Female Viagra': What You Need to Know
Of participants, 99 and 94, respectively, were in the intention-to-treat (ITT) analysis and 90 and 84, respectively, completed all study visits.1 When measuring outcomes based on the SFQ28 Arousal Sensation domain, increased efficacy was reported for the sildenafil cream group vs the placebo cream group. However, statistically significant improvements were not observed for either coprimary endpoint during the double-blind period, nor were the number of satisfying events improved. In the ITT population, patients in the sildenafil cream group had significantly improved SFQ28 Desire domain scores at week 8, which was considered an exploratory endpoint. Women with female sexual arousal disorder with concomitant orgasmic dysfunction had lessened treatment benefits at week 12 vs those with other sexual dysfunction diagnoses.1 The largest 12-week improvements in sexual dysfunction from sildenafil cream were observed among women with only female sexual desire disorder as their sexual dysfunction. These patients had significant improvements in the SFQ28 Arousal Sensation domain, SFQ28 Desire domain, and SFQ28 Orgasm domain vs placebo users.
What should I do in case of overdose?
Sildenafil belongs to the drug class called phosphodiesterase (PDE) type 5 inhibitors. Sildenafil (Viagra, Vybrique brands and generic) is used to treat erectile dysfunction (ED, impotence). It increases blood flow to the penis following sexual stimulation by blocking the enzyme responsible for the breakdown of cGMP. This allows men to keep an erection hard enough for sex. Sildenafil (Viagra, Vybrique brands and generic) only works following sexual stimulation.
Comparison table
It works within 30 to 60 minutes, but may be taken up to four hours before sexual activity. Sildenafil (Revatio brand) reduces high blood pressure associated with pulmonary arterial hypertension (PAH). These results indicated improved outcomes from sildenafil cream among women with female sexual arousal disorder. Investigators recommended removing the restrictions to enroll sexual partners in future studies to evaluate a more diverse study population.1 Johnson I, Thurman A, Cornell K, et al. Preliminary efficacy of topical sildenafil cream for the treatment of female sexual arousal disorder: A randomized controlled trial. Potential first-in-category therapy for female sexual arousal disorder. Sildenafil (Viagra, Revatio) reduced antidepressant-associated sexual dysfunction in women in a randomized controlled trial, which investigators characterize as the first conducted in women with this adverse drug effect.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Kamagra Oral Jelly | 100mg | 10 Sachets | 54.55€ 51.95€ | |
| Viagra Generic | 200mg | 30 + 2 Pills | 83.07€ 79.11€ | |
| Viagra Generic | 150mg | 270 + 10 Pills | 326.61€ 311.06€ | |
| Kamagra | 100mg | 32 Pills | 121.24€ 115.47€ | |
| Viagra Generic | 200mg | 270 + 10 Pills | 379.76€ 361.68€ | |
| Kamagra Soft Tabs | 100mg | 12 Pills | 57.55€ 54.81€ | |
| Kamagra Polo | 100mg | 60 + 4 Pills | 189.39€ 180.37€ | |
| Viagra Generic | 50mg | 10 Pills | 26.87€ 25.59€ | |
| Kamagra Oral Jelly | 100mg | 63 + 7 Sachets | 224.18€ 213.50€ | |
| Kamagra | 100mg | 12 Pills | 55.64€ 52.99€ | |
| Kamagra | 100mg | 20 Pills | 86.09€ 81.99€ | |
| Kamagra Soft Tabs | 100mg | 120 + 6 Pills | 311.78€ 296.93€ | |
| Viagra Generic | 200mg | 120 + 8 Pills | 204.80€ 195.05€ | |
| Viagra Generic | 100mg | 360 + 10 Pills | 330.21€ 314.49€ |
The study, recently published in JAMA, was conducted by George Nurnberg, MD, of the department of psychiatry, University of New Mexico, and colleagues.1 This group's 2003 study, also published in JAMA, demonstrated sildenafil's benefit in men with this complaint.2 That study was a departure from the anecdotal or open-label reports that served as an evidence base for a myriad of proposed remedies.3 Although the association between sexual dysfunction and antidepressant therapy has been recognized since the introduction of tricyclics, the incidence of this adverse effect has increased since the advent of serotonin reuptake inhibitors (SRIs).
