Is "female Viagra" right for you?

If you're a woman dealing with low sex drive, there are several treatments that may help. These include two medications, sometimes touted as “female Viagra,” which have been approved by the U.S. Food and Drug Administration (FDA) to treat sexual dysfunction in premenopausal women. 

In August 2015, following a trio of clinical trials, the FDA approved Addyi (flibanserin). Four years later, in June 2019, another medication called Vyleesi (bremelanotide) got the FDA’s go-ahead. Both are available only by prescription. Addyi is a once-a-day pill, while you take Vyleesi via injection as needed, with some restrictions.

Find out how these drugs work—and whether they could be right for you.

Though "female Viagra" is convenient shorthand, neither Addyi or Vyleesi works like Viagra does for men. Viagra treats sexual performance issues by increasing blood flow to help men get and maintain erections. Addyi and Vyleesi work on brain chemicals to increase women’s sexual desire. 

In a clinical trials, women taking Addyi reported between 0.5 and 1 additional satisfying sexual events per month, had slightly more desire for sexual activity, and reported less stress related to low desire compared with women taking a placebo. 

In trials for Vyleesi, around 35 percent of patients taking the drug reported a significant reduction in sexual distress, versus 31 percent on a placebo. Additionally, about 25 percent of Vyleesi patients experienced improvements in sexual desire. Only 17 percent on a placebo did the same. There was no change in the number of satisfying sexual events for women taking Vyleesi.

The drugs are approved for premenopausal women with a condition known as hypoactive sexual desire disorder, or HSDD. It’s thought to affect about 10 percent of adult women and is characterized by a new low sex drive and accompanying personal distress that lasts for at least six months. The issue does not stem from other medical, medicinal, or psychiatric reasons, or problems with a relationship. The type of sexual activity, the partner, and the situation have no effect on desire in a woman with HSDD

"We don’t know for sure, but the mechanism of action suggests Addyi would probably be effective in postmenopausal women," says Keith Roach, MD, an Associate Professor in Clinical Medicine in the division of general medicine at Weill Cornell Medical College and New York Presbyterian Hospital. Neither Addyi nor Vyleesi is indicated for postmenopausal women, however, so it’s best to speak with your health care provider (HCP) for more information.

Addyi can cause low blood pressure and fainting. These effects may be magnified by alcohol, some oral contraceptives, and certain antifungal medications. The medicine should be taken at bedtime to minimize the risk of injury associated with general sedation/sleepiness and loss of consciousness. Women taking Addyi should stop drinking alcohol two hours before a bedtime dose (or skip the dose), and then not drink again until the next day.

Dr. Roach says about 15 percent of women experience these side effects. “Dizziness, somnolence, nausea, and fatigue are all at significantly increased rates compared with placebo,” he adds.

Vyleesi may cause nausea, vomiting, redness of the face, reactions at the site of injection site, and headache. In the clinical trials, about 40 percent of participants experienced nausea and 13 percent needed medication to treat it. Some people may experience a darkening of the skin in certain areas, such as the gums, face, or breasts and the discoloration may remain even after you come off the drug. Vyleesi can trigger a temporary rise in blood pressure, as well. People with cardiovascular disease or uncontrolled high blood pressure should not use the medication.

Some critics contend that the side effects and low rates of improved sexual desire of HSDD drugs outweigh their benefits. Just under half of the women in the Addyi trial said their sexual desire improved while taking the drug, but 38 percent of women taking a placebo said the same. “It was more effective than a placebo, but not a lot,” says Roach. But he adds that a woman prescribed Addyi has a 50-50 chance of improvement, whether it’s due to the placebo effect or not.

It should be noted: The FDA is evaluating Addyi after flagging it in July 2021 for drug hypersensitivity, which occurs when the immune system overreacts to a drug.

“I’ll prescribe the drug to an appropriate female patient who is willing to accept the risks, provided she understands them,” says Roach. He adds that because there is high demand for this treatment, "you’ll find a lot of people willing to accept even high risks of side effects.” 

There are also other options for treating HSSD including sexual therapy, testosterone (for pre- and postmenopausal women), and bupropion (an antidepressant) and buspirone (an antianxiety medication). If you feel any of these treatments may be right for you, talk to your HCP about potential risk and benefits.