CONTENT WARNING: This article contains explicit sexual references.
Can a new product close the ‘orgasm gap’ and liberate midlife women?
When Dr Iona Weir, a cellular biologist, went in for a birth-repair surgery in 2008, she never countenanced the impact it would have on the rest of her already stellar career.
Weir, then aged 42, had been warned that the operation carried a 5% risk of a surgically induced menopause. She did not think it would happen to her. But within a fortnight of the surgery, she says, it was “pretty obvious” that her hormones were in freefall.
“My gynaecologist told me, ‘I’ve got to give you a heads-up of what’s coming for you, because it’s not going to be pretty.’ But I already knew,” says Weir.
Weir is a pioneer in the field of apoptosis: in layman’s terms, the death of cells. During the 2000s, she had been applying her expertise to the treatment of eczema. At her lab in New Zealand, she had developed a cream that aimed to activate the skin’s natural capacity to renew, which she called Atopis.
“My gynaecologist had previously remarked on the youthfulness of my skin,” she recalls, “and she asked if I’d considered expanding Atopis into something that would work for vaginal atrophy [the thinning, drying and inflammation of the vagina], another physical consequence of menopause and one that hugely contributes to low libido in women.”
That potentially devastating conversation marked a fulcrum point in Weir’s career. Since then, her work has been focused on the creation of a plant-based cream that could be applied externally to the vulva and vagina and address the issue of low libido in midlife women. Called Myregyna, her new product finished year-long clinical trials in May and came on to the market worldwide through the company’s website this summer.
Inevitably, some of the more excitable coverage called it a possible “female Viagra”, something that could solve a seemingly intractable problem with a single product. At the moment, there is no drug licenced in the UK that could ever be described as such. Will there ever be?
‘It’s physically uncomfortable’
While both sexes can experience low libido, it affects more women than men; some sources estimate more than one in three women will suffer during their lives. This could be the result of hormonal changes, physical pain or discomfort, psychological problems, chronic illness, relationship difficulties, self-esteem issues, or a side effect of medication. For women, the problem typically worsens as they age. For some, it feels insurmountable – a shameful, undiscussable secret.
It’s early in the morning in Auckland when I talk to Weir, via video call. Now 59, sitting at her kitchen table, she still looks extraordinarily youthful – a result, she says, of that same cream that she developed decades earlier. And when the cream is applied to the vagina and vulva, Weir says, it reverses problematic tissue thinning and muscle wastage.
As women age, she explains, in her soft, clipped Kiwi accent, the genitals undergo changes which, while natural, are nonetheless difficult to accept. “There is the dry vagina, which most people know about,” she says, “but there is also a lack of sexual response. The nerve between the G-spot and the clitoris atrophies. Women lose about 20% of that nerve sensitivity, which means female orgasms, if they happen, are less intense – so sex is less enjoyable.
“The elasticity of the vagina is lost and the area loses its plumpness. When a [couple wants to have sex], it’s like sleeping on a mattress with no padding. It’s physically uncomfortable – even painful.”
Weir says “many women” in this stage of life “do not have sex. Once it gets physically uncomfortable and less enjoyable, sex stops.” And then, “over time, the vagina will shrink and atrophy if not used”, she explains.
When she launched a pilot study for her cream seven years ago, enquiries about being in the test group were overwhelming. “I had women ringing and emailing saying, ‘I haven’t had sex with my husband in 10 years because it’s so painful. He thinks I’m just not interested in him. I don’t know how to tell him,’ and others who had completely turned their backs on their partners because of these issues. Some were having sex but it was really uncomfortable and he could tell she wasn’t enjoying it. These women weren’t even telling their friends what was going on. And I realised, it’s a really big issue.”
New perspectives on sex
The idea of all but giving up on your sex life in your late 40s or early 50s may have been sad but potentially palatable back when options were limited and people were living into their early 70s. Today, the UK average life expectancy is 81.24 years, meaning that some people spend almost half their lives lacking in intimacy.
