Sex drive, hormones and honesty
The conversation your friends have over wine and nobody has with a doctor. What turns desire down, and what can turn it back up.
Low desire is one of the most common things women bring up with us, usually at 11pm, usually apologising first. Do not apologise. Large surveys suggest around one in ten women have low desire that bothers them.1
What turns it down
Desire is fragile, and a lot can quietly flatten it. Exhaustion and stress. The months after giving birth, when the breastfeeding hormone prolactin stays high. Perimenopause. Some antidepressants, especially SSRIs. Sometimes hormonal contraception. Low iron and an underactive thyroid can do it too, by making everything feel like effort.
And relationships: resentment, routine, or a partner who never learnt what works for you. No molecule fixes that one.
Fix the cheap causes first. Sometimes the answer costs ₦8,000 and is called a blood test.
Where PT-141 fits
Bremelanotide, sold in the US as Vyleesi, was approved in 2019 for premenopausal women with low desire that is not caused by another condition, a medicine or the relationship.2 It acts on melanocortin receptors in the brain, the wanting side, not blood flow. You take it about 45 minutes before sex, no more than once a day.
In the trials, women on it reported more desire and less distress than placebo. The gain was real but modest. It is not a switch.2
The side effects
About 40% had nausea, mostly with the first doses. Flushing and headache were common. A small number developed darker patches on the face or gums after repeated use. It is not for you if you have uncontrolled high blood pressure or heart disease, or if you are pregnant or trying.
- Shifren JL et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008;112:970–8.
- Kingsberg SA et al. Bremelanotide for the treatment of hypoactive sexual desire disorder: two randomized phase 3 trials. Obstet Gynecol 2019;134:899–908.
