Managing Expectations for Libido Medications

Perhaps the one thing Viagra and Addyi have in common is that both reify unrealistic, normative standards for what sexual behavior should look like. Viagra gave us the narrative that male sexuality is mechanical, a simple on-off switch—that what matters for men is not their desire, but their erections.

Why the FDA rejected Addyi twice

Critics say that the way it has been defined in the psychological literature—as a lack of sexual fantasies and spontaneous interest in sex—doesn’t reflect how most women experience their sexuality. Judging women by this male-centric standard, said Brotto, risks pathologizing huge swaths of women who fall within a normal range of sexuality, selling them a drug, and calling it feminism. By forcing Addyi into a Viagra-shaped box, both the FDA and the drug’s makers have only increased confusion over the role of desire and arousal in female sexuality. Addyi’s website spotlights women who don’t feel physical desire and whose bodies don’t respond during sex—in other words, women with arousal problems, which Addyi doesn’t address. Sprout’s previous marketing campaign, “Even the Score,” argued that there were 26 drugs for male sexual dysfunction, but none for women, ignoring the fact that Addyi tackles a very different problem than Viagra. Meanwhile, the way people talk about Addyi narrows the conversation around female sexual problems, says Brotto. If drugs like Addyi are the only tools doctors have to offer, she worries, they’ll reach for them before determining what other factors might be leading to a patient's lack of lust.

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“If all you have is a hammer, right?” she said. The gendered narratives behind these pills obscure the fact that desire and arousal, mind and body, are involved in every sexual experience. They erection tablets also obscure the fact that the real female Viagra is, well, Viagra. In people with vulvas, Viagra works in exactly the same way, pumping blood to the genitals and leading to clitoral and labial swelling. Researchers are currently investigating the use of topical sildenafil (the generic form of Viagra) gel to increase sensation, arousal, and orgasm in women. And while Addyi has mainly been tested in heterosexual, pre-menopausal, partnered women, there is no reason it can’t be used in queer women, post-menopausal women, gender-diverse folks, and yes, men (who, it turns out, also have brains). Once we get beyond the his-and-hers, pink-and-blue branding, it’s clear that, like sexual pleasure, these drugs have no gender. Fifteen years ago if you’d told me that my mission for women’s sexual health to receive equal consideration would be the subject of a independent documentary I would have laughed. “It’s just science” I would have said…. Never did I anticipate all of the roadblocks, personal attacks or blatant misinformation that were going to be part of this path to equality.

Aspect	Description	Usage Frequency	Intended Benefits
What is the Pink Pill	A supplement or medication aimed at improving women's health	Daily, Weekly, As prescribed	Enhances mood, energy, libido
Main Ingredients	Melatonin, herbal extracts, vitamins	varies	hormonal balance, vitality
Target Audience	Women aged 25-50	N/A	Women's health improvement

Nor did I expect three absolutely incredible, award winning, female filmmakers to reach out and tell me they were making a film about it. I didn’t want to revisit the past when it’s been 15 years of telling myself just look forward.

• The pink pill can improve blood flow, leading to increased arousal.
• It may help with vaginal dryness or discomfort during intimacy.
• Psychological factors, like stress, also influence its effectiveness.
• Combining with counseling or therapy can enhance results.

But they reminded me that sometimes you have to go back to the beginning to break the future wide open. That is why they chose to make this film. They are on the same mission as I am. As are all of the incredible doctors, advocates and women in this film who are my inspiration to continue to show up and fight for what’s right. It’s the stuff of movies as they say… Streaming March 6th Paramount+ @thepinkpillfilm Everywoman Studios I cannot WAIT to meet you tonight Cindy Eckert on the pink carpet, Cindy. I’ll be proudly PInK and I’m genuinely obsessed with joining your fight to close the gap in awareness, fundingh, and seriousness around women’s sexual health.

• Pink pills are sometimes associated with the "pink economy" in sexual health.
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As someone who has spent decades listening to women’s stories about how intimacy and desire caused a marriage breakdown….I’m honored to stand beside you and use my LOUDEST voice to spread awareness for the PINK pill! How did I not even know myself about Addyi myself???

What does finally receiving FDA approval for Addyi in post-menopausal women mean for women’s health?

She ate a cookie afterward?—was never fully defined. “That was asinine,” said Dr. Anita Clayton, a psychiatrist and expert in female sexual problems at the University of Virginia, who worked as a paid consultant for Addyi. “Women will not know what you're talking about. They will not be able to rate this.” While Addyi failed its first two FDA trials, the third showed a modest increase of about one “event” per month, which was deemed significant enough to lead to its approval in 2015.