“Among my friends who talk honestly about this stuff, there’s a communal feeling of ‘I know this could be better for me’, whether that’s down to physical issues or emotional ones,” says 49-year-old graphic designer Rosie*, from Manchester.
Indeed, increasing numbers of women see sexual pleasure as not a “nice to have” but a “need to have”, and they are paying for products to help them.
Dr Grace Hatton, a women’s health specialist at Numan, an online healthcare company, says three in 10 women asking for help with a lack of desire seek consultations to discuss testosterone supplements (the hormone is sometimes offered to improve female sex drive when regular HRT alone does not work).
Figures from Lovehoney, the sexual wellness brand, show that online sales of its “better female orgasm” category (including orgasm gels and balms, position enhancers and supplements) are up 10% this year on 2024. Clitoral vibrators are up 15% year on year, and clitoral suction vibrators are currently the brand’s most popular category.
And if that last paragraph makes you blush, you may soon be in a minority: female sexual desire is becoming a more mainstream topic. Noise around the subject has become louder and more urgent in the past five years, from myriad sex-positive podcasts to Netflix’s 2022 series The Principles of Pleasure, which explored women’s sex lives; Nicole Kidman’s erotic thriller Babygirl; and the hit drama Rivals based on the late Jilly Cooper’s book. And then there are sexually charged books such as Miranda July’s All Fours, Gillian Anderson’s Want (which details 174 anonymous women’s sexual fantasies) and More: A Memoir of Open Marriage by Molly Roden Winter – all spreading a message of midlife sexual liberation.
Which is all very well, but if women are looking for a product to “raise temperatures”, wouldn’t a miracle drug hit the spot more effectively than an erotic novel?
Weir says there is nothing on the market that addresses the physical symptoms that leave women unsatisfied. “There are hormones or moisturising creams giving a bit of hydration,” she says. “There are also lubricating gels and probiotics, but that’s about it.”
Naturally, she claims her product is different. Weir says that using it regularly means things “down below” improve over the long term (not only while the cream remains on the skin, like some other products) – but regular application is essential. Clinical trials showed that positive effects start to be lost after four weeks of not using Myregyna.
Despite the heat around her launch, and her impressive data, she doesn’t yet have a manufacturing deal. “I want to take this global,” she says of her product, which costs £60 (NZ$140) for a three-month supply. “To find a manufacturing partner who shares our values, and make it available to women everywhere, ideally low cost on prescription.”
Finding a saleable medical solution to women’s libido issues would be worth serious money for drug giants: potentially tens of billions of dollars could flow from a product that fixed this seemingly intractable problem. After all, the equivalent for men is one of the world’s most famous drugs.
Since US drug company Pfizer launched Viagra in 1998, the little blue pill has earned the company tens of billions of dollars; its annual sales peaked at US$2.1b in 2012. As Pfizer’s patents expired and generic versions became available, revenues declined significantly, to less than $500m in 2019 – which, when competitors are considered, still suggests a drug generating a lot of money.
A female “sexual dysfunction” product is the obvious growth area, although investment experts caution that the current focus on midlife users – rather than adult women of any age – limits potential. “The market for female products is currently about a fifth of the male equivalent,” says Derren Nathan, the head of equity research at Hargreaves Lansdown.
“But there’s a push-pull effect here. There are some treatments on the market, but the focus has been largely on premenopausal women. Until a product that resonates more widely with women hits the market, the balance will stay that way.”
Early adopters
There have been several bold attempts to cash in on the midlife section of the market.
Ten years ago, the little pink pill known as Addyi (flibanserin) was approved by the US Food and Drug Administration (FDA) for the treatment of acquired, generalised hypoactive sexual desire disorder (HSDD) – a persistent lack of sexual desire and fantasies. Its American creator, Sprout Pharmaceuticals (which declined interview requests from The Telegraph), says the non-hormonal medication works by altering brain chemicals. At the time of its launch in 2015, Sprout chief executive Cindy Eckert (née Whitehead) described the product, a daily pill available on prescription, as “just such a huge moment for women”, but its efficacy has been questioned.
