Addyi vs. Vyleesi: Pros, Cons, and What to Know Before Trying Medication for Low Desire

Low sexual desire is one of the most common reasons people seek help for their sex lives — and one of the most misunderstood. For some, medication can be part of the conversation. Two FDA-approved options that often come up are Addyi (flibanserin) and Vyleesi (bremelanotide).

Neither medication is a “pink Viagra,” and neither works the same way for everyone. Understanding their differences — and their limitations — is key to making an informed choice.

First, an important reminder

Low desire is rarely caused by biology alone. Stress, emotional disconnection, trauma history, hormonal changes, relationship dynamics, identity, and nervous system overwhelm all play a role. Medication may help some people — but it works best when considered as part of a broader, holistic approach.

What is Addyi?

Addyi is a daily oral medication taken at bedtime. It works on neurotransmitters in the brain associated with motivation and desire, rather than on blood flow or physical arousal.

Pros of Addyi

• Taken daily, which may support overall desire rather than desire tied to a specific moment

• FDA-approved for hypoactive sexual desire disorder (HSDD)

• May be helpful for people who prefer a consistent, long-term approach

Cons of Addyi

• Takes weeks (sometimes up to 8 weeks) to notice effects

• Must be taken every day, regardless of sexual activity

• Side effects can include dizziness, fatigue, nausea, sleepiness, and dry mouth

• Alcohol use requires careful timing due to risk of low blood pressure and fainting

• Benefits tend to be modest, not dramatic

What is Vyleesi?

Vyleesi is an as-needed medication delivered via a self-administered injection, typically about 45 minutes before anticipated sexual activity. It activates brain pathways related to desire and arousal.

Pros of Vyleesi

• Used only when desired, rather than daily

• Works closer to the moment of sexual activity

• Different mechanism than Addyi — may help people who didn’t respond to daily medication

• No strict alcohol timing restrictions

Cons of Vyleesi

• Requires giving yourself an injection, which some people find uncomfortable

• Nausea is very common, especially with early doses

• Effects are temporary (a few hours)

• Limited to one dose per day and a set number per month

• Not recommended for people with uncontrolled high blood pressure or certain heart conditions

Addyi vs. Vyleesi: A Quick Comparison

What these medications don’t do

It’s important to be realistic about what Addyi and Vyleesi can and cannot address.

They do not:

• Fix relationship conflict or emotional distance

• Resolve sexual shame or trauma

• Address resentment, burnout, or lack of safety

• Automatically increase pleasure or satisfaction

Some people experience an increase in sexual thoughts or motivation — others feel very little change.

Who might consider medication?

Medication may be worth discussing if:

• Desire loss is persistent and distressing

• Medical contributors have been evaluated

• You want to explore all available options

• You understand the risks and realistic outcomes

Medication tends to be most effective when paired with:

• Sex therapy or relationship counseling

• Nervous system regulation

• Honest conversations about desire, boundaries, and expectations

A more helpful question than “Which one works?”

Instead of asking “Which medication works best?” a more useful question is:

“What is my desire responding to — and what does it actually need?”

For some people, medication helps reduce friction. For others, the real shift comes from addressing stress, emotional safety, autonomy, and attunement.

Bottom line

Addyi and Vyleesi can be useful tools for some people, but they are not cures for desire. Desire is contextual, relational, and embodied. Medication may open a door — but lasting change usually comes from understanding the ecosystem in which desire lives.

If low desire is affecting your wellbeing or your relationship, working with a qualified clinician can help you explore all your options — medical, emotional, relational, and somatic — with nuance and care.

Ready to go deeper. Join me for coaching sessions here , read my book here and my Online Pleasure School is here.