Two brand-new therapies to improve sexual response and satisfaction in women are now available at our office.

• Vylessi (bremelanotide), is a melanocortin pharmaceutical designed to improve low libido (sexual desire).
• VFit Plus, a self-use at-home device utilizing heat, sound waves, and photo modulation, has the potential to improve vaginal health and overall sexual satisfaction.

These two new cutting-edge therapies add to Dr. Goodman’s already- longstanding sexual medicine practice to help improve sexual response in both men and women. Therapies already include both information, ideas, and intensive counseling, as well as administration of the O-Shot™, using PRP (platelet-rich plasma) to improve clitoral and especially vaginally-activated orgasms.

What is Vyleesi?

For years I have been watching the development of the pharmaceutical bremelanotide for the treatment of ghosted sexual desire. Bremelanotide belongs to a class of compounds termed “melanocortins.” Melanocortins are what I consider to be the “Holy Grail” of sex-enhancing medications, as they not only affect the melanin system, facilitating tanning, they are a modest appetite suppressant (…weight loss…), and improve sexual desire (aka libido). Melanocortins are hormones that affect physiological activity in the body by binding with specific melanocortin receptors, of which there are currently five identified: MC1R – MC5R. These receptors are prolific within the human body and present in virtually every organ, making the effects of the melanocortins widespread and varied. Known physiological activity influenced by the melanocortins includes pigmentation, inflammation, energy homeostasis, appetite, and sexual function, especially low sexual desire. The U.S. Food and Drug Administration on June 21, 2019, approved Vyleesi (bremelanotide) to treat acquired, generalized hypoactive sexual desire disorder (HSDD; low sexual desire) in premenopausal women, although indications are that Vyleesi is effective in menopausal women as well.

What is “…generalized hypoactive sexual desire disorder..?” What, for that matter, is “…hypoactive sexual desire?”

It is diminishment or loss of libido, the desire to initiate or participate in sexual activity. When this diminished desire is significant enough to cause true bother in an individual’s sexual response, it can rightfully be considered a disorder. Whether a situation or disorder, loss or absence of sexual desire is an uncomfortable situation for many individuals and couples, and as such may lead to a request for treatment in many individuals. Even understanding that the joy of sexual activities relates to the arousal produced, the intimacy inherent in the activity, and the orgasmic response that is at the peak of sexual activities, loss of desire or disinterest in sexual activities, much less initiating these activities, may adversely influence a couple’s sexuality. While counseling utilizing “permission,” information, specific suggestions, and occasionally intensive psycho-sexual therapy remains the mainstay of treatment, the development of other modalities such as oral or injectable medications opens other paths to improvement.

How can you screen yourself to appreciate whether a lack of desire has adverse effects on your sexual universe? Take the following “quiz” answering “yes” or “no” as appropriate.

• In the past, was your level of sexual desire or interest good and satisfying for you?
• Has there been a decrease in your level of sexual desire or interest?
• Are you bothered by the decreased level of sexual desire or interest?
• Would you like your level of sexual desire or interest to increase?

If you answered “yes” to these questions, you may be a good candidate for a trial of Vyleesi. Keep in mind, however, that sexual function is not as simple as using a pill or a potion (or injection!), and it is important that you consult with a sexual medicine specialist prior to simply getting a prescription. Issues such as depression, many medical conditions, injuries or operations, certain medications, drugs or alcohol mediate sexual response and should be investigated by a savvy practitioner. Pregnancy, recent childbirth, menopausal symptoms, sexual pain, and other sexual issues should be evaluated. Your partner’s sexual problems, dissatisfaction with your relationship or partner, and stress or fatigue symptoms must be addressed. Sometimes a “husbandectomy” is the most effective therapy for diminished sexual desire!

