Efficacy of Sildenafil in the Treatment of Female Sexual Dysfunction Due to Multiple Sclerosis

And, since then, it has revolutionized how doctors approach male sexual health complaints.

Benefit	Explanation	Evidence Level	Notes
Improved Blood Flow	Enhances genital blood circulation	Moderate	May aid sexual arousal
Increased Libido	Possible enhancement of sexual desire	Limited	Varies among women
Better Orgasm Response	Some reports of improved orgasm	Anecdotal	Not scientifically proven
Enhanced Clitoral Sensitivity	Possible increase in sensation	Theoretical	Needs more research

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.

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Journal of Urology 170(6): 2333-2338. (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Diagnostic and Statistical Manual of Mental Disorders. (2014) Prevalence Survey of Sexual Dysfunction among Women in the Reproductive Age. (2007) Female sexual dysfunction in Lower Egypt.

Anatomy and physiology of female sexual function and dysfunction: classification

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. 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. These similarities have led to studies being done on women who are struggling with female sexual arousal disorder (FSAD).

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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.

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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. Chivers MI, Rosen RC (2010) Phosphodiesterase type 5 and female sexual response. J Sex Med 7(2): 858-872. Leddy LS, Yang CC, Stuckey BG, Sudworth M, Haughie S, et al. (2012) Influence of sildenafil on genital engorgement in women with female sexual arousal disorder.

Curr. Opin. Neurobiol.

Sildenafil increases serum testosterone levels by a sildenafil 50g 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 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. 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. These studies suggest that Sildenafil may help with sexual issues stemming from a lack of appropriate physical arousal, but Sildenafil does not help with increases in sexual desire or libido.

• Psychological support can enhance the effectiveness of medical treatments.
• Female sexual health is complex and multifaceted.
• Sildenafil should not replace comprehensive sexual health assessments.
• Evidence supports combining medication with behavioral therapies.

It should be noted that using Sildenafil tablets does still come with the risk of side effects.

• Sildenafil is primarily approved for erectile dysfunction in men.
• Some studies explore its potential to treat female arousal disorder.
• Its use for women remains off-label in many regions.
• Long-term safety data for women is limited.

These studies have noted headaches, flushing, heartburn, nasal congestion, and visual disturbances to be more common in the Sildenafil treatment groups. Sildenafil tablets are currently only FDA approved for sexual disorder use in men with erectile dysfunction, and women should not attempt to use them unless under the guidance of their doctor who has decided to prescribe them off-label.

Does Viagra help women?

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. Statistically significant improvement following sildenafil was only reported in the lubrication domain of sexual function during the double-blind phase.

Side effects

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]. 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. You may find the active ingredient, Sildenafil, in formulations other than the manufactured oral tablet from compounding pharmacies that include it in formulations meant to help improve female sexual satisfaction and blood flow called “scream creams”.

Materials and Methods:

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. 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].

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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 sildenafil citrate tablets 150 mg with sildenafil. 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. In these topical creams, the medication is meant to be applied externally to help enhance smooth muscle relaxation and improve blood flow to the vaginal and clitoral regions for a period of a few hours. These compounded creams may also contain other ingredients mean to enhance the blood flow and sensitivity of the area, and they require a prescription from a doctor in order to be made up.

Off-label Use	Description	Evidence Level	Caution
Treatment of Female Sexual Dysfunction	Improving desire and arousal	Limited	Not FDA-approved, consult doctor
Pulmonary Arterial Hypertension	Used in women with this condition	Approved in some countries	Under medical supervision
Erectile Dysfunction in Partner	Enhancing sexual activity indirectly	Anecdotal	Not primary use

Topical Sildenafil-containing scream creams are thought to greatly reduce the amount of medication that is delivered systemically through the entire body and may help reduce any whole-body side effects as compared to the Sildenafil tablets.

MeSH terms

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. Sildenafil citrate seems to improve orgasm in a sample of Egyptian females with sexual dysfunction.

Female Sexual Dysfunction—Medical and Psychological Treatments, Committee 14

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. (2003) Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder. Compounded Sildenafil creams for women are often meant to be applied about 30 minutes before sexual activity and gently rubbed in.

Side Effect	Severity	Frequency	Management
Headache	Mild to Moderate	Common	Analgesics, hydration
Flushing	Mild	Common	Cooling measures
Dizziness	Mild	Occasional	Sit/lie down, avoid sudden standing
Nasal Congestion	Mild	Common	Decongestants if needed
Vision Changes	Rare	Rare	Stop medication if occurs