Rachel Rubin, MD, assistant clinical professor of urology at Georgetown University and urological surgeon, discusses how hypoactive sexual desire disorder in women has been defined and treated historically.

Pharmacy hours interviewed Rachel Rubin, MD, assistant clinical professor of urology at Georgetown University, a urological surgeon specializing in the treatment of sexual dysfunction in both men and women, and one of the few physicians trained in female sexual medicine and male, on hypoactive sexual desire disorder (HSDD) and the current treatments available for this medical condition.

Alana Hippensteele: How was HSDD defined and treated and do some of these same practices still exist today?

Rachel Rubin: So HSDD has been around. Well, I mean, let’s be real – low libido has probably been around since libidos have existed. It was defined as a medical condition by Helen Singer Kaplan, who is a truly wonderful figure, decades ago.

So this idea that women’s sexual health is entirely psychosocial has really taken hold in the world, and like anything, can be cured with sex therapy and reading. 50 shades of gray or having a glass of wine, when men’s sexual health has really advanced in the biological realm, and it’s all about testosterone, blood flow, nitric oxide and all that. And that’s a real problem because we’re all biopsychosocial beings and we need to understand that dopamine, norepinephrine, and serotonin all play a role in HSDD.

So we can all understand as pharmacists – you understand better than most – that antidepressants can have sexual side effects. People who take antidepressants can have delayed orgasm or decreased libido or erectile function problems or arousal disorders, so why couldn’t there be a drug that could do the opposite, that could stimulate dopamine in the brain. And of course it can, and of course there is. We have 2 FDA approved options for improving dopamine in the brain that can and have been shown in randomized controlled clinical trials to improve sex drive.