According to the American drug information website drugs.com, 29% of users said Addyi had a positive effect, while 61% reported a negative effect, with drowsiness, dizziness, nausea and problems with low blood pressure reported. In addition, women are advised not to drink alcohol with the medication (no such concerns limit Viagra use).
Next came Vyleesi, the brand name for bremelanotide (manufactured since 2023 by Cosette Pharmaceuticals), which was approved by the FDA in 2019. Administered via injection around 45 minutes before sex, the drug was found in a clinical trial to increase sexual desire in 25% of women, compared with 17% on a placebo. On drugs.com, the medicine scores better than Addyi, with 68% of users experiencing a positive result and 18% a negative one.
While Vyleesi is thought to activate receptors in the brain responsible for mood and sexual desire, the exact way it works is unknown (satisfied users describe unusual feelings of “burning desire” towards their partners), but doses are limited to one a day, with a recommendation of no more than eight a month.
Perhaps due to lingering taboo, there is still some confusion about what causes low libido in women. Is it physical, mental, social or psychological – or a mix of these? For that reason, the quest for a single “treatment” is extremely challenging.
“Sexuality is not just a biological act, but instead influenced by a complex net of aspects from psychology, society, biology and more,” says Elisabeth Neumann, a sexologist and the head of user research at Lovehoney. “Reducing sexuality and sexual function to pure biology ultimately takes a lot away from the experience.”
The pleasure puzzle
Part of the problem, she believes, is that we simply don’t understand enough about female sexual pleasure. “We have mountains of data on problems and dysfunctions, but far less on what makes sexual experience rich, fulfilling and pleasurable. Erectile issues, for example, are extensively studied, while desire, arousal and the nuances of pleasure remain under-explored.” Neumann goes on: “Pleasure, as one of the core reasons why people seek intimacy, sex, or self-touch, is still not at the centre of the research agenda.”
Which may explain why there are, as yet, no plans to launch a medication to guarantee that women have multiple orgasms, for example.
“There’s a quote: ‘The orgasm gap is bigger than the gender pay gap,’” says 34-year-old writer Leah Scott. “I’m pretty happy with my sex life, but orgasms are hit and miss. If there was a recreational pill that guaranteed satisfaction available for women, I would definitely be up for it, as would pretty much every woman I know.”
There’s also a pervasive idea that low libido in women is too difficult to address, while male sexual problems can be solved by a pill. “Many men link a healthy sex drive with being able to have reliable erections,” says Dr Dave Weinstein, a men’s health specialist at Numan, “[so] these medicines often have a positive effect on their desire as well, whereas women tend to describe [low libido] in terms of a reduced or absent desire for sex, even when circumstances are otherwise favourable.”
Nicola*, a 59-year-old who works in television in London, says: “In his early 40s, my husband became depressed and the medication he was on, coupled with the illness, put paid to our sex life. To begin with, it was distressing for me. I thought that connection through sex was important, and I took it personally. But after a couple of years I found a place of acceptance, because I valued other things about the relationship. Now, 15 years later and having gone through the menopause, my desire has fizzled out.
“My husband now manages his depression through exercise and sometimes attempts to instigate intimacy with me, but after more than 10 years in a ‘sex desert’, I don’t really have any desire to reignite that part of my life. We both feel our relationship is good, but I think for him it would be better if we had physical intimacy. If it became a real deal-breaker, would I take medication to improve my desire? I’m not sure.”
Such ambiguity is commonplace. Dr Lori Brotto is a professor of gynaecology and obstetrics at the University of British Columbia, in Canada. “I remember the first ever human sexuality conference I attended, in 2000, and the presenter on stage showed this image of dials. There was an ‘on/off’ switch to depict male sexuality, and then a picture of multiple levers, knobs and dials to illustrate female sexuality.”
While women’s desire is more than about the level of blood flow in the pelvis, says Brotto, it is unhelpful to describe it as complicated. “It might preclude providers from wanting to take on female patients with low desire, because they think it’s too complex,” she says.
