Medication Options for Low Sexual Desire

Spontaneous vs. responsive desire

Before deciding your libido is "low," it helps to know there are two normal styles of desire:

• Spontaneous desire shows up out of nowhere — a thought, a feeling, wanting sex before anything sexual has started. This is the style movies portray.
• Responsive desire shows up in response to something — touch, closeness, connection, or getting started. The wanting follows the warming up, not the other way around.

To be clear: this is not "lower your expectations" or "that's just aging." If your desire feels genuinely diminished, if it doesn't show up even once things get going, or if the change bothers you — that is real, it matters, and it's treatable. The point of knowing your desire style is making sure treatment is aimed at the right target. The self-check below helps sort that out: once things get started, does desire show up — and is it working for you? If yes, start with the libido page. If no, keep reading.

Is this actually a desire problem?

Addyi and Vyleesi are approved for one specific condition: hypoactive sexual desire disorder (HSDD) — low desire that developed after a period of satisfying desire, that bothers you, and that isn't better explained by something else. This self-check is adapted from the screening questions clinicians use.

Addyi (flibanserin)

Addyi adjusts brain chemicals involved in sexual desire — serotonin, dopamine, and norepinephrine. Think of it as helping to turn down the brakes and turn up the gas on desire over time. It is not a hormone.

• How you take it: One 100 mg pill by mouth every night at bedtime. It must be taken daily — it does not work on an as-needed basis.
• How long until it works: Up to 8 weeks to notice a benefit. If nothing has improved after 8 weeks, it should be stopped.
• What to expect: In clinical studies, women taking Addyi averaged about one additional satisfying sexual experience per month versus placebo, with improved desire scores and less distress. The benefit is real but modest.
• Common side effects: Dizziness, sleepiness or fatigue, nausea, and insomnia (more common after menopause).

• Medication interactions: Addyi cannot be combined with certain medications called CYP3A4 inhibitors — some antifungals (fluconazole, ketoconazole), certain antibiotics (clarithromycin), and even grapefruit juice. Tell your provider about every medication, supplement, and herbal product you take.
• Liver problems: Addyi cannot be used with any liver disease.
• Driving: Avoid driving or operating heavy machinery for at least 6 hours after your dose.
• How you get it: Your provider and the pharmacy must both hold a special safety certification (REMS), and you'll sign a form acknowledging the alcohol rules.
• Cost: As low as $20/month with insurance; approximately $149/month without, through a specialty pharmacy.

Vyleesi (bremelanotide)

Vyleesi activates melanocortin receptors in the brain that are linked to sexual desire — boosting the excitatory signals involved in wanting sex. Like Addyi, it is not a hormone.

• How you take it: A small self-injection in the abdomen or thigh using a prefilled autoinjector pen, at least 45 minutes before you anticipate sexual activity. Used only when needed — not every day.
• Limits: No more than one dose in 24 hours, and no more than 8 doses per month.
• What to expect: Improved desire and less distress compared to placebo in clinical studies. Like Addyi, the benefit is modest.
• Nausea is the most common side effect — about 40% of women with the first dose. It usually improves significantly after that first injection and typically lasts about 2 hours. Some women need anti-nausea medication.
• Other side effects: Facial flushing, injection site reactions, headache, vomiting.

• Skin darkening: Some women develop hyperpigmentation — on the face, gums, or breasts. It's more common with darker skin tones and may not fully fade after stopping.
• Alcohol: Unlike Addyi, there are no alcohol restrictions.
• How you get it: Specialty pharmacies only. No REMS certification required.
• Cost: Expensive, and may not be covered by all insurance plans, including government insurance.

How do they compare?

What else should you know?

• Medication works best as part of a bigger picture. Many women benefit most when medication is combined with the approaches on our libido page — and sometimes counseling, sex therapy, or couples therapy. We may recommend this as well.
• Set realistic expectations. Both medications offer a modest improvement — not a magic fix. Many women notice a meaningful difference, but the change is gradual and subtle for most.
• Give it a fair trial. For Addyi, take it consistently for at least 8 weeks before judging. For Vyleesi, try several doses — the nausea usually gets much better after the first time.
• There's no reason to continue a medication that isn't helping. Talk to us if you have questions, side effects, or aren't noticing benefit.