Sex Drive and Libido in Women - Value of Viagra

Following the success achieved with Viagra in the male, some researchers have begun to study this drug for women. Some, but not all, studies have shown encouraging results.

  • VIAGRA has an established safety profile of over 9 years.
  • Viagra isn't licensed for use in women and its safety in women hasn't been established.
  • Viagra is available 25mg and 50mg and 100mg tablets.
  • Viagra has become the fastest selling pharmaceutical drug in history.
  • Viagra was approved by the Food and Drug Administration in 1998 as a therapy for erectile dysfunction (ED), a term for impotence that surfaced in the 1990s.

Viagra is an oral medication for erectile dysfunction (ED). It helps the majority of men with ED improve their erections. That means they are able to achieve harder erections. Viagra works by blocking an enzyme that normally inhibits blood flow, causing penile tissue to swell. That enzyme is found in great quantities in the penis and is also found in the pelvic region of women.


In a study from Canada,0202 the efficacy and safety of sildenafil were evaluated in estrogenized and estrogen-deficient women with sexual dysfunction that included female sexual arousal disorder (FSAD). Patients were randomized to receive 10-100 mg sildenafil or matching placebo. A total of 577 estrogenized and 204 estrogen-deficient women were randomized to treatment. All were diagnosed with FSAD, but it was the primary presenting symptom in only 46% and 50% of women, respectively. Differences in efficacy between sildenafil and placebo were not significant for any patient or partner end points. The main adverse effects were headache, flushing, nausea, visual disturbances, and dyspepsia, which were generally mild to moderate in nature.

  • It was concluded that any genital physiological effect of sildenafil was not perceived as improving the sexual response in estrogenized or estrogen-deficient women with a broad spectrum of sexual dysfunction that included FSAD.

In the study by Laan and colleagues,0201 the effect of a single oral dose of sildenafil citrate on vaginal vasocongestion and subjective sexual arousal in healthy premenopausal women. Twelve women without sexual dysfunction were randomly assigned to receive either a single oral 50 mg dose of sildenafil or matching placebo in a first session and the alternate medication in a second session. Significant increases in vaginal vasocongestion (engorgement) were found with Viagra treatment compared with placebo. There were no differences between treatments on subjective sexual arousal experience. Analyses by suspected treatment received found that significantly stronger sexual arousal and vaginal wetness were reported for the treatment that was believed to be sildenafil vs. the treatment that was believed to be placebo. The suspected treatment se quence was incorrect for half of the women. Sildenafil was well tolerated, with no evidence of significant adverse events.

  • Sildenafil was found to be effective in enhancing vaginal engorgement during erotic stimulus conditions in healthy women without sexual dysfunction but was not associated with an effect on subjective sexual arousal.

Researchers in Italy0303 set out to determine the changes, if any, on female sexual pathways using sildenafil (primary outcome), and to verify the safety of this drug (second outcome). Sixty-eight healthy volunteer women aged 19-38 years, asymptomatic for sexual disorders, were enrolled. The study consisted of 4 weeks sildenafil, 2 weeks washout, and 4 weeks placebo, by two possible se quences: sildenafil 50 mg, washout, placebo; or placebo, washout, sildenafil 50 mg. Fifty women completed the study at the first follow-up, and 38 women reached the second follow-up. Six women withdrew because of adverse events. Sildenafil improved arousal, orgasm, and enjoyment with respect to placebo. Significant differences were noted during sildenafil usage with respect to the baseline for arousal, orgasm, and sexual enjoyment. The adverse events were transient and mild or moderate.

  • It was concluded that sildenafil acts on different sexual pathways in healthy women, improving their sexual experience.

In California, a study was undertaken to evaluate the efficacy and safety of sildenafil citrate in spontaneously or surgically postmenopausal women with female sexual arousal disorder (FSAD). There were significant improvements inincreased genital sensation during intercourse or stimulation and increased satisfaction with intercourse and/or foreplay. For women with FSAD without concomitant hypoactive sexual desire disorder(HSDO) sildenafil was associated with significantly greater improvement in sensation and satisfaction compared with placebo. No significant improvements were shown for women with concomitant HSDD.

  • The conclusion was that Sildenafil was effective and well tolerated in postmenopausal women with FSAD without concomitant HSDD or contributory emotional, relationship or historical abuse issues.

Pfizer once had great hopes for its clinical program testing Viagra in women. In one early clinical trial, researchers gave six women Viagra and six others a placebo, sat them in front of erotic videos and used a pelvic probe to measure any change in genital blood flow. The sex organs of women given Viagra were more engorged than those given placebos. The program seemed to be succeeding. But a larger trial that included a questionnaire found that although Viagra was associated with greater pelvic blood flow, the women experiencing this effect did not feel any more aroused. Pfizer researchers spent years trying to find some well-defined group of women for whom increased pelvic blood flow and desire could be linked. 

