Sildenafil in women with sexual arousal disorder following spinal cord injury

(2007) Female sexual dysfunction in Lower Egypt. El Gelany S, Moussa O (2013) Reproductive health awareness among educated young women in Egypt. Spector IP, Carey MP and Steinberg L (1996) The sexual desire inventory: Development factor, structure, and evidence of reliability.

(2011) Sexual dysfunction and difficulties in Denemark: Prevelance and associated socio-demographic factors.

Other approaches

(2003) Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder. Journal of Urology 170(6): 2333-2338. (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sildenafil syrup sexual function. Diagnostic and Statistical Manual of Mental Disorders. (2014) Prevalence Survey of Sexual Dysfunction among Women in the Reproductive Age. Arch sex behave 40(1): 121-132.

Abdallah I Y, AbdelrahmanSh (2014) female sexual dysfunction in relation to the age of marriage .thesis submitted for fulfillment of master degree in dermatology and Andrology in Banha city, Banha University, Egypt. Omidi A, Ahmedvand A, Najarzadan MR, Mehrzad F (2016) Compairing the effect of treatment with sildenafil and cognitive-behavioral therapy on treatment of sexual dysfunctioninwomen: arandomized controlled clinical trials.

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[11] concluded that men and women who had trouble in paying their bills were twice as likely to report sexual dysfunctions compared with peers without such economic troubles. In women, there was also a statistically significant trend of increasing sexual dysfunction prevalence with decreasing income. As regard masturbation practice before marriage, it was more common among participants living in cities. In the current study 53.85% of participants living in towns and 46.15% in villages; about 80.76% of them stated that they did not know what masturbation is. This can be attributed to customs and traditions which to some extent discourage sexual education especially among females.

Key Findings

[12] found that sexual satisfaction seemed to be associated with residence as (26.4%) and (39.1%) of participants living in town were very and moderately sexually satisfied compared to (18.2%) and (20.5%) of women living in villages who were very and moderately sexually satisfied. Regarding masturbation (17.3%) of town residents practiced it before marriage versus (11.4%) of those living in a village and (59%) of participants living in town and (54.5%) of participants living in rural areas stated that they did not know what masturbation is. This study revealed no significant differences between both groups regarding their baseline sexual desire or orgasm (Table 2). On the same side, the study carried by Omidi et al. [13] in Iran compared the two groups in terms of primary mean scores of sexual function, sexual satisfaction, and marital satisfaction showed similarities in terms of factors and prevalence of disorders at the beginning of the study. Chivers MI, Rosen RC (2010) Phosphodiesterase type 5 and female sexual response.

• Sildenafil's effect duration in women may range from 4 to 6 hours.
• It may help women experiencing low libido linked to blood flow issues.
• The drug’s efficacy in women is less predictable than in men.
• Female sexual dysfunction has multiple causes beyond blood flow.

J Sex Med 7(2): 858-872. Leddy LS, Yang CC, Stuckey BG, Sudworth M, Haughie S, et al.

Treatment Information

This study revealed no significant association between both groups in comparison of post treatment regarding sexual dysfunction assessment except in orgasm less than half times, which become (84.6%) versus (30.8%) in sildenafil group and placebo group respectively. These results can be supported by the study of Leddy et al. [17]; 13 of 19 (68%) subjects achieved a ≥50% increase in clitoral engorgement from baseline when administered sildenafil or placebo 30 minutes after dose administration. At 60 minutes after administration, 17/19 (89%) subjects receiving sildenafil and 16/19 (84%) subjects receiving placebo had responded (P value 0.3). [16] used self-reported measures of sexual function which showed mixed results whereas studies examining physiological effects of PDE5i on genital vasocongestion consistently report significant effects on genital sexual response.

Female neurogenic sexual dysfunction secondary to clitoral neuropathy

The improvnent in FSFI in-group A may be related to increase in androgen level as there might be a positive correlation between sildenafil intake and increase testosterone blood level [18]. Also it increases the pelvic blood flow which may give more improvement in lubrication and decrease pain during sexual act and increase overall sexual satisfaction. [19] stated that sildenafil citrate only acts on the physical phenomena of arousal and does not completely respond to the complexity of female sexual arousal disorders (FSADs). In fact, encouraging results were achieved in specific groups of patients affected by secondary FSADs (e.g., diabetes mellitus, multiple sclerosis, chronic antidepressant users) in which the genital arousal disorder is clearly connected with a neurological or vascular injury. [20] reported only lubrication changes in vaginal and clitoral sensitivity in patients treated with sildenafil. (2012) Influence of sildenafil on genital engorgement in women with female sexual arousal disorder.

• Sildenafil is being studied for female sexual dysfunction.
• It may improve blood flow to vaginal tissues.
• Not officially approved for women in many countries.
• Side effects can include headaches and flushing.