Learn to recognize the signs of HSDD in your patients.4

This, for some, was gender parity: “I took on the government for women’s sexual pleasure,” Cindy Eckert, the founder of Sprout Pharmaceuticals, which developed Addyi, says in the film. The answer says a lot about how medicine has struggled to imagine male and female sexuality—and how gendered assumptions continue to shape the medical interventions we have today. Viagra solves a plumbing problem, pumping blood to the penis until it swells, like blowing up a balloon. Addyi, by contrast, works on the brain, adjusting levels of neurotransmitters, like dopamine and serotonin. While the drug was initially explored as an alternative antidepressant, it instead showed a promising secondary effect in women: it seemed to boost low desire, defined as a troubling lack of spontaneous thoughts and fantasies about sex.

Does Addyi interact with foods or drinks?

In other words, Viagra gets the juices flowing; Addyi, ostensibly, generates the fantasies. “In no way is there really a similarity, except that they both treat a type of sexual dysfunction,” said Clayton. (Clayton, who appears in the film, has consulted for numerous pharmaceutical companies. I was also listed as a consultant on the film, as was my book Vagina Obscura, but I had no part in the narrative.) In biological terms, Viagra is an arousal drug; Addyi is a desire drug. Desire is the match; arousal is the flame. Side effects are horrible with Addyi, my blood pressure went way low I almost passed out. Thank goodness my sex drive came back naturally. Cannot wait to watch Cindy Eckert you are MY inspiration behind Lorai Health, and I just keep telling myself you did it, we - my cofounder Raisa Monteiro - can do it too. You have done incredible research and the amount of work and effort you have into women's health is very inspiring. Women outside the industry dont believe it because it is inconcibible. But we will not stop until every women is able to receive the right care.

Before Using

So in 1998, when Viagra’s blockbuster success set off a gold rush for a similar drug for women, researchers ran into a problem: they had no female version of erectile dysfunction to target. They tried valiantly to isolate one, using electrodes and infrared cameras to measure arousal factors like vaginal engorgement, blood flow, lubrication, and clitoral erection. But nothing proved as obvious or easy to measure. Part of the problem was, the split between arousal and desire isn’t quite as neatly defined as the cake analogy would suggest. Arousal is usually thought of as what’s happening in your body in the moment, explains Lori A.

Less common

Brotto, a psychologist at the University of British Columbia and expert in female sexual problems. But researchers still disagree on how to measure it, and whether it can also include “feelings of mental excitement,” leaving “little agreement about the most intrinsic features of this construct,” three psychologists wrote in 2013. The chief complaint among women is not lack of arousal, but lost desire, according to Dr. Irwin Goldstein, an influential sexual health researcher and paid proponent of both Viagra and Addyi, who also appears in the film. “Most people don’t walk in saying, ‘I don’t swell sufficiently,’” he told me. Thank you Cindy Eckert for a cool decade of blood sweat and tears for the very first SexDrug (and Rock n Roll) for us....and to push and push uphill against to get the December 2025 approval was just monumental.

Boxed Warnings with Addyi

Think of it like this: When you crave a birthday cake—imagining the funfetti frosting melting on your tongue—that’s desire. When your mouth waters and your stomach gurgles in response, that’s arousal. Aisling Chin-Yee, the Canadian filmmaker behind the documentary, is aware of the distinction. “It is super cringey to call it the female Viagra for so many reasons,” she told me. (More reasons: Addyi has to be taken every night, not just when one might want to get busy, can’t be combined with alcohol, and might make you faint.) Starting the film with the comparison, she says, gives viewers a launching-off point to consider the double standards at play in the fight to get Addyi into doctors’ offices and women’s medicine cabinets.

Keys to patient success

But while the film does explain Addyi’s mechanism of action, framing a female desire drug as the equivalent of a male arousal drug echoes ancient assumptions about the nature of male and female sexuality. The implication is that for men, sexual problems are all in your penis. But for women, they’re all in your head. If you had a problem with your sex life in the 1950s, you were likely one of two things: impotent or frigid. Both sounded more like a character flaw than a medical diagnosis.

Are you currently using Addyi (flibanserin)?

(“Frigidity” goes back to Freud, who first invented the “vaginal orgasm” and then deemed anyone who didn’t achieve it “frigid.”) But you could say the playing field was even. Both male buy cenforce 120mg and female sexual problems were “all in your head”—that is, under the purview of psychology. The two branched off in 1992, when the National Institutes of Health replaced the wince-worthy “impotence” with the more respectable “erectile dysfunction,” defined as an inability or difficulty maintaining an erection over a period of six months or more. Suddenly, a hard penis was the proxy for healthy male sexuality. While “frigidity” eventually fell out of favor, there was no equivalent effort to replace it. Thanks for the courage I know it took to do this film. If you told me 30 years ago that women were at risk of having their genitals removed due to vulva cancer which happened to myself and other women. Still 30 years later women seem reluctant to open the conversations of the importance of vulval health.