Could the drug used to treat erectile dysfunction help women who have difficulties with arousal?
It’s a question that sexual medicine researchers have puzzled over since at least the late 1990s, when the Food and Drug Administration approved sildenafil, known as Viagra, for men.
Doctors prescribe sildenafil off-label to some female patients, either in the form of low doses of the pill or as a topical cream made by compounding pharmacies. Telehealth companies, like Alloy and Wisp, sell the creams on their platforms. Daré, a pharmaceutical company, is in the process of seeking approval from the F.D.A. for its topical sildenafil cream, which it plans to market specifically to women. Yet the research, including a study from Daré out today, suggests that if the drug is at all effective at increasing arousal in women, it’s only likely to do so for a small subset.
So should women experiencing sexual difficulties consider trying sildenafil? Here’s what experts advised.
Female Sexual Arousal Disorder and the Promise of Viagra
Research over the years, including the new study funded by Daré, has suggested that sildenafil might help women who have female sexual arousal disorder. This is the inability to attain or maintain sexual excitement, often including a lack of lubrication or genital swelling, to the extent that a person experiences distress as a result.
F.S.A.D. is technically separate from having low sexual desire, though in many cases, the two conditions overlap. It is sometimes a side effect of selective serotonin reuptake inhibitor antidepressants, and can also occur alongside other conditions that disrupt blood flow or nerve function, including diabetes and spinal cord injuries.
Difficulty with physical arousal in women is akin to erectile dysfunction in that it can come down to blood flow, said Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University, who has prescribed sildenafil for her female patients for almost a decade. Increased blood flow, particularly to the clitoris, heightens nerve sensitivity and triggers lubrication. Sildenafil dilates blood vessels, which makes it easier for blood to flow through them.
In the Daré study, the 174 premenopausal women who completed the study were given either a cream version of sildenafil or a placebo that was rubbed directly onto the clitoris and surrounding area. They were asked to report on their arousal, desire levels, number of recent sexual encounters and whether they felt distressed about their sexual function. Researchers found that women who had been diagnosed with female sexual arousal disorder alone — a total of 65 women, half of whom were given the cream — reported an increase in arousal with the sildenafil cream. But the cream didn’t significantly change arousal or the resulting distress among women who had F.S.A.D. alongside other conditions, like genital pain or the inability to orgasm. The improvement in the F.S.A.D.-only group was not significant because the number of participants was too small, the study authors wrote.
The findings echo the conclusions of other, smaller studies in which sildenafil pills improved sexual function for women with just arousal disorder and for women who experienced the condition as a side effect of S.S.R.I. medications or diabetes.
Not a Solution for Everyone
The study’s mixed results underscore that, for many women who struggle with arousal and desire, blood flow may only be part of the equation, or not the source of the problem at all, said Justin Garcia, executive director of the Kinsey Institute at Indiana University, which focuses on sexuality research. Arousal in women is often a “biopsychosocial response,” he said. Psychologically, “your sense of body image, your sense of your stress, how much sleep you have had” all affect sexual function, as do other factors, like vaginal dryness from menopause or pelvic floor tightness.
Given that, “I find myself using sildenafil when women have tried other therapies and not found success, or that distress associated with that dysfunction is so significant that we want to try something else,” said Dr. Jewel Kling, chair of the women’s health internal medicine division at the Mayo Clinic in Arizona. In the last three months, she has prescribed low doses of oral sildenafil to just three of her patients; she has not prescribed the compounded cream.
Dr. Streicher has found that sildenafil can be helpful for menopausal women too, particularly those who are on antidepressants for mood disruptions or have diabetes.
Women experiencing sexual difficulties have few pharmaceutical tools, Dr. Garcia said, and “want more options,” but the question about the sildenafil cream, he said, is “how significant of a benefit are people going to get from this?”
There is often a placebo effect when it comes to pharmaceuticals for sexual health. In studies on Viagra, even the men who were taking placebo pills found an improvement in erectile function. The same could be true of a sildenafil cream rubbed onto the clitoris, Dr. Streicher said.
She added: “I always say if you rub it in long enough, anything’s going to help.”
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