Sildenafil increases serum testosterone levels by a direct action on the testes. Lo Monte G, Graziano A, Piva I, Marci R (2014) Women taking the blue pill (sildenafil citrate) such big deal. (1999) Safety and efficacy of sildenafil in sildenafil chewable tablets postmenopausal women with female sexual dysfunction. Learn more about compounded Sildenafil creams made for women. Sildenafil and its brand medication, Viagra, has been around since 1998 for the treatment of erectile dysfunction in men. And, since then, it has revolutionized how doctors approach male sexual health complaints.

This has lead to the question of if Sildenafil or Viagra may just have positive sexual effects in women as well. Men and Women do have different sexual anatomies, but at the core of arousal is the same function involving smooth muscle relation and increased blood flow to the genital area, which is the underlying function of PDE-5 inhibitors such as Sildenafil.

European Journal of Obstetrics & Gynecology and Reproductive Biology

In the treatment arm of the present study, there was improvement in sexual dysfunction particularly in sexual desire, maintenance of lubrication, orgasm and satisfaction. Regarding the desire, the obvious change was in patients with no desire weekly pretreatment to improve from zero to 61.5% post-treatment. The orgasm differences in women who achieved orgasm less than half the time were 38.5% versus 84.6% pre- and post-treatment respectively (Table 2). Indeed these results were opposite to the study of Dasgupta et al. [14] which included 19 women completed the 2 arms of the double-blind phase and 12 completed the optional open label extension phase.

Br. J. Obstet. Gynaecol.

Statistically significant improvement following sildenafil was only reported in the lubrication domain of sexual function sildenafil 200 mg during the double-blind phase. There was no overall change in quality of life after sildenafil. [15] found that efficacy was shown on only one sexual function measure and only in a small subsample of women who had no associated hypoactive sexual desire disorder (HSDD) and had sufficient estradiol and free testosterone concentration or were receiving estrogen and/ or androgen replacement therapy. Proposed reasons for the unconvincing efficacy of sildenafil in women have included failure to adequately characterize the study populations, differences in the physiologic response to sildenafil in men and women, and the mechanism of action of the drug needing to be central and not peripheral. It is also possible that lack of concordance between physiological and subjective aspects of women’s sexual experiences need to be further investigated [16]. These similarities have led to studies being done on women who are struggling with female sexual arousal disorder (FSAD).

Other FDA‑approved treatments for low libido in women

When examining the effects of sildenafil on female sexual dysfunction, it was found that sildenafil may increase congestion of the vagina, but it has no effect on excitement. This difference in results can be attributed to the manner and extent of drug administration, assessment of sexual status, and cultural status of the subjects in the study. Moreover, in most studies, the sample size has been very small, which makes their validity questionable. The limitation of this study is that it was conducted on only Egyptian patients, so further well-designed studies are needed to see if the same conclusions apply to other races. On the other hand, points of strength include among others, the good sample size and the prospective randomized double-blinded study design.

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Sildenafil citrate seems to improve orgasm in a sample of Egyptian females with sexual dysfunction. Desilva P (1995) Sexual dysfunction in S.J.E Lindsay and G.E.Powell, The hand book of lineal and adult psychology. London and New York rout ledge (2): 199-288. Jaafapour M, Khani A, Khajavikhan J, Suhrabi Z (2013) Female sexual dysfunction, prevalence and risk factor and Journal of clinical and diagnostic research 7(12): 2877-2880. (2006) Sildenafil improve sexual functioning in premenopausal women with type 1 diabetes who are affected by sexual arousal disorder. FSAD has to do with persistent difficulties in arousal in female patients. One placebo-controlled trial in women who were experiencing sexual dysfunction while taking an antidepressant found that adding in Sildenafil helped improve reported arousal, lubrication, and orgasm as compared to the placebo groups, but did not change any reported pain from sexual intercourse.

• Discussions with healthcare providers are crucial before considering sildenafil.
• Female sexual dysfunction may have hormonal, psychological, or physical causes.
• Sildenafil should never be used with other medications without medical approval.
• Its use in women should be part of a broader treatment plan.

Another placebo-controlled study looked into using Sildenafil in postmenopausal women with FSAD and found significant improvements in reported arousal, as long as they did not also have hypoactive sexual desire disorder (HSDD).One study considers PDE-5 inhibitors, such as Sildenafil, to have conflicting results when it comes to treating FSAD. Suggesting that these medications should be kept as the last option due to FSAD being composed of many different factors including medical, psychological, and sexual, and requiring a global approach to treatment. A consensus of if oral Sildenafil tablets should be a treatment option for women experiencing a lack of arousal or FSAD is still up for debate, although some doctors may prescribe Sildenafil tablets off-label for women.

• Some studies investigate sildenafil’s impact on vaginal blood flow.
• Psychological factors also significantly influence female sexual response.
• Not all women will experience improved sexual function with sildenafil.
• Sexual therapy remains an important treatment option.