Is the “Female Viagra” Revolution Finally Here?

“Why does nobody know about the little pink pill?” Anika Ackerman, MD, a board-certified urologist asks on TikTok.

A decade after its release, a flurry of viral videos are suddenly talking about a drug dubbed female Viagra. Why now? As female pleasure becomes more centralized (or female orgasms, at least—Babygirl, anyone?), more women are examining the anatomy of their desire.

Margaret is one of those women. “I’d always felt like something wasn’t normal about my libido, and I mourned that, always,” she tells me over email. “It felt like I was missing half of life that everyone got to have.” As a teen and into her 20s, she waited for the feeling to hit her. Even when she lost her virginity at 23, it was just a box she checked off, she says. Then in her 30s, she met her husband and hoped it could be different.

At first, she coasted—when they had sex she was usually dry and the stray orgasm was “okay,” but their emotional connection held them together. After a couple of years, however, their fights began to escalate. “I enjoy sex with him, I just never had that feeling of needing to have it.” She saw a chasm growing and went to the doctor looking for solutions, but as a healthy woman in her 30s, her doctor didn’t offer anything other than “a shrug and the medical version of ‘Well that sucks.’”

She became desperate, feeling like her biology had failed her and wanting to save her marriage. She remembered an Instagram ad for a female libido drug called Addyi, paid $25 for a telehealth visit and $250 out of pocket for a three-month supply and received the prescription within a week.

You may recall that Addyi was dubbed “pink Viagra” upon release in 2015. “ One of the first headlines for us was ‘Female Viagra? Isn’t that jewelry?’” Cindy Eckart, founder of Sprouts Pharmaceuticals (the maker of Addyi) and The Pink Ceiling, a venture capital firm that invests in women-focused companies, told me over the phone. She has the remnants of a Southern twang, a warm voice, and a smooth delivery that reminds me I’m speaking with a billionaire.

The truth is any medication meant to treat female sexual dysfunction—for which there are two FDA-approved drugs, Addyi and Vyleesi (which got its FDA approval in 2019), as compared to the 26 for men—works in vastly different ways from Viagra.

[Addyi] works to slowly boost desire in the brain by actually putting some breaks on the overthinking that women do and clearing out that prefrontal cortex to allow for sex. —Heather Hirsch, MD

Addyi functions similarly to an antidepressant, by selectively increasing dopamine and slightly decreasing serotonin. Taken daily, the nonhormonal drug is only approved for premenopausal women, although Eckart assures me she will get it approved for menopausal women, too (in Canada it’s already approved). “Between the two of us, I don’t think your insurance company is really keeping track of when you go into menopause,” says Kim Einhorn, MD, a board-certified ob-gyn in a TikTok about Addyi. In other words, there’s a chance you could get it approved. “It works to slowly boost desire in the brain by actually putting some breaks on the overthinking that women do and clearing out that prefrontal cortex to allow for sex,” says Heather Hirsch, MD, a board-certified internist and the founder of the menopause clinic at Brigham and Women’s Hospital in Boston.

Viagra widens blood vessels to allow more blood flow to the penis, like a wrench loosening a screw. Addyi does telekinesis on that screw.

This difference has puzzled drug makers. After the blowout success of Viagra, Pfizer began the development of a female equivalent. It dropped the project in 2004, reporting that despite signs of physical arousal in women, it didn’t change their desire for sex. “Women can take Viagra and increase blood flow in their genitals, but they won’t notice it and they won’t make meaning of it,” says Debra Wickman, MD, a board-certified gynecologist and sexual health expert.

Colloquially, there’s a blurry distinction between arousal and desire. Shannon Chavez, PhysD, a licensed sex therapist in Beverly Hills, explains that arousal is usually a physiological response to stimulation (e.g., you get wet), whereas desire is sexual motivation, a sexy, sometimes fleeting thought. It’s not strictly sexual—it could be desire for connection or to feel seen.

This is why female libido medications aim to tinker in the brain, rather than the genitals. But the conversation around Addyi is fraught. Many experts I spoke to are wary of the drug: skeptical of its effectiveness and adamant about a holistic approach to libido.

Addyi has garnered criticism for its modest efficacy—one study found it improved sexually satisfying events by 1.6 to 2.5 times per month—but, as Hirsch says, if you’re going from no sex to once or twice a month, that’s a 100 percent improvement. “More often it’s very subtle. You might be doing the dishes, have a sexy thought, and think, Oh that could be fun,” Hirsch says.

“The mistake women make is taking Addyi and waiting for desire to hit them,” Wickman says. First, she focuses on intentionality with her patients. “If it’s your intention, you can stimulate the sensual aspects—sight, sound, touch, smell, memory—all those things can evoke past episodes of arousal.”

Then there’s the placebo. “Whenever there are studies on sex responses, there is a massive placebo effect,” says Sarah McKay, PhD, a neuroscientist in Australia with a special focus on women’s brain health. One meta-analysis found that placebo accounted for 68 percent of the effect of drugs like Addyi and Vyleesi. This doesn’t negate their efficacy—our brains are just mighty!—but it’s a big clue: “What’s happening outside the bedroom is happening inside the bedroom,” McKay says.

