Nam Kiwanuka: You're listening to Mistreated. I'm Nam Kiwanuka. Did you know that there is a medical term for women who are experiencing low sexual desire or libido? It's called hypoactive sexual desire disorder or HSDD. According to the National Institutes of Health, HSDD is the most commonly identified sexual problem among women.

Nam Kiwanuka: HSDD is characterized by a deficiency of sexual thoughts, feelings, or receptiveness to sexual stimulation that has been present for at least six months, causes personal distress, and is not due to another medical condition. The NIH stressed that HSDD in women has been viewed quote inaccurately by some in the medical community as being similar to erectile dysfunction ED in men. Hypoactive sexual desire disorder is not female erectile dysfunction.

Nam Kiwanuka: Ajamama study showed that the prevalence of low sexual desire ranged from 26.7% among premenopausal women to 52.4% among naturally menopausal women. One of the medications used to treat HSDD is called Addyi. And in December 2025, history was made when the US Food and Drug Administration, the FDA, approved it for both pre and post-menopausal women. It became the first medication to treat low sexual desire for women under the age of 65.

Nam Kiwanuka: But did you know that including Viagra, there are already 26 drugs that have been approved by the FDA for male sexual health, but only two FDA approved drugs that target women's sexual health. Addyi was first approved in 2015. Cindy Eckhard, whose pharmaceutical company developed Addyi, said this. HSDD was characterized in 1977. Medicine has understood it for some time now. But what crept in was social commentary, a societal bias that questions whether pleasure matters for women. In the end, Addyi was approved on the basis of science with clinical trials involving 13,000 women, which was three times the size of the trials conducted on Viagra. Granted, erectile dysfunction is different from HSDD in women, but the FDA took 6 months to approve Viagra, and by contrast, it took us 6 years to earn approval for Addyi.

Nam Kiwanuka: On today's episode, we speak with Ashling Chini about the history of how Addyi came to market and how she told that story in her documentary, The Pink Pill, Sex Drugs, and Who has Control. But first, let's take a listen to a short clip from the documentary.

Documentary Clip: When I started, there were 25 FDA approved drugs for men. The 26th drug for men came to market and it's for curvature of the penis that interferes with your enjoyment of sex. The studies were on around a thousand or so men and it had a pretty important but rare side effect and that was penal rupture. So, let me get this straight. We can give men a product and their dick can explode, but women can't have the seven dwarfs of side effects like sleepy, dizzy, nausea. 26 times we had done that for men.

Nam Kiwanuka: Ashling Chini, welcome to the podcast. What does a documentary like this mean during a time like this?

Ashling Chini: Thanks for that question. It means that there's so much urgency around these conversations needing to be had and for voices to really speak up. Particularly in the US, it feels like the era my mom fought for is getting rolled back. Having access to proper safe healthcare seems more urgent than ever. Cindy Eckert says, "The biggest crisis in women's health is that you're not taken seriously."

Nam Kiwanuka: Was there anything that surprised you along the way? Like, what's the biggest thing that surprised you?

Ashling Chini: How little do physicians get trained on women's bodies. It's both stark and alarming. Medical establishments have never prioritized women's bodies in research for generations. Another thing was this condition HSDD. It disappears not necessarily because they aren't interested in their partner anymore, it's biology.

Ashling Chini: They did brain scans and in the MRIs you could see the difference on how their brain activity was reacting to sexual images. It's been in the literature since 1977 and yet we don't really know very much about it.

Nam Kiwanuka: How did this drug come to be?

Ashling Chini: It started off as a anti-depressant developed by Boehringer Ingelheim in Germany. Kind of like how Viagra was a blood pressure drug, women were reporting that it was making them friskier. They took it to the FDA in 2010 and it was rejected. Then Cindy Eckert thought it was going to be easy sailing following the roadmap for men, but it wasn't.

Ashling Chini: When she went in front of the FDA, the panel were all urologists. They didn't like her talking back to them. They were like, "Oh, improving by one more event a month is not very much." But if you're not having any sex, once a month is actually a lot. It's potentially 12 times a year, a huge improvement.

Nam Kiwanuka: Why do you think it was seen as problematic whereas the blue pill was seen as a revolutionary thing?

Ashling Chini: The cultural layer is that we've never been comfortable with women having agency over their own bodies. We don't respect women's right to enjoy pleasurable sex. With Viagra, labels say guys can take five glasses of wine, but women cannot take any. They had to sign a form like a permission slip. It's this guise of protecting women because they can't be trusted.

Nam Kiwanuka: In the documentary, you also hear from women who HSDD was destroying their relationships. You really humanized it.

Ashling Chini: A lot of women would just grin and bear it and have duty sex, and that doesn't make anyone feel great. We interviewed Barbara, whose husband divorced her because of this. People were so mean, saying "just get a new husband." That's not seeing someone's humanity.

Ashling Chini: Pleasure, joy should be a basic human right. It should be your choice. We should have bodily agency just like men have. We shouldn't be taking those things away from women.

Nam Kiwanuka: It was a terrific documentary. Congratulations, Ashling. It's been a pleasure having you here.