Why “Low Libido” Isn’t One Problem

And why the search for a single “female Viagra” may have been the wrong question

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We keep calling it “low libido,” as if it’s one problem with one solution. But if you listen closely to how women actually talk about it, the category starts to fracture in your hands.

For many women, the issue isn’t desire at all. It’s sensation. The brain still lights up. The imagination still works. The relationship is still there. But arousal doesn’t arrive. Touch doesn’t land the way it used to. Orgasms require effort, precision, and tools and sometimes, the orgasms don’t show up at all. For some, sex doesn’t feel like a loss of appetite. It feels like the body has stopped speaking the same language as the mind.

That distinction matters, because it quietly explains why the hunt for a “female Viagra” has been so disappointing. Not because the science is impossible, but because the market has been misnamed.

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The flawed search for a female Viagra

For nearly three decades, the search for a female equivalent to Viagra followed a familiar script. When sildenafil was approved for erectile dysfunction in men in 1998, the results were immediate and visible. A simple mechanism which improved blood flow produced a clear, measurable outcome. Within a few years, Viagra became one of the most recognisable pharmaceutical brands in the world. It didn’t just treat a condition; it reshaped the cultural conversation around aging, masculinity, and sexual function. Naturally, the industry went looking for symmetry for women.

But the analogy was flawed from the beginning.

Male erectile dysfunction is, in many cases, a mechanical problem. Blood flow in, erection follows. The physiology is relatively linear. Female sexual function is not. It is hormonal, neurological, psychological, relational, and contextual, often all at once. Desire and arousal are not the same thing. Neither are arousal and orgasm. And the pathways that govern each of them don’t sit in a single place in the body.

Still, the market wanted a mirror image.

The first wave of libido drugs targeted the brain. Addyi, approved in 2015, worked on neurotransmitters associated with desire. Vyleesi, approved a few years later, acted on a melanocortin pathway to stimulate sexual interest. Both were framed as breakthroughs, expected to unlock a vast, underserved market but the reality has been more modest. Adoption was slower than expected. Clinical effects were real, but subtle. Side effects, prescribing restrictions, and reimbursement friction added further barriers. Vyleesi, one of the few approved hypoactive sexual desire disorder (HSDD) drugs, generated just under nine million dollars in gross product sales in Palatin’s fiscal year ended June 2024 before the asset was sold for twelve million dollars upfront, with additional payments tied to future sales milestones. What had been imagined as a blockbuster category began to look more like a collection of niche indications, each with its own biological logic and commercial constraints.

The narrative started to shift. Maybe there wasn’t one female Viagra. Maybe there were several different problems, each requiring a different kind of solution.

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What the Daré trial actually showed

That is where the current moment becomes interesting. A publicly listed company, Daré Bioscience, has been developing a topical sildenafil cream for women with female sexual arousal disorder. At first glance, it sounds like the original idea all over again: take the mechanism that worked for men and apply it to women.

But the company didn’t pursue it as a universal solution. They ran a clinical study across defined patient groups, using specific endpoints. And the data told a more granular story. In the full trial population, the drug did not significantly outperform placebo on its primary endpoints. That means the broad, one-size-fits-all version of the thesis didn’t hold. Yet within a more specific subset of women (those with a defined arousal profile), the drug produced a statistically significant and clinically meaningful improvement in arousal sensation.

So, while it didn’t work for everyone in the study, for some women, it worked enough to matter.

So what does that actually mean for women, for the science, for the market, and for the capital behind it? On paper, libido therapeutics should be enormous. The patient population is large, the unmet need is obvious, and the demand shows up in clinics every day. Yet the financial outcomes tell a very different story.

That disconnect is not accidental. It reflects a deeper structural reality about how female sexual dysfunction actually works; biologically, clinically, and commercially.

In the rest of this piece, I walk through:

• The true size of the libido therapeutics market

• The hidden demand signal most forecasts miss

• Why this is not one market but several overlapping ones

• What that means for patients

• And why capital still hasn’t fully institutionalized the category