Can women use Cialis (tadalafil) for female sexual arousal disorder?

Can Women Use Cialis (Tadalafil)?

No, Cialis (tadalafil) is not recommended for women with female sexual arousal disorder due to insufficient evidence of effectiveness, and it is not FDA-approved for use in women. 1, 2

Guideline Position on PDE5 Inhibitors for Women

The NCCN Survivorship Panel explicitly states they do not recommend oral phosphodiesterase type 5 inhibitors (PDE5i), which includes both sildenafil and tadalafil, for female sexual dysfunction. 1 Although these medications theoretically increase pelvic blood flow to the clitoris and vagina, randomized controlled trials have shown contradictory results in women being treated for sexual arousal disorder. 1, 2 More research is needed before any recommendation can be made regarding the use of these medications for female sexual dysfunction. 1

FDA Approval Status

Tadalafil is FDA-approved only for men with erectile dysfunction, benign prostatic hyperplasia (BPH), or both conditions. 3 The FDA label explicitly states: "Tadalafil tablets are not for women or children" and "Tadalafil tablets are only for men over the age of 18." 3 There is no FDA approval for tadalafil use in women for any indication.

Evidence Limitations

While some small research studies have suggested potential benefits of tadalafil in specific female populations (such as type 1 diabetic premenopausal women with genital arousal disorder), 4 these studies had significant limitations including small sample sizes and lack of placebo control groups. 4 Larger, well-designed trials have failed to demonstrate consistent efficacy. 5

FDA-Approved Alternatives for Women

For Premenopausal Women with Hypoactive Sexual Desire Disorder:

• Flibanserin (100 mg daily at bedtime): FDA-approved in 2015, resulting in approximately 1 additional satisfying sexual event every 2 months. 1, 2, 6
• Bremelanotide: FDA-approved as a self-administered subcutaneous injection used as needed. 2, 6
• Off-label options: Bupropion or buspirone may be considered despite limited safety and efficacy data. 1, 6

For Postmenopausal Women with Dyspareunia (Painful Intercourse):

• Ospemifene: FDA-approved in 2013 for moderate to severe dyspareunia in postmenopausal women without known or suspected breast cancer or history of breast cancer. 1, 2
• Prasterone (vaginal DHEA): FDA-approved in 2016, though contraindicated in women with a history of breast cancer. 1, 2
• Vaginal estrogen (pills, rings, or creams): Effective for treating vaginal dryness, itching, discomfort, and painful intercourse. 1

Non-Pharmacological First-Line Approaches

Before considering any medication, the following should be implemented:

• Water-, oil-, or silicone-based lubricants and moisturizers for vaginal dryness and sexual pain. 2
• Pelvic floor muscle training to improve sexual pain, arousal, lubrication, orgasm, and satisfaction. 1, 2, 6
• Topical lidocaine applied to the vulvar vestibule before penetration for dyspareunia. 1
• Psychotherapy and sexual/couples counseling, as psychological factors frequently contribute to sexual dysfunction. 1, 2

Common Pitfalls to Avoid

• Do not assume all female sexual dysfunction is the same: Treatment must be targeted to the specific type of problem (desire, arousal, orgasm, or pain disorders). 2, 6
• Do not overlook relationship factors: Partner communication and relationship quality significantly impact treatment success. 2
• Do not prescribe tadalafil off-label for women: Despite theoretical mechanisms, clinical evidence does not support its use, and guideline panels explicitly recommend against it. 1, 2
• Screen for contributing medications: Hormone therapy, narcotics, and serotonin reuptake inhibitors commonly impair sexual desire. 6