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Female Sexual Dysfunction  (FSD)

About half of American women will experience problems with sexual function at some point and some may face them throughout their entire adult life. If the problems are severe enough to cause distress, they may be considered sexual dysfunction. It is convenient to divide FSD into problems of desire, arousal, orgasm or pain. Nearly 12 million women suffer from low sexual desire, the most common sexual problem. It gets confusing, the terms are often used interchangeably, but the take home point is some women are just not interested in sex and it causes them no distress. But the other group of women do care about their lack of sex drive, causing them considerable distress, those are the women we will discuss. 


Hypoactive sexual desire disorder (HSDD) also known by its newer term,  Female Sexual Interest/Arousal Disorder (FSIAD), is a persistent or recurrent deficiency or absence of sexual fantasies and thoughts and or desire for receptivity to sexual activity which causes personal distress or interpersonal difficulties not caused by medication or drugs. It is the most common sexual disorder in women, effecting  about 25% of women in the United States 18 years and older.  

Common causes may be:

  • Decreased Estrogen levels

  • Decreased Testosterone levels

  • Pregnancy/breastfeeding

  • Side effects from commonly prescribed medications

  • Coronary Artery Disease

  • Stress/fatigue psychological factors

  • Relationship problems


Unlike ED, men are usually happy to risk a little embarrassment in order to get a "little blue pill" and get them back in the saddle again.  Women, not so much.  As a matter of fact, in our practice it's mostly the sexual partner who speaks up about his/hers partners lack of desire. HSDD is, in our opinion, more difficult to treat than it's male   Women are more cerebral and emotional when compared to men. 


What's Available?

There are  currently two  FDA approved medications for treatment, Addyi and Vyleesi. Several other medications are used off label, and are at least as effective, if not more so in some cases.


Addyi, chemical name Fibanserin, is a pill, it is not a hormonal treatment. It works in the Central Nervous System (CNS) affecting neuro-chemical transmitters mostly Serotonin, Norepinephrine and Dopamine. Side effects include nausea and drowsiness. We have not had a great deal of success with this drug. Insurance coverage is limited, if you pay out of pocket, you are looking at over $400 per month using GoodRx.

Vyleesi, chemical name Bremelanotide, is a subcutaneous injection that binds to receptors in the brain called Melanocortin Receptors, but it's unclear exactly how the drug works to boost sexual desire. It is taken about an hour before intimacy and lasts for about 11 hours afterwards. It has a novel mechanism of action, activating endogenous Melanocortin pathways involved in sexual desire and response. Side effects include headache and nausea. Cost through GoodRx, I love this site, is $2900 for 4 autoinjectors) of Vyleesi 1.75mg/0.3m We offer same treatment at considerable cost savings.

Other treatments for HSDD, that are not FDA approved, but are effective include:

  • Testosterone

  • Dihydrepiandrosterone (DHEA) 

  • Buspirone

  • Bupropion


While Oxytocin certainly lives up to it's reputation as the “Love Hormone,” it also has broader applications like weight management

and a performance enhancer. Oxytocin levels reach extreme levels during childbirth and breastfeeding, however they have also found to be elevated during sexual arousal, skin to skin contact, and orgasm. Due to this, research has been conducted and shown that exogenous administration of Oxytocin can improve libido, orgasm intensity/frequeny and sexual pleasure.



Whether you’re a male or female looking for a more spontaneous and natural sexual experience our novel

approach may be exactly what you’ve been looking for.

Apomorphine is a dopaminergic agonist with affinity for dopamine receptor sites, mostly D(2), within the

brain known to be involved in sexual function. It enhances normal neurological signaling in sexual response.

It stimulates dopamine receptors in the hypothalamus, causing neural signals that relax smooth muscle and

allowing erections to happen more easily.

Like Apomorphine, Tadalafil is a proven ED medication and its effects are cumulative and improve with daily

use. For females, Tadalafil orally can be effective to increase sexual desire, sexual arousal, sexual orgasm and

sexual satisfaction. It not only increases nitric oxide in the corpus cavernosum of men, but in women it also

results in the relaxation of clitoral and vaginal smooth muscle and increased blood flow in these sites, a

normal step in arousal and necessary to achieve orgasm.

Apomorphine with Tadalafil is often the perfect combination for both men and women to experience a

spontaneous and natural sexual encounter. Apomorphine is effective in 43% of men who don't respond to

tadalafil alone. Daily use allows sexual activity to happen any time, without needing to wait for a pill to start



PT141 NOW available  in an intranasal formulation. Bremelanotide PT 141 is a very exciting drug which is frequently used by both men and women. It works on the central nervous system to directly induce an increase in libido and induce erections. It works in 80% of men who

don't respond to PDE5 inhibitors and most will now use it as a first line therapy. The results with women are much less objective but there is far more research showing its success. It is FDA approved for women and is known to increase sexual gratifying experiences by 50%.


Scream Cream

This is a topical cream made of l-Citrulline, Aminophylline, Ergoloid Mesylate, and Pentoxifylline. The primary mechanism of action is substantial vasodilation to the area of application which increases sensitivity. It has been reported that only ~25% of women achieve orgasm from sexual intercourse, and even with clitoral stimulation that number only increases to 43%. Women have reported adding Scream Cream significantly increased libido, intensity of orgasm, and also vaginal lubrication.


Scream cream

Shop at our on-line store, without embarrassment, and no waiting for an appointment at you doctors office.  All orders will be mailed to your address. Call us at Invigorate Med Spa for any questions. 412-248-7777.  Note  all prescriptions drugs will need a Telemedicine evaluation.  

 Bremelanotide PT 141


Testosterone Cream for women

Multiple studies have shown the effectiveness of testosterone cream or pellets for HSDD treatment. Transdermal testosterone (TDT)  increases the frequency of sexual desire and sexually satisfying activity in both naturally and surgically menopausal, and premenopausal  women with HSDD and decreases personal distress. Adjuvant estrogen might not be needed. The evidence is high for short-term use of TDT but less clear for long-term use.

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