While understanding that, unlike men who require a desire to obtain and maintain an erection, women can have a perfectly joyous sexual encounter without strong libido/desire so long as trust and intimacy are involved, diminished desire is anathema for women’s sexuality, and much research has taken place over the past 10+ years into both the place of sexual desire in a woman’s sexual hierarchy and pharmaceutical modalities to help accomplish this. Towards this end, the development of both testosterone via creams, gels, and subcutaneous implantation, and other pharmaceutical interventions has been, while perhaps not quite “front-burner,” important in the field of sexuality research. Towards this end, bremelanotide has been heavily researched, and finally brought to market in the form of an as-needed sexual event medication. Other medications designed to improve sexual desire in women, testosterone, and Addyi (flibanserin,) are both pharmaceuticals taken on a daily basis, and both have mixed reports on their positive effects on female libido, while bremelanotide (Vyleesi) is in the form of an easy to use sub-cutaneous injectable, similar to the pens used by diabetics and others needing painless self-injectable medications. It is used only when needed (i.e. prior to a possible sexual event,) to significantly improve desire for that event. It takes about 30-60 minutes for full effect. Side effects not rarely can include nausea in about 1/3rd of individuals, which usually is transient (1-2 hours) and subsides. If nausea is present, it frequently subsides after the first couple times Vyleesi is used, but If nausea proves to be a continuing distraction, but the overall effects of Vyleesi are pleasurable, a simple and safe oral anti-nausea medication can be taken prior to or concomitant with Vyleesi injection.

Additional information about Vyleesi may be found on unblush.com or VyleesiPro.com. Vyleesi is the first and only as-needed therapy that has been FDA-approved for the treatment of hypoactive sexual desire disorder (HSDD.) Vyleesi prescriptions may be written by a qualified sexual medicine practitioner only, and go through one of two pharmacies (Avella, or BioPlus) in the U.S. specializing in this FDA-Approved medication. Vyleesi comes in an individual compact one-time use, disposable cartridges with a fine-gauge, non-visible needle. Dr. Goodman or personnel at his office can supply additional information on whether Vyleesi is for you briefly by phone, or for your specific individual situation via an in-person or virtual telephone consultation. Each Vyleesi prescription is for 4 cartridges; co-pay for the first prescription is $0, while copays for additional prescriptions are $99, or about the same as men pay for 4 Viagra or Cialis tabs to improve their erections.

What is the V-Fit Plus system

The V-Fit Plus system is an entirely different adjunct to women’s sexual response. The only similarity to Vyleesi is that it also is designed to improve sexual enjoyment. V-Fit is a home-use “intimate wellness device” without any side-effects, designed to improve a woman’s overall sexual life. Consisting of a vaginally-insertable handpiece designed for easy and pleasurable vaginal insertion, the “working end” of the handpiece contains a series of red LED lights with a wavelength of 662 nm and an energy density of 21 J/cm2 for photo modulation (a light wave therapy in a similar category as LASER light waves) and sonic vibration which may be individually adjusted to 10 modes for customization. The insertable portion of the handheld device is utilized with a photonic gel which helps with device insertion and comfort and is formulated with hyaluronic and aloe. V-Fit+ heats to 40-42 degrees centigrade, providing gentle vaginal warming during each therapy session. V-Fit+ Sessions are every other day and initially about 6-8 minutes long, increasing to 8-10 minutes after the first 1-2 weeks. Time may be increased to 10-12 minutes after 2-3 weeks, continuing for a 2-month protocol.

You pay so much attention to your skin with creams, emollients, scrubs, etc. You pay attention to your finger and toenails, to your hair, figure, and butt. WHAT ABOUT YOUR VAGINA??! Much like the things women do to look and feel good in other areas it is about time that a product became available for women’s vaginas to resurface, rejuvenate, recondition and allow it to “…see the light of day!”

This is basically a home vaginal wellness system with no adverse effects. It is felt that the combination of light in the red wavelength spectrum plus the heat and local vibratory activity serves to maintain and improve the health of both vaginal tissue and the structures (fibrous layers; blood vessels, etc.) beneath it. Manufactured by JoyLux, a small startup company specializing in sexual health, VFit Plus is available only through health care professionals interested in Sexual Medicine. More information may be found at getvfit.com, orFacebook.com/getvfit.