Ten Years On: Why Is Women's Desire Still a Medical Blind Spot?

Viagra arrived in 1998. The first medicine for low sexual desire in women arrived in 2015, after being turned down twice. And it was only in December 2025 that US regulators approved it for women after menopause. If you have ever felt that women's desire is treated as an afterthought, you have a point. Here is the story behind it, and what it means if your own desire has quietly faded.

A Decade-Long Fight for One Small Pill

The drug is flibanserin, sold in the US as Addyi. The FDA turned it down in 2010 and again in 2013, citing a modest benefit and side effects such as dizziness, nausea and low blood pressure, particularly with alcohol. It was finally approved in 2015, but only for women who had not yet been through menopause. A second medicine, an injection called Vyleesi (bremelanotide), followed in 2019.

That left a striking gap. Low desire is one of the most common sexual concerns women report, and it becomes more common in midlife. In a large US survey, around 1 in 8 women aged 45 to 64 had low desire that caused them real distress, the point at which it may be diagnosed as a disorder. Yet for a decade there was no approved medicine for women after menopause at all.

On 15 December 2025, the FDA extended Addyi's approval to postmenopausal women under 65 with hypoactive sexual desire disorder. Women's health specialists welcomed it as long overdue, and many said openly that women's sexual health had been neglected for too long.

Normal Variation or a Diagnosis?

Before going further, one point matters more than any other. Low desire is not, by itself, a medical problem. Desire naturally rises and falls with age, health, stress, relationships and life stage, and there is no "correct" amount you should be aiming for. Many women with lower desire are perfectly content.

Doctors only consider a diagnosis when low desire is persistent and causes you personal distress. Different systems name it differently. Many clinicians and the US drug labels use the term hypoactive sexual desire disorder (HSDD). The American psychiatric manual, DSM-5, combines desire and arousal into a single diagnosis called female sexual interest/arousal disorder. Both require that the change bothers you, not your partner, your doctor or a questionnaire score.

Why Desire Is Not a Blood-Flow Problem

The "female Viagra" nickname stuck, but it is misleading. Viagra works on blood flow. It does not create desire, it helps the body respond once desire is already there. The approved medicines for women work on brain chemistry instead, because desire is not a plumbing problem.

Women's desire is shaped by many things at once: hormones, brain chemistry, stress, sleep, pain, body image, relationships and medications, especially some antidepressants. That is one reason a single pill struggles to fix it, and why the benefits of the approved drugs are modest. In trials, women taking flibanserin reported on average around half to one extra satisfying sexual experience a month compared with placebo. For some women that matters a great deal. For others it is not enough to justify daily medication.

It is also worth applying a little healthy scepticism in both directions. Women really were underserved by medicine, and research into female sexual health lagged decades behind research in men. At the same time, some of the public campaigning for these drugs, framed as a fight for equality, was supported by the companies that make them. Both things can be true.

Where Herbs Come In

Many women look to traditional herbs instead, and some have been studied. The results are interesting, but they need to be read carefully.

Maca, a root from the Peruvian Andes, was tested in a 2015 trial of 45 women with sexual side effects from antidepressants. After 12 weeks, the maca group did better than placebo on one of the two questionnaires used, mostly among postmenopausal women. Korean red ginseng was linked to improved arousal scores in a small trial of menopausal women. Tribulus and ashwagandha have each shown improvements in small studies of women with low desire. Ginkgo, on the other hand, performed no better than placebo in a well-designed trial when taken on its own.

The honest picture is this: small studies, short timeframes, and some funded by companies that sell the ingredients. That makes them worth knowing about, but not proof. A dose that was used in a trial may also be very different from what is in a typical product.

Where to Start If Your Desire Has Changed

First, low desire is common, and it is only a problem if it bothers you.

If it does bother you, look at the usual suspects. Some antidepressants, hormonal contraceptives and blood pressure medicines can lower desire. Around menopause, vaginal dryness can make sex uncomfortable, and that is very treatable. Stress, poor sleep, low mood, thyroid problems and relationship strain all play a part too.

Talk to your GP or a menopause specialist. Depending on your situation, options can include HRT, local treatments for dryness, and in the UK, NICE guidance says testosterone can be considered for low sexual desire after menopause when HRT alone has not helped. Sex therapy and mindfulness-based approaches also have good evidence behind them.

If you are considering herbal supplements, check interactions first. Ginkgo, dong quai and ginger may increase bleeding risk if you take blood thinners. Ginseng can interact with some medicines, including blood thinners and diabetes medication. Dong quai should be avoided in pregnancy. Ashwagandha may not suit people with thyroid or liver conditions. Always tell your doctor what you take.

If your desire has changed, nothing is wrong with you, and you are certainly not alone. What has been wrong is how little attention medicine paid to it for so long. That is finally starting to shift. You deserve a real conversation about it, with someone who looks at the whole picture rather than handing you a quick fix.

This article is intended for informational and educational purposes only and is not medical advice. Medicines and regulatory approvals described here differ between countries. If a change in your sexual desire is bothering you, or you are considering a medicine or supplement, please speak to your GP, a menopause specialist or a pharmacist.