When Lisa’s desire for sex disappeared, it had a seismic effect on her relationship with her partner, whom she’d moved to Toronto from Italy to be with. “I could see the confusion and hurt in his eyes, the quiet questioning of whether he was still wanted,” said Lisa, 41-year-old travel professional who asked to be quoted by her first name only for privacy around her sex life. “How do you explain that you love someone fully, but your body is not responding?”
Soon, Lisa began to pull away from affection entirely. Intimacy became something she feared and felt pressure around, as she felt she was disappointing her partner. Today, the couple is separated and moving toward divorce, though they remain friends.
“I wish I had known earlier that desire cannot be forced, that love does not disappear just because libido does, and that avoiding the conversation causes more damage than truth ever could,” Lisa said. “It is painful to acknowledge how this struggle affected our relationship, but I’m grateful for what remains.”
Low desire is a leading reason women reach out to women’s health experts and sex therapists, often propelled by feelings of shame and guilt that impacts their relationships. But while the issue of male sexual dysfunction has warranted plenty of discussion and research, including one of the most famous medications of all time, it’s something women tend to grapple with in silence, in the privacy of their bedrooms.
That’s the focus of a new documentary on the battle to launch a “Viagra for females”; the first medication for women’s sexual dysfunction. “The Pink Pill: Sex, Drugs, & Who Has Control,” available to stream now on Paramount+, is produced by Toronto film producer and investor Julie Bristow and Knix founder Joanna Griffiths’s women-centred Docs For Change.
The film zeroes in on a pill designed to treat women’s Hypoactive Sexual Desire Disorder (HSDD), defined as a recurrent lack of sexual interest that causes significant life distress. (A lack of sexual interest is only classified as a disorder when it is causing life distress.)
There were 26 drugs on the market for male sexual dysfunction, but health care entrepreneur Cindy Eckert and her team came up against many obstacles trying to get FDA and Health Canada approval for their “pink pill” called Addyi, named after Grey’s Anatomy’s Addison Montgomery. “There’s long been a blue pill, so why not a pink pill?” Eckert asked.
She eventually succeeded: Addyi did gain FDA approval for the treatment of HSDD in pre-menopausal women in 2015, and just last December, approval was expanded to post-menopausal women under 65. In Canada, it was approved for pre-menopausal women in 2018, and expanded in 2021 to naturally post-menopausal women 60 and under. The prescription drug’s potential side effects include severe low blood pressure and fainting, and there’s a warning about combining it with alcohol.
There’s a long history of medical systems prioritizing male sexual desire and dysfunction over female, said “The Pink Pill” director Aisling Chin-Yee. “I want everyone to understand that low desire isn’t a personal defect; it exists within a larger system that has historically undervalued female sexual health,” said Chin-Yee. “Inherent bias determines whose pleasure is considered legitimate and whose desire is treated as medically meaningful. When our bodies are underresearched, patients are more likely to be dismissed, misdiagnosed or told their experiences are purely psychological rather than biological.”
Medication may not be the answer to a women’s struggle with low desire, but the option should exist. “The goal isn’t to prescribe a solution, but to empower informed choice,” said Chin-Yee. “Whether someone seeks treatment or not, the decision should come from autonomy, not shame.”
Some female patients request testosterone supplements to increase their low libido, said Dr. Stephanie Finn, a family doctor and women’s health specialist in Toronto. But while testosterone can be part of the solution in some cases of diagnosed Hypoactive Sexual Desire Disorder, Finn said many other hormones, neuromodulators and biological factors play a role.
Sometimes, estrogen, progesterone and medications that work on neurotransmitters can help with low libido, Finn said, but there is no one-size-fits-all approach. Relationship context, stress, psychological factors and past experiences are equally important. “It’s almost always multifactorial,” Finn said. “Those of us who practice in this area always work with skilled sex therapists and pelvic floor physiotherapists because addressing libido well requires a truly integrated approach.”
Sex therapist Dr. Morag Yule said low desire is the main reason clients reach out to her Toronto practice, Therapy Suites. Often, a woman feels guilty for not wanting sex, and her male partner feels hurt, rejected or lonely. The first thing Yule does is reframe the issue so that it’s grounded in an accurate understanding of sexual desire. While men are often able to spontaneously desire their partner, Yule said, female desire is often “responsive” — it emerges in response to intimacy, not out of the blue, and sometimes only after a sexual encounter has begun.
Low desire is particularly likely to show up during periods of transition and stress, but it can also occur when the conditions for “responsive desire” are not present. Reducing sex to the goal of penetration and orgasm can make things worse. “Expanding what counts as intimacy and playing in that space without pressure for more is often what allows sexual interest to emerge,” Yule said. “Starting with a goal to spend quality time together and feel connected is an excellent starting point.”
Last year, Lexi, a 28-year-old yoga instructor in Toronto who asked to be identified by her first name only for privacy, went through a depressive episode that flattened her libido along with her mood. She barely wanted to kiss her boyfriend of two years, let alone have sex with him. She went on antidepressants, and when her mood improved, so did her sex drive. Now, she tries to be more curious about her own desire, rather than shutting down sex right away. “Sometimes I get into a habit of not ‘being in the mood,’ but now I know I need half a day’s worth of gentle affection to be in the mood,” she said.
During this time, her boyfriend felt like he was doing something wrong. “He was taking my low libido as an indication of something about himself, when it had nothing to do with him. It was about me,” said Lexi. This highlighted his own insecurities around sex and self-worth, something he’s now working through, and they’re figuring out what they both need to feel supported when their libidos are at odds. Having gone through this experience together, they’re now looking at engagement rings.
The way a couple gets through this challenge often hinges on how they communicate, with couples who can talk about sex without blame much more likely to thrive. Yule recommends having ongoing check-ins, rather than holding in feelings until emotions surge into charged conversations. “When we stop asking ‘what’s wrong with you?’ and start asking ‘what do you need?’, things shift.”
After her separation, Lisa is hoping to bring some desire back into her life, by taking supplements, exercising and seeing a therapist. “Healing is not linear, and desire does not return on demand,” she said. “But compassion, honesty and patience with myself have become my starting point.”
