response — both positive and negative — TMS affects the ability of patients to process positive stimuli. It accomplishes this goal by increasing response in those parts of the brain that deal with reward and pleasure. These areas of the brain, says Prause, are the same areas that are underactive in both men and women with low sex drive.
Results of Study on TMS
Prause was the lead author of a study that explored the effects of theta burst stimulation (TBS), a form of TMS, on reward processing mechanisms in the brain. The results of the study were published in the November 30, 2016, issue of “PLOS ONE.”
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Researchers recruited 20 men and women, each of whom had had at least two opposite-sex partners during the previous 12 months. All study participants were subjected to two forms of TBS — continuous stimulation and intermittent stimulation. After each TBS session (either continuous or intermittent stimulation), participants were asked to complete tasks designed to assess their responsiveness to monetary and sexual rewards.
EEGs Measure Brain Activity
Electroencephalography (EEG) was used to measure brain responsiveness to various forms of TBS. EEG alpha response varied noticeably depending on the form of TBS administered. The research team concluded that their findings support further study of the effects of TBS in modulating reward response in the brain. Continuous wave TBS appeared to have an inhibitory effect on sexual reward response, while intermittent wave TBS seemed to excite or enhance sexual reward response. Researchers theorized that TBS designed to lower reward response might be useful in treating men and women who find themselves drawn to sexually risky behaviors.
Next up for Prause and her fellow researchers will be a clinical trial during which study participants will be subjected to multiple rounds of TMS treatment in an attempt to evaluate its long-term efficacy. For those who fear that TMS might someday be misused to produce sex fiends, Prause offered O’Donnell these words of reassurance:
“The important thing to remember about TMS is that it’s thought to be normalizing. If you actually have a normal sex drive, and I come in and zap you 30 times, I can’t make you [into someone with a hyperactive sex drive].”
Could Be Prescribed Off-Label
Even if Prause’s upcoming study proves successful, it could be years before direct brain stimulation is approved by the FDA as a treatment for abnormally low sexual desire. However, Prause notes that the device has already won FDA approval for use in the treatment of depression, and doctors could technically begin prescribing it for off-label use right now.
While TMS has already been the subject of multiple studies and, as noted, is already in use for treating intractable depression, less study has been done of DCS as a means of modulating sexual desire. Prause told O’Donnell that early studies showed that patients subjected to DCS therapy showed increased brain activity when they were shown sexually explicit images. This was in contrast to other test participants who received placebo treatment and showed little, if any, increased brain activity in response to those same images. However, Prause notes, “that’s still a far cry off from having an actual sexual response.”
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