Two prescription medications are FDA-approved specifically to increase sexual desire in women, and a handful of other options are used off-label with varying degrees of evidence. None of them work like an on-off switch. The approved drugs target brain chemistry rather than blood flow, and they come with real tradeoffs in side effects and how they’re taken.
The Two FDA-Approved Options
Both approved medications treat a specific condition called hypoactive sexual desire disorder (HSDD), a persistent lack of sexual desire that causes personal distress. They work through completely different mechanisms and are taken in different ways.
Flibanserin (Addyi)
Flibanserin is a daily pill taken at bedtime. It works by shifting the balance of brain chemicals involved in desire. Specifically, it raises levels of dopamine and norepinephrine (both linked to motivation and arousal) while temporarily lowering serotonin (which can suppress sexual interest) in key areas of the brain, particularly the prefrontal cortex. Think of it as turning down the brakes on desire while pressing lightly on the gas.
It’s not a fast-acting drug. You take it every night, and the effects build over weeks. In clinical trials, women taking flibanserin reported roughly one additional satisfying sexual encounter per month compared to placebo. That may sound modest, but for women who’ve been experiencing little to no desire, the change can be meaningful. The largest trial (BEGONIA) showed 2.5 additional satisfying events versus 1.5 with placebo.
The biggest practical limitation is the alcohol restriction. Drinking within two hours of taking flibanserin raises the risk of dangerously low blood pressure and fainting. If you’ve had three or more drinks in an evening, you’re supposed to skip your dose entirely. After taking it at bedtime, alcohol is off limits until the next day. Common side effects include drowsiness, nausea, dizziness, and dry mouth. The drowsiness is why it’s taken at night.
Flibanserin is currently approved only for premenopausal women whose low desire developed after a period of normal sexual function. It’s not approved for postmenopausal women or for desire issues that have been present since puberty.
Bremelanotide (Vyleesi)
Bremelanotide takes a completely different approach. Instead of adjusting serotonin and dopamine balance directly, it activates melanocortin receptors in the brain, which in turn trigger dopamine release in areas tied to sexual motivation and arousal. It’s given as a self-injection in the abdomen or thigh at least 45 minutes before anticipated sexual activity.
The on-demand format appeals to some women who don’t want to take a daily pill, but there are limits: no more than one dose in 24 hours and no more than eight doses per month. Nausea is the most common side effect and tends to be more pronounced than with flibanserin. Other side effects include flushing, hot flashes, headache, injection site irritation, and fatigue. One unusual effect is skin darkening, which can cause dark spots on the gums, face, and breasts. Bremelanotide can also slow stomach emptying, which may reduce how well other oral medications you take get absorbed.
Off-Label: Bupropion
Bupropion is an antidepressant that works differently from SSRIs. Rather than boosting serotonin (which often suppresses libido as a side effect), it increases dopamine and norepinephrine activity. This profile makes it one of the few antidepressants that doesn’t typically dampen sexual function, and in some cases, it appears to do the opposite.
In one study of women experiencing sexual dysfunction during breast cancer treatment, eight weeks of bupropion improved scores across five sexual function areas: drive, arousal, lubrication, orgasm, and satisfaction. Improvements showed up by week four and persisted through week eight. This was a small, uncontrolled trial of 20 women, so the evidence isn’t as strong as what exists for the FDA-approved options. Still, bupropion is commonly prescribed off-label by clinicians who treat sexual dysfunction, particularly in women already dealing with depression.
Testosterone Therapy
Testosterone isn’t just a male hormone. Women produce it naturally, and levels decline with age, particularly after menopause. A large meta-analysis of randomized controlled trials found that testosterone is effective for postmenopausal women with low sexual desire causing distress.
There’s no FDA-approved testosterone product for women, so doctors who prescribe it use compounded formulations or low doses of products designed for men. The preferred route is transdermal (patches or creams applied to the skin) rather than oral, because oral testosterone negatively affects cholesterol levels, raising LDL and lowering HDL. Transdermal application avoids this lipid problem. The most common side effects are acne and increased hair growth. Some weight gain has also been observed. No serious adverse events were recorded in the trials reviewed in the meta-analysis.
What These Drugs Don’t Do
None of these medications work the way something like Viagra works for men. Viagra increases blood flow to produce a physical response within 30 to 60 minutes. The drugs that increase desire in women target brain chemistry, not blood flow. Flibanserin takes weeks of daily use to produce noticeable changes. Bremelanotide acts faster (within about 45 minutes) but still works through the brain’s reward and motivation pathways rather than through a direct physical mechanism.
Desire is also more complex than any single pill can address. Stress, relationship quality, hormonal changes, other medications (especially SSRIs), fatigue, and body image all play significant roles. These drugs tend to work best when combined with addressing those broader factors, not as standalone fixes.
How These Options Compare at a Glance
- Flibanserin (Addyi): Daily pill at bedtime. Takes weeks to work. Strict alcohol rules. Approved for premenopausal women only. Side effects include drowsiness, nausea, dizziness.
- Bremelanotide (Vyleesi): Self-injection 45+ minutes before sex. Up to 8 times per month. More nausea than flibanserin. Can cause skin darkening. No alcohol restriction.
- Bupropion: Daily pill, off-label use. May help especially if you’re also dealing with depression or SSRI-related sexual side effects. Less robust evidence for sexual function specifically.
- Testosterone: Transdermal cream or patch, off-label. Best evidence is for postmenopausal women. May cause acne and hair growth. Requires monitoring by a doctor.