Desert Hearts is notable for being the first to depict a lesbian relationship where both characters enjoy a satisfactory ending, in contrast to previously released films such as Personal Best that focus less on the relationship of the main characters, and where one returns to a relationship with a man. It is also the first lesbian-themed movie to be directed by a woman.
The New York Times wrote that the film is "so earnest and sincere that it deserves an A for deportment," but criticized the lack of imagination in the writing and characters. However, The Times in London praised the film wholeheartedly, including both actors in the leading roles, writing "Fuelled by vibrant performances and an expert script that articulates feelings without ascending into wordy clouds, Desert Hearts rises far above such pigeon-hole categories as the nostalgic period drama or the lesbian love-story. Deitch's film is a passionate, beautifully controlled drama about making choices and exercising the heart: in a word, about living." The Washington Post also praised the film highly, calling it "polished" and remarking, "Donna Deitch's first feature, touches something about love that few movies even hint at - not the tremulousness, or the hiding and jousting (although there is that), but the way the attraction of two lovers warps the world around them, throws it out of whack," although criticizing some aspects of the cinematography. Desert Hearts has an 83% rating at Rotten Tomatoes, and Roger Ebert gave Desert Hearts two and a half stars for the simplicity and directness of the film, but noting the surprising power of the romantic scenes.
In time, however, the film has been recognized for its quality and impact. In 1996, the Sydney Morning Herald declared, "Donna Deitch's 1985 Desert Hearts is widely regarded as one of the best and most significant mainstream fiction films about lesbians." And The Globe and Mail said of it, "the film is one of the first and most highly regarded works in which a lesbian relationship is depicted favourably."
Helen Shaver claims that Greta Garbo was so impressed with her performance in the film that they attempted to meet but due to Garbo's poor health instead discussed her performance over the phone. Patricia Charbonneau, in turn, learned that model Gia Carangi patterned herself after Cay's character.
Author and lesbian literary critic Camile Paglia praised the movie for its riveting performances, having seen it 11 times in theaters. She claims that Patricia Charbonneau's magic is coming from hormonal glow, as she had found out she was pregnant before shooting began, and was sick on the set. In her landmark work Sexual Personae, Paglia said the lanky, spirited, mercurial Charbonneau would have made a perfect transvestite Rosalind in Shakespeare's "As You Like It."