In 2001 and 2002, Brotto worked on early trials for Viagra – which was initially intended to be a heart medication – that also used female volunteers. “None of the trials showed that Viagra improved sexual desire in women, but they did increase blood flow to the clitoris,” she says. While ultimately unsuccessful for women in the short term, the rise of Viagra, Brotto says, ushered in more research on female sexuality and low desire, which is “the most prevalent of the sexual concerns, and one that increases with age and peaks at menopause”.
While Brotto agrees that there are “a lot of limitations associated with the two approved medications [Vyleesi and Addyi]”, she says “new, excellent research is finding contributing factors as diverse as a genetic predisposition to low desire to trauma, contextual factors, lack of education, maybe their partner doesn’t know how to stimulate them, depression, anxiety, stress… Any or all of those things”.
She continues: “People can also have low desire for one particular partner, which then resolves with a new relationship.”
Brotto dedicates a lot of her practice to using techniques such as cognitive behavioural therapy and mindfulness. “Patients have usually already had a full physical check-up,” she says. “This week I saw people dealing with life stress, or difficulties talking about sex or knowing what turns them on. Some can’t communicate to a partner about what arouses them, engage in fantasy or are embarrassed about using a vibrator.
“I also see a lot of anxious women; some have a full-blown anxiety disorder and others, chronic stress from the never-ending to-do lists, and feeling burnt out by taking care of parents and children and also working at the same time.”
In many of these situations, Brotto says, developing a mindfulness practice as part of your daily routine helps you cope with stress, which can then have a positive impact on your sex life.
‘Mental Viagra’
No quick fix, then. But there could be hope on the horizon – for both sexes – through a new treatment dubbed a “mental Viagra”, which initial trials show can reignite long-lost feelings of desire. After being given kisspeptin, a naturally occurring hormone that stimulates the release of reproductive hormones, both men’s and women’s brains responded far more to erotic pictures or videos (even in a decidedly unsexy MRI scanner, where some of the trials took place). They reported feeling far more aroused than when not on the treatment; men also experienced better erections.
“The predominant theory is that HSDD in both sexes is due to an overactive sense of introspection or self-awareness, meaning people overly self-monitor and are overly self-conscious. This effectively blocks feelings of arousal,” explains Professor Alexander Comninos, a consultant endocrinologist at Imperial College Healthcare NHS Trust. “Administering kisspeptin suppressed introspection and self-monitoring and, as a result, allowed feelings of sexual desire.”
Indeed, in two clinical trials reported in 2023, Comninos, alongside fellow endocrinologist Prof Waljit Dhillo, found that on brain scans as well as blood and behavioural tests, treatment with kisspeptin resulted in “positive effects on sexual behaviour compared with a placebo”.
The key to being “in the mood” might be related to that age-old advice not to overthink it.
“Low libido [that is psychological in nature] doesn’t bother some people – and then that’s not a medical problem,” says Comninos. “But for others it can be distressing. Treatment options in women are limited, carry significant side effects and, in some cases, can be harmful even to try. And unfortunately, these treatments have limited effectiveness.
“In men, there are currently no licensed treatments, and none on the horizon. Therefore, there is a real unmet need to find new, safer and more effective therapies.”
The initial trials also showed no significant side effects, meaning that further studies are now required to evaluate the true potential of kisspeptin as a treatment for sexual problems; unfortunately for some, the time frame is likely to be years rather than months.
Weir says that at the start of her lengthy trials of Myregyna, her team was shocked at the impact that the low-libido problems had inflicted on every part of the female test subjects’ lives.
“When they first came in to join the trial, many were dressed down and quite subdued,” she recalls. “Then, within four weeks, when they came back they were wearing make-up, looking happy and sounding excited about life. After eight weeks, these women were talking about sex and having the time of their lives. Helping [tackle] low desire has a positive effect on women’s lives far beyond the bedroom.”
*Some names have been changed