Types, how they work, and side effects

Sildenafil (Viagra) treats erectile dysfunction in males. In the United States, two drugs have been approved to treat low libido in females. Some people call these medications “Viagra for females.”

Viagra is the trade name of a drug called sildenafil, which treats erectile dysfunction in males. Sildenafil can also treat pulmonary arterial hypertension in a person of any sex.

About 10% of females have a low sex drive. Some may take Viagra, off-label, to treat this condition, which was once called “hypoactive sexual desire disorder,” but is now called “female sexual interest/arousal disorder” (FSIAD).

The Food and Drug Administration (FDA) have approved two drugs — flibanserin (Addyi) and bremelanotide (Vyleesi) — to address low desire or arousal in females. However, both are approved for use only in people who have not yet entered menopause.

This article describes the FDA-approved medications, including how they work and the possible side effects. It also explores alternative approaches.

The FDA has approved two drugs to address FSIAD:

Vyleesi (bremelanotide)

The FDA states that this medication can treat FSIAD in premenopausal females.

A person injects it into their thigh or stomach at least 45 minutes before having sex. The effects can last for up to 24 hours. People should not use the drug more than eight times per month.

Addyi (filbanserin)

Addyi was the first drug approved to treat FSIAD. Like Vyleesi, Addyi is designed for premenopausal people, but it comes as pills, not an injection

A person takes this drug daily before bed, even if they do not intend to have sex that day.

It can take up to 8 weeks to see an increase in sexual desire, although some people experience the effects much sooner.

Comparison table

The table below compares Vyleesi and Addyi:

Viagra is not FDA approved for use in females. To understand why, it can help to understand what Viagra was designed to do in the male body.

Usually, after sexual stimulation in a male, there is a release of nitric oxide, which increases levels of a regulatory agent in cells called cyclic guanosine monophosphate (cGMP).

This increase in cGMP causes smooth muscle relaxation, and it leads to increased blood flow to the penis, resulting in an erection.

In males, an erection goes down when an enzyme called phosphodiesterase type 5 (PDE-5) breaks down.

The active ingredient in Viagra is sildenafil. It blocks the action of PDE-5. This means that blood flow to the penis is increased, resulting in an erection that lasts longer.

Sildenafil is also the active ingredient in a drug called Revatio. This blocks PDE-5 in the smooth muscle of the lungs, which can help treat pulmonary arterial hypertension in a person of any sex.

Viagra is approved to treat erectile dysfunction in males. As the manufacturer states, Viagra is not FDA approved for females, including those who are pregnant.

According to 2014 research, Viagra may increase blood flow to the genital area in females, as well as increase sensitivity in the area. However, little data indicates that it is safe or effective for females, and the FDA has not approved it for this use.

In some cases, a medical professional may prescribe sildenafil off-label to treat FSIAD if it stems from the use of antidepressants, such as selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.

A new trial to test a sildenafil topical cream for premenopausal females began looking for participants in 2020, and as of this article’s publication, it is still recruiting participants.

Although Viagra is not FDA approved for females, Revatio, which also contains sildenafil, is. This drug can treat pulmonary arterial hypertension.

Anyone who would like to try Viagra should ask a medical professional, who may prescribe the drug off-label.

Learn what “off-label” means here.

Other drugs that are not FDA approved

Some people with FSIAD try medications that the FDA has not approved for this use.

Specific medications may target different causes of FSIAD. A female with low sexual arousal resulting from antidepressant medication should talk with their doctor about other depression treatment options, such as bupropion (Wellbutrin, Zyban) or mirtazapine (Remeron).

The FDA has only approved Vyleesi and Addyi to treat FSIAD, and only in premenopausal females. For people who are going through menopause or have gone through it, estrogen replacement therapy may help boost low libido.

Studies have suggested that adding testosterone to estrogen therapy may help improve FSIAD.

Research shows that Addyi changes the brain’s serotonin system and indirectly affects dopamine. When low sexual desire or arousal is linked with serotonin levels in the brain, Addyi may be effective. Dopamine is a neurotransmitter linked with motivation and pleasure.

Vyleesi targets melanocortin receptors, which are linked to sexual function. The drug modulates the brain pathways involved in sexual response.

The FDA describes two placebo-controlled trials that have shown statistically significant increases in sexual desire and arousal among females who used Vyleesi.

Addyi lasts for around 11 hours. If a person has even a mild liver problem, it can last for 26 hours. Taking the drug with food increases its absorption into the body.

After 3 days of taking the medication, there is a steady level of the drug in the body. However, some people do not metabolize CYP2C19, an enzyme protein, effectively, and this can cause levels of the drug to build up, resulting in side effects.

Vyleesi lasts around 2.7 hours, and the average time it takes to clear the body is 6.5 hours. The drug may slow how fast the body can process other medication.

