Hypoactive Sexual Desire Disorder (HSDD)
A condition characterised by persistently low sexual desire causing significant distress. Bremelanotide is approved for premenopausal women with HSDD, acting on melanocortin receptors (MC3R/MC4R) in the brain to modulate sexual desire pathways. It is self-administered as needed via subcutaneous injection.
Technical Context
HSDD: persistently low sexual desire causing significant personal distress, not attributable to medical conditions, medications, or relationship factors. Affects approximately 10% of premenopausal women. Bremelanotide (Vyleesi): MC3R/MC4R agonist acting on hypothalamic melanocortin pathways involved in sexual desire and arousal. Dosing: 1.75mg SC self-injection ≥45 minutes before anticipated sexual activity, maximum 1 dose per 24 hours, maximum 8 doses per month. Phase III RECONNECT trials: statistically significant increase in satisfying sexual events and reduction in distress related to low sexual desire. Side effects: nausea (approximately 40%), flushing, headache, and transient skin hyperpigmentation (MC1R activation). Contraindication: uncontrolled hypertension (bremelanotide can transiently increase blood pressure). Bremelanotide represents a novel mechanism — unlike flibanserin (a serotonergic/dopaminergic oral agent), it acts through the melanocortin system and is used on-demand rather than daily.