- Sildenafil’s interaction with other medications is an important consideration.
- It has a different impact depending on individual health conditions.
- Data on long-term effects of sildenafil in women are inconclusive.
- Use only under medical supervision to minimize risks.
Sexual dysfunction has also played a role in reducing patient adherence to the prescribed medication. Consequently, Nurnberg commented to Psychiatric Times, "treatments have been driven more by opinion than by solid data." Nurnberg and colleagues emphasize this concern in their latest study, warning that "without evidence-based data to treat sexual function associated with SRIs in women, clinicians may lack the confidence to manage it effectively, which leaves patients exposed to excess random pharmacology." The investigators employed a design and protocol similar to those in their study with men. The data for women indicated that sildenafil reduced adverse sexual effects, specifically including delayed orgasm responses and inadequate lubrication. Nurnberg commented on the relative sparsity of research on the effect of sildenafil on orgasm function, despite the fact that delayed or unachieved orgasm is "the central factor of SRI antidepressant-associated sexual dysfunction." He attributed this to the FDA-approved indication and marketing focus for male erectile dysfunction and to the more complex measures needed to assess orgasm function in women than sexual arousal in men. In addition, he noted, the initial studies of sildenafil had not shown sildenafil syrup benefit in women with sexual arousal disorder unrelated to antidepressant medication. Nevertheless, there was good reason to evaluate the effects of a selective phosphodiesterase type 5 inhibitor such as sildenafil in women experiencing sexual dysfunction from antidepressant medication, according to Nurnberg.
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Of participants, 99 and 94, respectively, were in the intention-to-treat (ITT) analysis and 90 and 84, respectively, completed all study visits.1 When measuring outcomes based on the SFQ28 Arousal Sensation domain, increased efficacy was reported for the sildenafil cream group vs the placebo cream group. However, statistically significant improvements were not observed for either coprimary endpoint during the double-blind period, nor were the number of satisfying events improved. In the ITT population, patients in the sildenafil cream group had significantly improved SFQ28 Desire domain scores at week 8, which was considered an exploratory endpoint. Women with female sexual arousal disorder with concomitant orgasmic dysfunction had lessened treatment benefits at week 12 vs those with other sexual dysfunction diagnoses.1 The largest 12-week improvements in sexual dysfunction from sildenafil cream were observed among women with only female sexual desire disorder as their sexual dysfunction. These patients had significant improvements in the SFQ28 Arousal Sensation domain, SFQ28 Desire domain, and SFQ28 Orgasm domain vs placebo users.
Anatomy and physiology of female sexual function and dysfunction: classification
These results indicated improved outcomes from sildenafil cream among women with female sexual arousal disorder. Investigators recommended removing the restrictions to enroll sexual partners in future studies to evaluate a more diverse study population.1 Johnson I, Thurman A, Cornell K, et al. Preliminary efficacy of topical sildenafil cream for the treatment of female sexual arousal disorder: A randomized controlled trial. Potential first-in-category therapy for female sexual arousal disorder. Sildenafil (Viagra, Revatio) reduced antidepressant-associated sexual dysfunction in women in a randomized controlled trial, which investigators characterize as the first conducted in women with this adverse drug effect. The initial studies of sildenafil for women with sexual arousal disorder may not have adequately controlled for hormonal factors or level of sexual interest, or measured efficacy in the varied facets of sexual response. Later, more focused studies yielded favorable results. In addition, Nurnberg noted, nitric oxide synthase isoforms, nitric oxide, and phos- phodiesterase type 5 inhibitors are present in female genital tissue. Phosphodiesterase type 5 inhibitor enhancement of nitric oxide–cyclic guanosine monophosphate signaling occurs in both women and men. Studying Drug Treatment of Adverse Drug EffectWomen in the Nurnberg study had to have reported good sexual interest and activity before the onset of depression and antidepressant treatment. Their episodes of sexual dysfunction had to be associated with antidepressant treatment and needed to have remitted with improvement of depression and discontinuation of medication. Baseline endocrine values were obtained in these women to later analyze for possible correlations with treatment response.
