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A changing sex drive is a normal part of life, but there are some women who have a condition called hypoactive sexual desire disorder (HSDD).

It’s defined as a mental and physical sexual dysfunction in which women lack motivation or lose desire to have sex for at least 6 months, causing distress to themselves or problems in their relationships (or both).

The condition may also be referred to as female sexual interest and arousal disorder (FSIAD).

About 10 percent of women live with HSDD. The condition can affect a woman’s quality of life and mental health.

HSDD is thought to be caused by an imbalance in the neural pathways in the brain, according to a 2019 article in Obstetrics & Gynecology. “That imbalance can lead to increased inhibition, decreased excitation, and a diminished responsiveness to sexual cues,” note the researchers.

Certain factors put women at risk for HSDD, including:

  • sexual functioning of a partner
  • medical conditions such as diabetes
  • medication side effects such as commonly used antidepressants or blood pressure medications
  • problems in a relationship, including emotional or physical abuse
  • psychiatric issues such as anxiety and depression
  • menopause

There are two prescription drugs on the market that have been approved by the Food and Drug Administration (FDA) to specifically address HSDD. They are available only for premenopausal women.

These drugs are dubbed “female Viagra,” as a play on the medication for men to alleviate erectile dysfunction. They work in the body in different ways and are also administered differently.

  • flibanserin (Addyi), a pill taken every evening.
  • bremelanotide (Vyleesi), a self-administered injection before sex

It should be noted, the FDA has not approved sildenafil (Viagra) for women to use, but it has been prescribed off-label for a women with low sex drive.

Off-label drug use

Off-label drug use means a drug that’s approved by the FDA for one purpose is used for a different purpose that hasn’t yet been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

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Vyleesi (bremelanotide) is an FDA-approved prescription injection for treating HSDD in premenopausal people who, for unknown reasons, no longer desire to have sex regardless of the sexual activity, situation, or partner.

This medication increases sexual desire but doesn’t help with sexual performance. It also manages HSDD-related distress.

You can take this medication at any time of the day, but it’s recommended to be taken at least 45 minutes before you’ll be having sex. You can only take it once in 24 hours and take no more than eight doses a month.

It’s advisable to stop taking this medication if it doesn’t work for your HSDD after 8 weeks.

The manufacturers warn that people with unmanaged high blood pressure and heart disease should not take this medication. Talk with your doctor about your health conditions and the medications you’re already taking before starting Vyleesi.


Addyi (flibanserin) is the first FDA-approved medication for HSDD in premenopausal people who, due to no health, medication-related, or relationship problems, start having low or no desire for sex, regardless of sexual activity, situation, or partner.

This medication can improve sexual satisfaction but doesn’t enhance sexual performance. It can also increase the desire for sex and reduce distress from low sexual desire.

You can take Addyi according to your doctor’s prescription. You can also take one tablet a day but only at bedtime. Addyi can raise the risk of low blood pressure, fainting, and sleepiness when you take it at other times of the day.

The FDA warns that people who consume alcohol should not take Addyi. If you do drink alcohol, wait for at least 2 hours before taking Addyi at bedtime. Doing otherwise can increase the risk of severe low blood pressure and fainting.

Additionally, wait until the next day before consuming alcohol if you’ve taken Addyi at night.

If you miss a dose, wait until the next day at bedtime to take your next dose.

Talk with your doctor if your HSDD symptoms don’t get better after 8 weeks of taking Addyi.

Both Addyi and Vyleesi work differently than Viagra, says Dr. Puja Uppal, a board certified family medicine physician and the chief medical officer at Think Healthy.


Addyi, manufactured by Sprout Pharmaceuticals, is a multimodal serotonergic agent originally developed for the treatment of major depressive disorder. Unlike Viagra, which works on men’s organs, Addyi targets the neurotransmitters serotonin, dopamine, and norepinephrine.

Addyi was unsuccessful in clinical trials for treating depression, but it was reported to have the side effect of increased libido in female patients, according to a 2017 article in Pharmacy & Therapeutics.


The Vyleesi injection is in a class of medications called melanocortin receptor agonists.

“It’s injectable and works by activating our melanocortin receptor 4 (MCRs) which helps to modulate sexual function,” says Uppal.

Both drugs have shown modest efficacy in trials, but the long-term effect is still unknown.

Addyi was rejected by the FDA twice before it was approved. Once it was rejected because it wasn’t more effective than a placebo. The second time was because of safety concerns. Some studies have shown about 10 percent of women notice a difference with HSDD after taking Addyi, according to the National Women’s Health Network.

A 2017 Pharmacy & Therapeutics article concluded the safety risks of using Addyi, in most cases, will outweigh the small net benefits in improving sexual desire.

So, it depends.

“They are fairly good but aren’t miracle pills for women,” says Uppal. “They do have a large side effect profile, but in the right person they can make a huge difference.


