What's the deal with "female Viagra"?

If she had a tablet she could prescribe women for low libido, consultant gynaecologist and psychosexual therapist Dr Leila Frodsham often tells her patients, she’d be on a yacht rather than working in the NHS.  

“I would love it if I had a one-size-fits-all solution,” says Dr Frodsham, who is also a spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG).  

Such a thing doesn’t really exist—but that’s not for lack of trying.

There are now two drugs available in the US for treating low libido in people with vulvas, but while both have been dubbed “female Viagra”, neither have reached the same level of efficacy or uptake as the little blue pill.  

Nor have the wave of over-the-counter supplements, gels and creams available on either side of the pond appeared to really take off, either.

It’s estimated that one in three women will find low sexual desire a problem at some point, so for all these efforts, how come none of these solutions have hit the mark? 

For one, the licenced drugs don’t appear to work very well.  

Addyi was licenced in 2015 and not only shows limited efficacy but was found to significantly increase the risk of side effects, including dizziness and nausea. It also can’t be taken with alcohol.  

“[There’s] evidence that if you take it, and you don’t have any of the hideous side effects…then it can raise episodes of sexual contact by one episode per month, which isn’t actually fabulous,” says Dr Frodsham, who was asked to give her opinion on behalf of the RCOG when the drug was being considered for licensing in the UK.

Addyi appears to work by balancing neurotransmitters that are responsible for sexual excitement, a nod to the fact that sex drive starts in the brain.

Then, there was Vyleesi, a self-administered injection that was licenced in 2019 and also works by stimulating brain receptors. The evidence isn’t super compelling here, either: according to the FDA, just 25 per cent of people within the clinical trials had an increase of desire by at least one point, compared to 17 per cent of people who were given a placebo.

There are no drugs currently licenced in the UK for low libido, but menopausal people who are experiencing this as a symptom can be prescribed hormonal treatments that may help. Non-hormonal treatments, such as sex therapy, are also available, Dr Frodsham adds.

“People have cottoned on to the fact that how women feel and the dopamine levels in our brains are very important for libido,” says Dr Catherine Hood, speciality doctor with a background in sexual health and sex therapist. “But it’s not just about the brain, you can’t just mess around with the dopamine levels and everything will be fine, which is probably why [the drugs licenced for libido] had mixed results.”   

Because there are so many different factors that influence how we feel about sex and, ergo, our sex drive—from our stage of life to our medical history, to how tired we feel on a given day—there isn’t really one quick libido fix that will work for everyone, Dr Hood adds.  

Relationship problems, for example, simply can’t be solved with a pill.  

Plus, even if a pill did help with one thing that influences sex drive, this is one part of a bigger picture and still might not be enough to have an effect.  

“You can make somebody’s hormonal life absolutely perfect, but if they are resentful towards their partner, or they have experienced sorts of sexual trauma in the past, it may still not make them want to have sex,” says Dr Hood.

But perhaps the biggest reason why we don’t, and perhaps will never, have a Viagra for women is because Viagra isn’t actually proof that a single drug can boost libido across the board.  

“All Viagra does is it improves the erection once it’s there. If libido and desire is low, it doesn’t give you an erection,” says Dr Frodsham. “If you feel that your erection is going to work, then you’re going to be more likely to try and have sex, aren’t you?” 

In other words: Viagra doesn’t create desire but can contribute to it.

Similarly, while products for people with vulvas with a physical effect don’t create desire, they can help to trigger it by making sex easier or feel more appealing—for example by making us feel sexier or more comfortable. “It’s kind of like a feedback loop,” says Dr Hood.

For Kailey, 35, the physical sensation that came from Vyleesi helped her reconnect with her libido. Despite her wanting to want sex and being happy in her marriage, her libido completely dropped off after she had her two children.  

Kailey was eventually prescribed Vyleesi, and despite the initial side effects of a racing heart and feeling flushed, she says that it’s been a great help.  

“This sensation just washed all over my body,” she says. “It wasn’t like I was ravenous, like I needed to pounce on my husband. But it was like, all the nerves in my body were so sensitive that…you could have an orgasm just from the slightest movement.”

For Barbara, a postmenopausal woman who is “reigniting her sex life”, lube is enough to do the trick. “It gets me where I want to go fast and it’s no mess—no cleaning up required afterwards so I can go straight to sleep,” she says.  

Instead of trying to find a single pill to sort us all out, then, it may be more helpful to think of sex drive as a collection of moving parts within a bigger picture that’s unique to each person.  

“For women, whether or not they engage in sex is really like a balance between the things that push us away from sex and the things that pull us towards it,” says Dr Hood.  

“As much as a drug company would love to come up with a drug that tackles all of this, they haven’t yet been able to do it...I don’t think they ever will.”  

There are plenty of books available, full of tips to help spice up your love and rekindle the romatic flame in your relationship. 

Read more: 5 Ways to boost fertility

Read more: How do non-monogamous relationships work?

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