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A 50 mg dose of sildenafil was prescribed, and patients were instructed to take sildenafil oral jelly 100mg lovegra it approximately one hour before sexual activity. They were told to increase the dose to 100 mg on the next occasion if they experienced a partial response or a lack of response to sildenafil. The nine patients, all of whom had experienced either anorgasmia or delayed orgasm with or without associated disturbances, reported significant reversal of sexual dysfunction, usually with the first dose of 50 mg of sildenafil. Sildenafil is used to treat erectile dysfunction (ED) in men or pulmonary arterial hypertension (PAH) in both men and women, depending on the brand. Viagra and Vybrique are used for ED and Revatio is used for PAH.
How much time does it take for Viagra to work for females?
Sildenafil works by blocking the action of an enzyme called cGMP-specific phosphodiesterase type-5 (PDE-5). This enzyme breaks down cGMP, a substance that induces smooth muscles to relax. Blocking PDE-5 means increased levels of cGMP within the smooth muscles which promotes muscle relaxation and vasodilation (a widening of blood vessels). High levels of PDE-5 are found in the penis, lungs, and retina. PDE-5 is also found throughout the body within the smooth muscle cells of the blood vessels and muscles. This analysis indicated that women whose sexual function improved after receiving sildenafil or placebo had higher mean levels of free testosterone and thyroxine.
3. Downsides
Ninety-eight women of 145 screened were randomized to receive either sildenafil in a 50-mg starting dosage or matching placebo. They were instructed to take the study medication approximately 1 to 2 hours before anticipated sexual activity but not more than once daily. They were asked to attempt to have sexual activity twice weekly, but not less than once weekly throughout the 8-week trial. Treatment 200mg sildenafil citrate efficacy was measured with 4 validated instruments. The primary outcome measure was the mean improvement on the Clinical Global Impression Scale (CGI) adapted for sexual function. Secondary outcome instruments were the Sexual Function Questionnaire, the Arizona Sexual Experience scale–female version, and the University of New Mexico Sexual Function Inventory–female version. Patients maintained logs that were reviewed for the frequency and percentage of successful intercourse attempts and the number of satisfactory attempts at orgasm.
How Viagra Works
Secondary outcome instruments were the Sexual Function Questionnaire, the Arizona Sexual Experience scale–female version, and the University of New Mexico Sexual Function Inventory–female version. Patients maintained logs that were reviewed for the frequency and percentage of successful intercourse attempts and the number of satisfactory attempts at orgasm. In the intention-to-treat analysis, women receiving sildenafil had a statistically significant higher mean score improvement from baseline of 1.9 on the CGI than the 1.1 mean improved score for those receiving placebo. In the secondary outcome measures, sildenafil was associated with greater improvement on scores in the domain of orgasm function, including the ability to reach orgasm and to experience orgasm satisfaction. The investigators proclaimed this study important "not only because women experience major depressive disorder at nearly double the rate of men and because they experience greater resulting sexual dysfunction than men, but also because it establishes that selective phosphodiesterase type 5 inhibitors are effective in both sexes for this purpose." In later discussion, Nurnberg added, "the issue is keeping patients compliant with a medication by actively treating a side effect." Although acknowledging that clinical options include switching adversely affected patients from an SRI to an antidepressant having less incidence of sexual dysfunction, Nurnberg cautioned against discontinuing an effective agent with side effects and substituting another agent, which may or may not be as effective.