Sexual response in women, the maker of Viagra has found, are a lot more complicated than men. After eight years of work and tests involving 3,000 women, Pfizer Inc. announced0401 that it was abandoning its effort to prove that the impotence drug Viagra improves sexual function in women. The problem, Pfizer researchers found, is that men and women have a fundamentally different relationship between arousal and desire. For men, arousal almost always leads to desire. So by improving a man's ability to have erections, Viagra measurably affects his sexual function. But arousal and desire are often disconnected in women. Although Viagra can indeed create the outward signs of arousal in many women, that seems to have little effect on a woman's willingness, or desire, to have sex. With women, things depend on a myriad of factors. Still, Viagra can be effective in some women. Women who once had normal sexual function but then suddenly lost all desire - often as a result of taking antidepressants - can be helped by Viagra. Women who have always had low libido levels are unaffected by Viagra. Much of Pfizer's research found that the real factor in determining desire and sexual function in women is hormone levels. Procter and Gamble is testing a patch with testosterone, the male hormone, as a means of improving female sexual function. Some gynecologists are already prescribing testosterone for patients who complain of low libidos. Estrogen treatments and supplements are also commonly used.

In 2008, research is again beginning to show some encouragementfor improvements for women.

In a randomized, double-blind, placebo-controlled trial, 22 women received a 50-mg dose of sildenafil (n=11) or placebo (n=11) daily for 15 days.0802 The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was used for subjective evaluation of the sexual-response cycle. Clitoral blood flow was measured. Blood flow was significantly more improved in the sildenafil than in the placebo group (P<0.05).

  • Sildenafil may improve clitoral blood flow and increase sexual satisfaction in postmenopausal women with orgasmic dysfunction.0802

Related Medical Abstracts - Click on the paper title:-

Low libido is a very common problem in women with some studies suggesting an incidence of 30 per cent. Sometimes there may be an underlying physical problem resulting in pain during intercourse (painful sex).

Libido in women is a complex issue. The sex hormones are probably not quite as important as they are in men. General health, self-esteem and emotional attachment to your partner, are equally, if not more important. On occasion, a patient with PMS may be troubled by reduced libido. Supplementation with implants of testosterone may improve sex drive (Q 28.17). There is some evidence that tibolone (Livial - Livial), which is available for postmenopausal women or women who have had a hysterectomy (hysterectomy), may increase libido. Counselling may sometimes be required.  

Whereas Sildenafil (Viagra) has become popular treatment for male problems, the place of this medication in women with problems remains unproven

In a recent review the clinical data0901 regarding the efficacy and safety of sildenafil for the treatment of female sexual dysfunction has been assessed from a database search from 1950 to February 2009. Clinical trials involving sildenafil treatment of premenopausal and postmenopausal women with FSD and women with FSD due to concomitant medications and/or disease states were reviewed. An increasing number of clinical trials have been published regarding the treatment of FSD with sildenafil. Eight studies demonstrated a possible benefit from treatment for FSD in patients receiving sildenafil, regardless of dose, while 4 trials did not show any significant differences with treatment.

It appears that sildenafil might be beneficial for women with FSD caused by diseases such as multiple sclerosis, type 1 diabetes, spinal cord injury, and use of antidepressant medications. Although data suggest a possible role of sildenafil for the treatment of FSD, the information should be interpreted cautiously, as many of the studies included small sample sizes, used inappropriate statistical tests, and used nonvalidated assessment tools.

 

Initial studies with Viagra for women have not been encouraging.


Related Medical Abstracts - Click on the paper title:-

Libido and the menopause.

The physiological changes that occur in menopause alter sexual function and affect well-being. Hormonal changes contribute significantly to reduced sexual function in older women and sexual dysfunction may well be amenable to treatment with exogenous hormones or other agents.  Hormone therapy benefits many women who have dyspareunia related to vaginal atrophy, reduced libido and decreased satisfaction, particularly if these symptoms adversely affect their quality of life. Alternative agents such as tibolone and sildenafil citrate can be useful adjuncts. It is increasingly important to recognise postmenopausal sexual dysfunction. Treatment of this syndrome must be individualised to the specific complaints of each woman. Hormones and other agents are relevant treatment options for properly-selected women.0801

Care of women in menopause: sexual function, dysfunction and therapeutic modalities.(2008-01)

 


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Women's Health


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