Women with HSDD seem to experience erotic situations differently than women with normal sexual function.

Some researchers think this happens because they can’t easily dial down the activity of certain parts of the brain. One 2009 study of women with HSDD found that the parts of their brains that were responsible for monitoring internal emotional states were overactive when they watched erotic videos–as if their brains were focused on judging whether their reactions were appropriate, instead of living in the erotic moment. Flibanserin helps to change the balance of active circuits in the brain by acting on the neurons that are normally controlled by two neurotransmitters: serotonin and dopamine.

Neurotransmitters are the chemicals that neurons use to send signals to other neurons. They’re released after an electrical signal moves through a neuron: When the signal reaches the end of a neuron’s axon, it releases the chemicals into a tiny gap between neurons called the synaptic cleft. Neurotransmitters diffuse across the gap and latch onto specific receptors on the neighboring neuron. When neurotransmitters dock into receptors, they start chains of chemical reactions that can help get an electrical signal moving through the new neuron.

Or not. Neurons aren’t simple on/off switches. Some neurotransmitters excite the neurons they dock to and push them toward firing, but others damp down electrical reactions. Every neuron is constantly receiving both types of signals from its neighbors—and the sum of the signals determines whether the neuron fires or not. The interplay between excitatory and inhibitory signals is one of the things that makes brain function so complex, because it allows the same circuits to react differently to a variety of different situations.

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-Clarke, Cohen, Salisbury