Professional resources
Instead, he recommended that clinicians "encourage the patient not to stop the medication but to call to discuss which option would be useful-including waiting for it to go away." SildenÂafil treatment of women with antidepressant-asso-ciated sexual dysfunction: a randomized controlled trial. Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. Rudkin L, Taylor MJ, Hawton K. Strategies for managing sexual dysfunction induced by antidepressant medication. In an open study, sildenafil (Viagra) was prescribed for nine women outpatients who reported sexual dysfunction induced by antidepressant medication, primarily selective serotonin reuptake inhibitors. In the intention-to-treat analysis, women receiving sildenafil had a statistically significant higher mean score improvement from baseline of 1.9 on the CGI than the 1.1 mean improved score for those receiving placebo. In the secondary outcome measures, sildenafil was associated with greater improvement on scores in the domain of orgasm function, including the ability to reach orgasm and to experience orgasm satisfaction. The investigators proclaimed this study important "not only because women experience major depressive disorder at nearly double the rate of men and because they experience greater resulting sexual dysfunction than men, but also because it establishes that selective phosphodiesterase type 5 inhibitors are effective in both sexes for this purpose." In later discussion, Nurnberg added, "the issue is keeping patients compliant with a medication by actively treating a side effect." Although acknowledging that clinical options include switching adversely affected patients from an SRI to an antidepressant having less incidence of sexual dysfunction, Nurnberg cautioned against discontinuing an effective agent with side effects and substituting another agent, which may or may not be as effective.
Methods and Objectives
The study, recently published in JAMA, was conducted by George Nurnberg, MD, of the department of psychiatry, University of New Mexico, and colleagues.1 This group's 2003 study, also published in JAMA, demonstrated sildenafil's benefit in men with this complaint.2 That study was a departure from the anecdotal or open-label reports that served as an evidence base for a myriad of proposed remedies.3 Although the association between sexual dysfunction and antidepressant therapy has been recognized since the introduction of tricyclics, the incidence of this adverse effect has increased since the advent of serotonin reuptake inhibitors (SRIs). Sexual dysfunction has also played a role in reducing patient adherence to the prescribed medication. Consequently, Nurnberg commented to Psychiatric Times, "treatments have been driven more by opinion than by solid data." Nurnberg and colleagues emphasize this concern in their latest study, warning that "without evidence-based data to treat sexual function associated with SRIs in women, clinicians may lack the confidence to manage it effectively, which leaves patients exposed to excess random pharmacology." The investigators employed a design and protocol similar to those in their study with men. The data for women indicated that sildenafil reduced adverse sexual effects, specifically including delayed orgasm responses and inadequate lubrication. Nurnberg commented on the relative sparsity of research on the effect of sildenafil on orgasm function, despite the fact that delayed or unachieved orgasm is "the central factor of SRI antidepressant-associated sexual dysfunction." He attributed this to the FDA-approved indication and marketing focus for male erectile dysfunction and to the more complex measures needed to assess orgasm function in women than sexual arousal in men.
Premenopausal women affected by sexual arousal disorder treated with sildenafil: a double-blind, cross-over, placebo-controlled study
In addition, he noted, the initial studies of sildenafil had not shown sildenafil syrup benefit in women with sexual arousal disorder unrelated to antidepressant medication. Nevertheless, there was good reason to evaluate the effects of a selective phosphodiesterase type 5 inhibitor such as sildenafil in women experiencing sexual dysfunction from antidepressant medication, according to Nurnberg. The initial studies of sildenafil for women with sexual arousal disorder may not have adequately controlled for hormonal factors or level of sexual interest, or measured efficacy in the varied facets of sexual response. Later, more focused studies yielded favorable results. In addition, Nurnberg noted, nitric oxide synthase isoforms, nitric oxide, and phos- phodiesterase type 5 inhibitors are present in female genital tissue. Instead, he recommended that clinicians "encourage the patient not to stop the medication but to call to discuss which option would be useful-including waiting for it to go away." SildenÂafil treatment of women with antidepressant-asso-ciated sexual dysfunction: a randomized controlled trial. Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. Rudkin L, Taylor MJ, Hawton K. Strategies for managing sexual dysfunction induced by antidepressant medication. In an open study, sildenafil (Viagra) was prescribed for nine women outpatients who reported sexual dysfunction induced by antidepressant medication, primarily selective serotonin reuptake inhibitors. A 50 mg dose of sildenafil was prescribed, and patients were instructed to take sildenafil oral jelly 100mg lovegra it approximately one hour before sexual activity. They were told to increase the dose to 100 mg on the next occasion if they experienced a partial response or a lack of response to sildenafil. The nine patients, all of whom had experienced either anorgasmia or delayed orgasm with or without associated disturbances, reported significant reversal of sexual dysfunction, usually with the first dose of 50 mg of sildenafil. Sildenafil is used to treat erectile dysfunction (ED) in men or pulmonary arterial hypertension (PAH) in both men and women, depending on the brand. Viagra and Vybrique are used for ED and Revatio is used for PAH.
