What Medicine Still Gets Wrong About Female Desire, Hormones, and Health

In a conference room in Phoenix in 2016, Dr. Haver stood listening to a talk on female sexual health. As Cindy Eckert spoke, tears began to fall. They were not tears of inspiration or relief. They were tears of shame.

As an experienced OB-GYN, Dr. Haver had delivered hundreds of babies, performed countless surgeries, and managed medical emergencies with confidence. Yet she realized, in that moment, that when her patients hesitated at the door after routine exams and said, “Doctor, there’s one more thing,” she had consistently failed them.

That “one more thing” was often sexual desire. Low libido. A loss of interest that felt confusing, distressing, and deeply personal. Her medical training had given her no tools to help. The best advice she had been taught to offer was dismissive and painfully inadequate: try to relax, have a glass of wine, give it time.

As though diminished sexual desire were a personality flaw rather than a medical issue.

The Biology of Female Desire That Medicine Overlooked

For decades, female sexual desire has been framed as psychological, emotional, or relational. Stress, parenting, relationship dynamics, and mental health were treated as the primary explanations. While these factors can matter, they are not the whole story.

Female libido is deeply rooted in neurobiology, hormones, and brain chemistry. These are areas that medicine historically under-researched in women.

Scientific imaging has shown that women diagnosed with hypoactive sexual desire disorder, or HSDD, have measurable differences in brain activity compared to women without the condition. When exposed to sexual stimuli during functional MRI scans, their brains respond differently. This is not speculation or subjective reporting. It is observable biology.

For many clinicians in that Phoenix conference room, the realization was jarring. The loss of desire was not simply “in women’s heads” in the dismissive sense it had long been framed. It was literally in the brain, involving neurotransmitters that regulate motivation, reward, and inhibition.

Yet for years, the advice women received focused almost exclusively on emotion and behavior. Schedule date night. Reduce stress. Seek therapy. Relax.

Those suggestions are not wrong, but they are incomplete. The biological component was missing entirely.

A Stark Double Standard in Sexual Health

Nothing illustrates medicine’s gender bias more clearly than the comparison between treatments for male and female sexual dysfunction.

Viagra moved from development to FDA approval in about six months. Roughly 4,000 men participated in clinical trials. It was celebrated publicly, even featured on the cover of Time magazine, and framed as a national health priority.

By contrast, Addyi, the first FDA approved medication for female sexual desire, took six years to gain approval. It was rejected twice by the FDA. More than 13,000 women participated in clinical trials. That’s over three times the data required for Viagra. Women were required to testify publicly about their most intimate struggles during FDA hearings.

Even after approval, media coverage mocked the medication, repeatedly calling it “female Viagra,” a label that is scientifically inaccurate.

When a prominent broadcaster questioned Cindy Eckert about Addyi’s side effects, her response was direct. Viagra also has side effects, including serious ones, yet discussions about men’s sexual health typically begin with benefits, while discussions about women’s sexual health begin with risks.

Why “Female Viagra” Is a Misleading Myth

Addyi and Viagra address entirely different problems. Viagra targets arousal by increasing blood flow to genital tissue. It helps with the mechanics of sex.

Addyi targets desire by acting on neurotransmitters in the brain. It alters levels of dopamine, norepinephrine, and serotonin, similar to how antidepressants work, although antidepressants often suppress libido rather than improve it.

As Cindy explained, women’s desire is about brain chemistry, not blood flow. The distinction matters because it highlights how women’s sexual health has long been viewed through a male framework instead of being understood on its own terms.

The Women Who Forced Medicine to Listen

The real catalysts for change were not pharmaceutical executives or researchers. They were the women who showed up. They arranged childcare, took time off work, and spoke openly at FDA hearings about how the loss of desire had affected their relationships, self esteem, and quality of life. They were ridiculed by commentators and dismissed by some professionals.

One woman shared how the absence of desire contributed to the end of her relationship. A response from the room suggested she eat chocolate.

Chocolate.

For a documented medical condition affecting millions of women.

A System With No Owner

One of the most troubling realities of female sexual dysfunction is that no medical specialty truly claims it.

Male sexual dysfunction clearly belongs to urology, with established training pathways and treatment protocols. Female sexual dysfunction often falls into psychiatry by default, reinforcing the idea that it is purely psychological.

OB-GYN training historically focused on pregnancy, surgery, and cancer screening. Desire, arousal, orgasm, and sexual pain received little to no attention. Even physicians who wanted to help often had no guidance.

When patients raised concerns, many clinicians sought advice from senior colleagues, only to receive the same dismissive responses they had already given. Drink wine. Relax. Read a relationship book.

This was the state of women’s sexual health education for physicians well into the late 2010s.

Barriers That Persist Even After Approval

FDA approval did not end the struggle. Insurance companies often require women to fail marriage counseling before covering medication for HSDD. Men have never been required to fail counseling before receiving erectile dysfunction treatment.

Pharmacists sometimes ask women whether their husbands know they are taking the medication, a question rarely posed to men. The paternalism remains deeply embedded, reinforced by cultural discomfort with female desire.

What Women Need to Know

Loss of sexual desire is common. According to data cited by the Mayo Clinic, roughly half of women over 50 experience it. This does not mean they are broken, stressed beyond repair, or failing their partners. For many, it represents a treatable medical condition.

Women deserve clinicians who take their concerns seriously, provide accurate information, and offer the same respect afforded to male sexual health concerns. They deserve informed choices about their bodies and their pleasure.

The Education That Never Happened

Medical residents are trained extensively to manage obstetric emergencies and surgical complications. Yet many complete their training without ever learning how to assess sexual desire or discuss treatment options.

Sex has often been framed as something women provide rather than something they are entitled to enjoy. This narrative is slowly changing, but only because patients and advocates refused to stay silent.

Why This Conversation Matters

The moment in that Phoenix conference room reshaped one physician’s career and understanding of women’s health. It revealed how deeply gender bias shapes research funding, clinical education, insurance policies, and everyday medical conversations.

Progress begins when someone says no. No to dismissal. No to platitudes. No to the idea that women’s pleasure is optional or trivial.

The Bottom Line

Female sexual desire is biological. It deserves the same scientific rigor, research investment, insurance coverage, and medical attention as male sexual health.

Not special treatment. Equal treatment.

Women struggling with desire are not complicated or broken. They are human, and they deserve better care.

The women who spoke up changed medicine. The clinicians who listen can continue that change. And the conversation is far from over.

You can find the full podcast episode with Cindy Eckert on unPAUSED.