Can Viagra Be Prescribed to Women?
Viagra (sildenafil) is not recommended for women with female sexual dysfunction due to lack of efficacy demonstrated in clinical trials, despite theoretical mechanisms suggesting it might work. 1
Guideline Recommendations
The National Comprehensive Cancer Network explicitly states that oral phosphodiesterase type 5 inhibitors (PDE5i) should not be used for female sexual dysfunction because of lack of data regarding their effectiveness in women. 1 Although sildenafil theoretically increases pelvic blood flow to the clitoris and vagina, randomized clinical trials showed contradictory results in women being treated for sexual arousal disorder. 1
Evidence from Clinical Trials
The research evidence consistently demonstrates limited to no benefit:
In estrogenized and estrogen-deficient women with female sexual arousal disorder (FSAD): A large randomized trial of 577 estrogenized and 204 estrogen-deficient women found no significant differences in efficacy between sildenafil and placebo for any patient or partner endpoints. 2 Any genital physiological effect was not perceived as improving sexual response. 2
In postmenopausal women: An open-label study of 33 postmenopausal women showed overall sexual function did not improve significantly, with only 18% having a significant therapeutic response (>60% improvement). 3
One notable exception: Sildenafil demonstrated efficacy specifically for antidepressant-induced sexual dysfunction in premenopausal women taking selective serotonin reuptake inhibitors (SRIs). 4 In this randomized controlled trial, women treated with sildenafil had significantly better outcomes compared to placebo (mean difference 0.8, p=0.001). 4
In postmenopausal women without concomitant hypoactive sexual desire disorder (HSDD): One study showed sildenafil was effective when women had protocol-specified estradiol and testosterone levels or were receiving hormone replacement therapy, but only if HSDD was not present. 5
Recommended Alternatives for Female Sexual Dysfunction
Instead of sildenafil, evidence-based treatments include:
- Vaginal estrogen (pills, rings, or creams) for vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal women 1
- Pelvic floor muscle training for sexual pain, arousal, lubrication, orgasm, and satisfaction 1
- Psychotherapy and cognitive behavioral therapy for women experiencing sexual dysfunction 1
- Vaginal dilators for vaginismus, sexual aversion disorder, vaginal scarring, or stenosis 1
Common Pitfalls to Avoid
Do not prescribe sildenafil off-label for general female sexual dysfunction based on the mechanism of action alone—clinical trials have not supported this practice. 1 The one exception where evidence exists is for antidepressant-induced sexual dysfunction in premenopausal women on SRIs, where sildenafil may be considered. 4
Side Effects in Women
When sildenafil was studied in women, adverse events included headache, flushing, rhinitis, nausea, visual disturbances, dyspepsia, and notably clitoral discomfort/"hypersensitivity" (21% of women in one study). 2, 3