Women with depression and those who drink alcohol should not take Addyi, according to Uppal.

Side effects for Addyi include:

  • dizziness
  • sleepiness
  • nausea
  • fatigue
  • insomnia
  • dry mouth
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The major side effect of Vyleesi is an increase in blood pressure.

Nausea after the injection and during sex was reported by about 40 percent of women in one study. The company’s website says the drug is not for women with cardiovascular disease.

“Women who are taking Naltrexone, a medication used for alcohol or opioid dependence, should not use Vyleesi because it can lead to a failure of Naltrexone,” says Uppal.

Side effects for Vyleesi include:

  • vomiting
  • headache
  • flushing
  • nasal stuffiness
  • cough
  • tiredness
  • dizziness
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Both drugs need to be discontinued if symptoms do not improve around 8 weeks, but your physician can advise on the exact time frame.

In order to get female enhancement pills, you’ll need a diagnosis of HSDD. There’s no specific test for HSDD, rather a combination of factors that lead doctors to diagnose it.

First, your healthcare professional will likely do a thorough medical exam, to rule out any health conditions that may be contributing to your low sexual desire.

Your doctor may diagnose you with HSDD if your low sex drive is causing you distress (this is key to the diagnosis) and you exhibit one or more of the following symptoms for more than 6 months:

  • lack or loss of interest to initiate or engage in sexual activity
  • absence or decrease of spontaneous desire, which is the need to experience sexual arousal
  • not responding to sexual stimulation or cues, which can be visual or related to other senses

Remember, having a low libido does not necessarily mean you have HSDD. “Sex drive varies from one woman to another, and what bothers one might not bother another,” say the medical professionals at the International Society for Sexual Medicine.

According to the Addyi website, an online consultation starts at $19 and a prescription is around $20 a month with commercial insurance coverage. The caveat at the bottom of the page says it’s only for a limited time and for certain customers.

In general, most insurance companies will not cover the cost. There are manufacturer coupons that can be found online to save money on the drug. Be sure to check with your insurance provider, however, because some, like Blue Cross Blue Shield, may cover Addyi. If you pay out of pocket it can cost hundreds for a 30-day supply.

Vyleesi offers a similar promotion. Some patients will not pay a copay for their prescription and no more than $99 for four injection refills, with or without insurance coverage. Paying out of pocket for Vyleesi can cost more than $4,000 at commercial pharmacies.

“Women can have low libido for a number of reasons, such as depression, pain with intercourse, or even from negative associations because of atrophic vaginitis,” says Uppal. “One of the biggest things that a person should know is that this is actually very common.”

According to Uppal, treatments may include psychological interventions, cognitive behavioral therapy, couples therapy, and mindfulness-based therapies.

Depression and anxiety medication may also have some effects on sexual desire. “For women with antidepressant-related female sexual arousal syndrome, bupropion can sometimes help with their symptoms,” adds Drupal.

Experts say combination treatment is the most effective in many cases. Your treatment plan may also include:

  • Introducing new experiences, like having a sensual massage, having sex in the middle of the day, or using sex toys to make your sex life more exciting and increase desire.
  • Sex education or counseling to help you (and your partner) learn why you might be having problems in your sex life, potential solutions to these problems, and better ways to communicate your sexual desires and differences with your partner.
  • Managing stress levels that may affect sexual desire by reducing work and home responsibilities, getting quality sleep every night, exercising, and engaging in other mind-body exercises.

Are female enhancement pills covered by insurance?

According to the Addyi website, most major insurance plans cover the cost of Addyi.

Vyleesi also mentions on its website that insurance may cover the cost of your medication. You can check in with your insurance provider first to see whether your plan covers female enhancement pills.

Can you get female enhancement pills over the counter?

No. Both FDA-approved female enhancement pills need a doctor’s prescription to get them. You cannot get them over the counter.

Who shouldn’t try female enhancement pills?

Avoid taking female enhancement pills if:

  • you’re having menopausal symptoms
  • you have a health condition like high blood pressure, heart disease, or liver disease that can make you prone to developing other potentially serious health problems when you take female enhancement pills
  • you want to improve sexual performance
  • you’re taking medications that can affect the amount of the female enhancement drug in your blood
  • you’re breastfeeding
  • you’re pregnant

If you suspect you have HSDD and you find that this condition is impacting your personal life and mental health, it’s important to talk with a doctor about your options. You may have an underlying health concern that is affecting your libido, such as undiagnosed diabetes.

Female enhancement drugs may not be perfect when it comes to treating women’s waning sexual desires, but they can be a leap forward for women’s health.

Tracee Herbaugh is a writer and journalist who lives in the Boston area. She writes about culture, lifestyle, health, and family relationships. You can view her work online or find her on Twitter.