| Medication Class | Interaction Type | Effect |
|---|---|---|
| Nitrates | Dangerous hypotension | Avoid combination |
| Alpha-blockers | Increased blood pressure lowering effects | Use cautiously, monitor BP |
| CYP3A4 inhibitors | Increased sildenafil levels | Dose adjustment may be needed |
| Other PDE5 inhibitors | Cumulative effect | Avoid combining or overlapping doses |
Sildenafil works by blocking the action of an enzyme called cGMP-specific phosphodiesterase type-5 (PDE-5). This enzyme breaks down cGMP, a substance that induces smooth muscles to relax. Blocking PDE-5 means increased levels of cGMP within the smooth muscles which promotes muscle relaxation and vasodilation (a widening of blood vessels). High levels of PDE-5 are found in the penis, lungs, and retina. PDE-5 is also found throughout the body within the smooth muscle cells of the blood vessels and muscles. Sildenafil belongs to the drug class called phosphodiesterase (PDE) type 5 inhibitors. Sildenafil (Viagra, Vybrique brands and generic) is used to treat erectile dysfunction (ED, impotence).
How does Viagra work?
Phosphodiesterase type 5 inhibitor enhancement of nitric oxide–cyclic guanosine monophosphate signaling occurs in both women and men. Studying Drug Treatment of Adverse Drug EffectWomen in the Nurnberg study had to have reported good sexual interest and activity before the onset of depression and antidepressant treatment. Their episodes of sexual dysfunction had to be associated with antidepressant treatment and needed to have remitted with improvement of depression and discontinuation of medication. Baseline endocrine values were obtained in these women to later analyze for possible correlations with treatment response. This analysis indicated that women whose sexual function improved after receiving sildenafil or placebo had higher mean levels of free testosterone and thyroxine.
Female neurogenic sexual dysfunction secondary to clitoral neuropathy
Ninety-eight women of 145 screened were randomized to receive either sildenafil in a 50-mg starting dosage or matching placebo. They were instructed to take the study medication approximately 1 to 2 hours before anticipated sexual activity but not more than once daily. They were asked to attempt to have sexual activity twice weekly, but not less than once weekly throughout the 8-week trial. Treatment 200mg sildenafil citrate efficacy was measured with 4 validated instruments. The primary outcome measure was the mean improvement on the Clinical Global Impression Scale (CGI) adapted for sexual function. It increases blood flow to the penis following sexual stimulation by blocking the enzyme responsible for the breakdown of cGMP. This allows men to keep an erection hard enough for sex.
- Some studies have shown mild improvements in female sexual distress.
- The drug may help women with orgasmic disorder by increasing sensation.
- Women should report any unusual symptoms to a healthcare professional.
- Alternative treatments include counseling and hormonal therapy.
Sildenafil (Viagra, Vybrique brands and generic) only works following sexual stimulation. It works within 30 to 60 minutes, but may be taken up to four hours before sexual activity. Sildenafil (Revatio brand) reduces high blood pressure associated with pulmonary arterial hypertension (PAH).
| Area of Research | Focus | Expected Outcomes | Challenges |
|---|---|---|---|
| Larger clinical trials | Efficacy and safety validation | Better approval pathway | Funding, recruitment difficulties |
| Combination therapies | Sildenafil with hormonal or psychological treatments | Enhanced effects | Interaction management |
| Delivery methods innovations | Topical, transdermal, or implantable forms | Increased convenience | Development complexity |
| Long-term safety studies | Effects of prolonged use | Safety confirmation | Ethical and logistical hurdles |