Is Viagra (sildenafil) used to treat female sexual dysfunction?

Viagra (Sildenafil) for Female Sexual Dysfunction

Viagra (sildenafil) is not recommended for the treatment of female sexual dysfunction due to lack of consistent evidence regarding its effectiveness in women. 1

Current Guidelines on Sildenafil for Female Sexual Dysfunction

• The National Comprehensive Cancer Network (NCCN) Survivorship Panel explicitly does not recommend oral phosphodiesterase type 5 inhibitors (PDE5i) like sildenafil for female sexual dysfunction due to insufficient evidence of effectiveness 1
• Although sildenafil is theorized to increase pelvic blood flow to the clitoris and vagina, randomized clinical trials have shown contradictory results in women being treated for sexual arousal disorder 1
• Multiple expert panels have concluded that more research is needed before sildenafil can be recommended for treating female sexual dysfunction 1, 2

Evidence from Clinical Trials

• Some small studies have shown potential benefits of sildenafil in specific populations:

  • Postmenopausal women with female sexual arousal disorder (FSAD) without hypoactive sexual desire disorder showed some improvement with sildenafil 3
  • Women with antidepressant-associated sexual dysfunction showed some reduction in adverse sexual effects with sildenafil 4
  • Type 1 diabetic premenopausal women with sexual arousal disorder showed improvements in both subjective and objective measures 5

• However, these positive findings have not been consistent across studies:

  • A study of postmenopausal women with sexual dysfunction found that only 18.1% had a significant therapeutic response to sildenafil 6
  • The overall sexual function did not improve significantly in many trials, despite some changes in specific parameters like vaginal lubrication 6

FDA-Approved Alternatives for Female Sexual Dysfunction

For women experiencing sexual dysfunction, the following FDA-approved options are available:

• For premenopausal women with hypoactive sexual desire disorder (HSDD):

  • Flibanserin - FDA-approved in 2015 for acquired, generalized HSDD in premenopausal women 1, 2
  • Bremelanotide - FDA-approved as a self-administered subcutaneous injection as needed for premenopausal women with HSDD 2

• For postmenopausal women with dyspareunia:

  • Ospemifene - FDA-approved in 2013 for moderate to severe dyspareunia in postmenopausal women without known or suspected breast cancer 1, 2
  • Prasterone (vaginal DHEA) - FDA-approved for dyspareunia in postmenopausal women, though contraindicated in women with a history of breast cancer 1

Common Side Effects of Sildenafil in Women

• Headache, flushing, and rhinitis are commonly reported 3, 6, 4
• Clitoral discomfort and "hypersensitivity" have been reported in some women 6
• Dizziness, dyspepsia, and visual symptoms may also occur 3, 6, 4

Clinical Approach to Female Sexual Dysfunction

• Begin with a thorough assessment of the specific type of sexual dysfunction (desire, arousal, orgasm, or pain disorders) 1

• Consider non-pharmacological approaches first:

  • Water-, oil-, or silicone-based lubricants and moisturizers for vaginal dryness and sexual pain 1
  • Pelvic floor muscle training for sexual pain, arousal, lubrication, and orgasm issues 1
  • Vaginal dilators for vaginismus, sexual aversion disorder, or vaginal stenosis 1
  • Psychotherapy, particularly cognitive behavioral therapy 1

• For specific conditions, consider FDA-approved medications:

  • For HSDD in premenopausal women: flibanserin or bremelanotide 1, 2
  • For dyspareunia in postmenopausal women: ospemifene (if no history of breast cancer) or prasterone 1, 2
  • For off-label treatment of HSDD: bupropion or buspirone may be considered despite limited data 1, 2