The recent failure of the professional and lay public to quickly widely adopt the newly approved prosexual drug for young women with acquired Hypoactive Sexual Desire Disorder (HSDD) stimulated this review focusing on the obstacles facing any candidate drug for women’s desire deficiencies. Because sexual desire is relational and contextual, it is inappropriate to compare prosexual drugs for women with the PDE-5i medications for men. Underlying the uncertainties about the best outcome measures to be used in prosexual women’s studies are four basic questions. Are all young women’s desire problems to be considered a disorder? Which of them, if any, represent a serious medical disorder? Does the source of a woman’s distress actually matter to the diagnosis and treatment of her circumstances? Are subjects included in the HSDD clinical trials representative of those in the community with acquired HSDD or Sexual Interest/Arousal Disorder (SIAD)? Advocates for the approval of future candidate agents, who are likely to greatly benefit financially from their drug’s clinical benefit, might consider discussing both the strengths and the limitations of their safety and efficacy findings. The controversies that occurred before and after the approval of flibanserin are better respected rather than dismissed as obstructionist.