"Is there a Viagra for women?" It is one of the questions women ask most, and the honest answer is yes and no. In this solo episode, Dr. Jillian unpacks why desire so often changes in midlife and what actually helps. She explains the difference between spontaneous and responsive desire, the accelerator-and-brakes model of sexual response, and why wanting sex, becoming aroused, and having an orgasm are three different things.
She walks through the two FDA-approved medications for low desire in women, Addyi and Vyleesi, including Addyi's December 2025 expanded approval for postmenopausal women under 65, and shows exactly how each one works. She also covers testosterone therapy, why "off-label" does not mean experimental, compounded arousal creams, desire differences between partners, and why the timing of sex matters more than most couples realize.
In This Episode
- Is there a Viagra for women?
- What do we actually mean by sex? Why "foreplay" is often the main event
- The doorknob phenomenon: the question women wait until the end of the visit to ask
- Spontaneous vs. responsive desire
- The accelerator and the brakes
- When low desire affects a marriage: HSDD and sexual desire discrepancy
- Does the timing of sex matter?
- Why desire changes in midlife: genitourinary syndrome of menopause, pain, and the other brakes
- The pill: how Addyi works, how to take it, and realistic expectations
- The shot: Vyleesi's surprising origin, how it is used, and its side effects
- Testosterone: why off-label doesn't mean experimental
- What about "scream cream"? Desire vs. arousal vs. orgasm
- Beyond medication: mindfulness, sex therapy, and relationship counseling
- Final thoughts: so, is there a Viagra for women?
Key Takeaways
- Wanting sex, becoming aroused, and having an orgasm are different parts of sexual response. Treating the right one matters.
- Only about 18 percent of women say intercourse alone is enough for them to reach orgasm. Many women need or prefer clitoral stimulation, so the experiences often called "foreplay" may be the main event.
- Low desire is common. In the PRESIDE study of more than 30,000 U.S. women, nearly 40 percent reported low desire, and distressing sexual problems were especially common at ages 45 to 64.
- Low desire on its own is not a disease. Hypoactive sexual desire disorder (HSDD) is defined by persistent low desire that causes personal distress and isn't explained by another condition.
- Many women experience responsive desire, which shows up after affection begins rather than before. It is normal, and it can become more prominent in long-term relationships.
- Most women in midlife don't have a broken accelerator. Look at what is pressing the brakes: pain, poor sleep, hot flashes, medications, mood, relationship tension, and the invisible work of running a household.
- If sex hurts, of course you don't want it. Treating genitourinary syndrome of menopause is often the first step.
- Differences in desire between partners, called sexual desire discrepancy, don't mean either partner is wrong, and they don't automatically mean the partner with lower desire needs medication. They do deserve an honest conversation.
- Timing matters. Sex at 10 PM after a full day of work and caregiving may feel like one more task. A rested weekend morning may feel very different.
- Addyi (flibanserin) is a nightly pill that acts on brain chemistry involved in desire. In December 2025, the FDA expanded its approval to include postmenopausal women under 65. It can take several weeks to work, and the prescribing information recommends stopping if there is no improvement after eight weeks. Alcohol timing matters.
- Vyleesi (bremelanotide) is an as-needed injection used at least 45 minutes before sexual activity. It is FDA-approved for premenopausal women. Nausea is the most common side effect, and it is not used in women with uncontrolled high blood pressure or known heart disease.
- Testosterone, a hormone women naturally produce, has meaningful evidence for appropriately selected postmenopausal women with HSDD. There is no FDA-approved testosterone product for women in the U.S., so it is prescribed off-label at carefully monitored doses.
- Compounded arousal creams, sometimes called "scream cream," target genital blood flow and are typically used for arousal rather than desire.
- Mindfulness-based approaches, sex therapy, and relationship counseling can help. They don't mean sexual concerns are "all in your head."
Research and Resources Mentioned
- Shifren JL et al. Sexual Problems and Distress in United States Women (PRESIDE). Obstetrics & Gynecology, 2008.
- Herbenick D et al. Women's Experiences With Genital Touching, Sexual Pleasure, and Orgasm. Journal of Sex & Marital Therapy, 2018. Study summary
- European Society for Sexual Medicine. Sexual Desire Discrepancy: A Position Statement, 2020. PubMed
- International Society for the Study of Women's Sexual Health. Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women, 2021. ISSWSH
- Global Consensus Position Statement on the Use of Testosterone Therapy for Women, 2019.
- Addyi (flibanserin) Prescribing Information, December 2025. Prescribing information
- Vyleesi (bremelanotide) Prescribing Information. Prescribing information
- FDA Approves Expanded Use of Flibanserin for HSDD in Postmenopausal Women. Contemporary OB/GYN, December 2025. Article
- Nagoski E. Come As You Are (book).
- Brotto LA. Research on mindfulness-based approaches to low sexual desire, University of British Columbia.
Coming Up Next
Dr. Ade returns for the next episode, releasing the day before Thanksgiving, with special guest Jen Gessert, LPC, CDCI, of White Wave Counseling. The topic: perimenopause rage, the short fuse that seems to come out of nowhere.
Connect With Us
Questions or topic ideas? Email connect@modernmidlifecollective.com or visit www.modernmidlifecollective.com.
This episode is for educational purposes and reflects Dr. Jillian's read of the current evidence. It is not personalized medical advice and does not create a doctor-patient relationship. Talk with your own healthcare provider before starting, stopping, or changing any medication or hormone therapy.