Vyleesi and Addyi treat FSIAD in premenopausal people. No research has tested the drug in people during or after menopause.

Approximately 41 in 100 premenopausal people globally may have one or more types of sexual dysfunction. And only 21 of 100 who have this type of condition discuss it with a healthcare professional.

The female sexual experience involves a number of different factors. These are:

  • Biological: Factors such as hormone changes, anatomical features, and medical conditions can affect sexual response.
  • Psychological: Depression, anxiety, trauma, and negative thoughts or memories can affect sexual activity.
  • Interpersonal factors: This involves the relationship, including the quality of communication, with a partner.
  • Sociocultural factors: Some examples include a person’s thoughts and attitudes about sex and about changes to their body, as well as social, cultural, and religious values and beliefs about sex.

There is no “normal” number of sexual thoughts or experiences. And there is no clinical point at which sexual desire becomes “low.” A person has low libido if they feel distressed by what they consider a lack of interest in sex.

A person who may benefit from “Viagra for women” is someone who feels that their sex drive is low and wants to have more sex.

This may include people who:

  • take medications that affect sexual desire
  • experience sexual boredom
  • suddenly feel less interested in sex

The United Kingdom’s National Health Service (NHS) mentions that the following are linked with a reduced sex drive in females:

The FDA-approved drugs for FSIAD can have the following side effects.


The side effects of this drug include:

  • drowsiness
  • dry mouth
  • nausea
  • dizziness
  • fatigue
  • insomnia

The following people should avoid Addyi:

  • those with liver conditions
  • those taking oral contraceptives
  • those taking CYP3A4 inhibitors
  • those who are nursing
  • those who have consumed alcohol in the last 2 hours

The drug can cause severe low blood pressure and fainting in people who take it with alcohol or who have liver conditions.


Vyleesi’s side effects include:

  • nausea and vomiting
  • flushing and hot flashes
  • irritation or a rash at the injection site
  • headache
  • flu-like symptoms
  • fatigue
  • dizziness
  • darkening of the skin, resulting in dark spots called hyperpigmentation on the gums, face and breasts
  • high blood pressure
  • a decreased heart rate
  • tingling

Vyleesi may reduce the efficiency of oral medications due to slower emptying of the gastric system.

It can also make drugs containing naltrexone to treat alcohol and opioid addiction less effective, so anyone taking a drug that contains naltrexone should avoid Vyleesi.

Finally, like other drugs, Vyleesi and Addyi can cause allergic reactions.

Anyone concerned about their sexual health should contact a healthcare professional for advice and information about the possible causes and treatments.

A person can buy drugs online but this is not recommended due to a lack of safety protocols on websites.

Sexual desire is complex, and low libido may not be something that medication can address. Trauma, unsatisfying sex, an unsympathetic partner, or boredom can each reduce desire.

More specifically, a 2017 study found that the following factors can reduce libido:

  • feeling pressure to conform to social norms of sex, including religious mandates
  • ever having had a sexually transmitted infection
  • not feeling emotionally connected with a partner during sex
  • having a partner with a history of sexual difficulties
  • having trouble talking about sex
  • not sharing sexual interests with a partner
  • having the same partner for more than 1 year

When low sexual desire results from any or a combination of these factors, medication may not be effective.

Some alternatives to medication, depending on the cause of low libido and a person’s preference, could include:

  • mindfulness-based cognitive therapy to address any trauma or negative feelings about sex
  • cognitive behavioral therapy for partners in heterosexual and same-sex relationships
  • open communication with a partner about sexual desires and preferences
  • exploring new sexual fantasies, toys, and techniques
  • natural alternatives to medication, including ginkgo, maca root, and ginseng

Check with a healthcare professional before trying the natural alternatives above, as each may cause interactions with medications.

Heterosexual stereotypes can also be problematic. One partner may believe that intercourse is the only, or best, type of sex, while the other partner may feel more pleasure and interest in other forms of sex.

A 2015 study showed that most females need or prefer clitoral stimulation to have an orgasm. Prioritizing this, such as with oral sex or manual stimulation during intercourse can make intercourse more pleasurable for some females.

Can any supplements boost libido?

The FDA warns against trying over-the-counter products marketed as libido-boosting supplements. These may contain ingredients in prescription drugs that are not advertised on the supplements’ labels.

However, one study found that older premenopausal females who took dehydroepiandrosterone, or DHEA, supplements reported improvement in their sexual function.

However, ensuring that this supplement is safe and effective requires more research.

Low sexual desire or arousal is complex and can stem from many causes. It may, for example, stem from a combination of hormonal shifts, relationship changes, physical challenges, and negative experiences.

A person can experience sexual dysfunction at any age. Medication may not treat all causes of low sexual desire. A knowledgeable, compassionate healthcare professional can help address concerns and recommend next steps.


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