We’re more multifaceted in arousal. We can get turned on by many, many more things… Women can think themselves off. —Shannon Chavez, PhysD

A high placebo effect cements that our desire can be shaped by context and beliefs. “We’re more multifaceted in arousal. We can get turned on by many, many more things,” Chavez says. While men can have two types of orgasms—condensed and sporadic—some intimacy experts, like Susan Bratton (who calls herself the orgasmanaut), think we can have up to 20. Chavez knows of 12, which she lists off neatly, beginning with the standard clitoral, G-spot, but then swerving to core-gasm, A-spot orgasm, multisensory orgasm, and eventually finishing with: “ Women can think themselves off.” (That comes from a 2004 study published in the journal Brain Research, in which scientists put women paralyzed from the waist down in an fMRI scan and watched them think themselves into orgasm.) There’s a long silence on my end.

In theory, the possibility for female pleasure is infinite, but Wickman says she sees many women adopt the “let’s just get this over with” approach. “That’s so negative for desire because it’s boring,” she says.

Overwhelmingly, the doctors I spoke to agreed on one thing: that a medication like Addyi should be implemented as part of a holistic approach to increase desire. Before any prescriptions, Wickman recommends her patients go on a gym date with their partner, citing a study in the Journal of Sexual Medicine that found up to six hours of physical activity a week led to lower sexual distress and more clitoral sensitivity for women. She says she has all her patients on nitric oxide supplements because it improves blood flow, and on vitamin D3 for its many effects, like improving insulin sensitivity, inflammation, and energy. She only resorts to medication (like Addyi) as a last resort within a holistic protocol.

 Please show me a time in which an insurance company has ever requested that a man fail marriage counseling before he gets a medication. —Cindy Eckart

At the same time, Eckert has made a career of pushing back against the onus on women to interrogate all parts of their psyche before they have the option to treat their biology: “My view on the holistic approach is that we’ve overindexed on talking to women about the psychological factors and we’ve dismissed the biological basis that millions of women could be struggling with.” She cites a case where Blue Cross Insurance sent a note back to a doctor saying that they would cover Addyi only if the patient first failed marriage counseling. “ Please show me a time in which an insurance company has ever requested that a man fail marriage counseling before he gets a medication,” Eckert says. She argues sexism is the reason why the establishment refuses to cite biology when discussing female arousal. Eckert’s twang becomes twangier. I feel her frustration.

To get a prescription of Addyi or Vyleesi, the FDA put up flimsy guard rails to ensure it’s a biological need, rather than psychological: You must have a diagnosis of female sexual desire disorder (FSIAD) (which exists beneath the umbrella term hypoactive sexual desire disorder, or HSDD). It’s defined by the The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a “distressing” lack of desire for at least six months—and it cannot be due to a variety of factors like a mental disorder, severe relationship distress, or “other significant stressors.”

This oblique definition asks doctors to cleave sex from any lifestyle or psychological factors. “It’s unusual to find somebody that doesn’t have anything else that could contribute to this lack of desire,” Wickman says. In 2021, the American Psychiatric Association found that 10 percent of women, or roughly 17 million women in the USA experience HSDD (the term more commonly used colloquially and in medicine).

While reporting this story, I found myself pitting the two schools of thought against each other—the biological versus the holistic approach. Where’s the sexism? Who are the bad actors, who are the stuffed suits? When it comes to women’s medicine, especially sexual medicine, it’s hard to trust anything when for so long women’s bodies have been treated as a niche, worth investigating only if it’s profitable.

The lack of research has obfuscated our understanding of female sexuality, making it seem inscrutable, too complex to ever understand. “There is nothing complex about women’s sexuality other than how we perceive it,” Chavez says. Perhaps Addyi marks a pendulum swing toward more studies on female sexual health. A tide change that means women like Margaret are not left behind.

After taking Addyi for around a month, Margaret began to see the full effects. “I was getting more sensitive, I had more interest, and orgasms started getting better and more intense.” Her insomnia was gone, and she felt connected to her husband again. She tells me about going to do some early-morning grocery shopping and sitting in the parking lot, holding back tears of relief. “It meant to me that yes there was a biological reason why I was missing that part and not broken from past experiences,” she says.

After three months on the drug, she says she never wants to stop taking it. “It changed everything for me. I feel more confident, braver and assertive. I’m more honest with him about what I like,” she says. “It has helped saved my marriage, that’s for sure.” She only wishes she’d seen that Instagram ad sooner—or that her concerns had been taken seriously by her doctor.

Why don’t more doctors prescribe it? “They’ve never heard of it. They don’t know how to talk about sexual health. It’s a lack of training, a lack of prioritization of women’s sexual health during residency. That’s it, hands down,” Chavez says.

There is hope. Hirsch, Wickman, and McKay all talk about the 10-year backup that happens with women’s sexual medicine. There’s pushback and misinformation and conspiracy, but after ten years the literature is unequivocal and the world adjusts. “This is like a revolution. Ten years ago? We were not here at all,” Hirsch says.

Addyi was approved in 2015. We’re two months into 2025. We’re close, right?