Sexual Function Questionnaires.Table 2 shows the mean (SD) scores on the secondary outcome measures from baseline to study end for both treatment groups.

What Are the Side Effects in Women?

In comparing the baseline sexual function questionnaire domain scores with those at the end of the study, women in the sildenafil group had a higher mean (SD) improvement (orgasm, P=.01) than women taking placebo for all domains except for pain. In the Arizona and the University of New Mexico questionnaires, the ability to reach orgasm and experience orgasm satisfaction was significantly better for those in the sildenafil group than for those in the placebo group for a mean difference from baseline of 0.5 (95% CI, 0.1-1.0; P = .01) for reaching orgasm for the Arizona questionnaire and 0.7 (95% CI, 0.1-1.3; P = .01) for the New Mexico questionnaire. In measuring depression, at baseline, women in both groups had nearly identical Hamilton scores.

Discussions with healthcare providers are crucial before considering sildenafil.
Female sexual dysfunction may have hormonal, psychological, or physical causes.
Sildenafil should never be used with other medications without medical approval.
Its use in women should be part of a broader treatment plan.

At the end of the study, their scores remained similar (P=.90) indicating persisting remission in depression.

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How It Works

Sexual Function Questionnaires.Table 2 shows the mean (SD) scores on the secondary outcome measures from baseline to study end for both treatment groups. In comparing the baseline sexual function questionnaire domain scores with those at the end of the study, women in the sildenafil group had a higher mean (SD) improvement (orgasm, P=.01) than women taking placebo for all domains except for pain. In the Arizona and the University of New Mexico questionnaires, the ability to reach orgasm and experience orgasm satisfaction was significantly better for those in the sildenafil group than for those in the placebo group for a mean difference from baseline of 0.5 (95% CI, 0.1-1.0; P = .01) for reaching orgasm for the Arizona questionnaire and 0.7 (95% CI, 0.1-1.3; P = .01) for the New Mexico questionnaire. In measuring depression, at baseline, women in both groups had nearly identical Hamilton scores. At the end of the study, their scores remained similar (P=.90) indicating persisting remission in depression.

Premenopausal women affected by sexual arousal disorder treated with sildenafil: a double-blind, cross-over, placebo-controlled study

The difference in change scores between treatment groups did not achieve statistical significance (P = .86). Among women who received treatment according to protocol, 3 women in the placebo group and 1 in the sildenafil group developed intermittent Hamilton depression scores of between 10 and 15. These were self-limited, transient, symptomatic changes distinguished from major depressive disorder relapse and not considered clinically meaningful to warrant intervention. No recurrence or relapse of major depressive disorder occurred in any of the women continuing a stable dose of antidepressants during the trial (Table 2). Mean (SD) baseline values for all endocrine values were within the normal range without significant differences between groups (Table 3). These were self-limited, transient, symptomatic changes distinguished from major depressive disorder relapse and not considered clinically meaningful to warrant intervention. No recurrence or relapse of major depressive disorder occurred in any of the women continuing a stable dose of antidepressants during the trial (Table 2).

Sildenafil is primarily approved for erectile dysfunction in men.
Some studies explore its potential to treat female arousal disorder.
Its use for women remains off-label in many regions.
Long-term safety data for women is limited.

Mean (SD) baseline values for all endocrine values were within the normal range without significant differences between groups (Table 3). Independent of treatment assignment, a comparison of women whose sexual function improved with those whose sexual function did not improve showed higher mean baseline levels of free testosterone (P ≤ .01) and thyroxine (P ≤ .01) among SRI-associated sexual dysfunction treatment responders. At study end, 76.9% (30 of 39) of women took a mean (SD) dose of 91.7 (19.8) mg of sildenafil and 86.5% (32 of 37) took 93.1 (17.5) mg of placebo. The maximum dose for the study sildenafil 100mg lowest price was 100 mg. The mean (SD) number of doses per 2-week interval was 5.0 (2.5) mg for sildenafil and 5.2 (2.5) for placebo, which supports the notion that the lack of efficacy in placebo patients was not due to a lack of attempts (P = .67).

Similar questions

Both trials relied on scoring based on subjective responses to different questions for men and women, so the roles of expectations and adverse effects, as well as treatment response, influencing subjective report measures cannot be ruled out. However, it seems clear that effective evidence-based treatments for treatment-associated adverse effects can lead to improved outcomes for major depressive disorder and other conditions requiring extended medication treatment. Sildenafil (Viagra) is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men. Sildenafil (Liqrev, Revatio) is used to improve the ability to exercise in adults (Liqrev, Revatio) and children 1 year of age and older (Revatio) with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness). Sildenafil is in a class of medications called phosphodiesterase (PDE) inhibitors.

Sildenafil inhibits phosphodiesterase type 5 in human clitoral corpus cavernousum smooth muscle

Sildenafil treats erectile dysfunction by increasing blood flow to the penis during sexual stimulation. This increased blood flow can cause an erection. Sildenafil treats PAH by relaxing the blood vessels in the lungs to allow blood to flow easily. If you are taking sildenafil to treat erectile dysfunction, you should know that it does not cure erectile dysfunction or increase sexual desire. The most common adverse event was headache, reported by 43% of women taking sildenafil and 27% taking placebo (P = .09). Less frequent were flushing, 24% vs 0% (P<.001); dyspepsia, 12% vs 0% (P = .01); nasal congestion, 37% vs 6% (P<.001); and transient visual disturbances, 14% vs 2% (P = .03), respectively. Adverse events more common in the placebo group than in the sildenafil group were nausea 16% vs 2% (P = .01) and anxiousness 6% vs 2% (P = .31). No serious adverse events related to trial medication were reported (Table 4). To our knowledge, this is the first randomized trial to demonstrate a significant reduction in adverse sexual effects, measured by the Clinical Global Impression sexual function, that compared sildenafil with placebo among women with SRI-associated sexual dysfunction, specifically including delayed orgasm responses and inadequate lubrication, while continuing stable-dose antidepressant treatment.

Precaution	Rationale	Advice
Medical consultation	To rule out contraindications	Always consult prior to use
Avoid Nitrates	Risk of severe hypotension in combination	Do not combine with nitrates
Monitoring Blood Pressure	Possible hypotensive effects	Check BP regularly
Use under medical supervision	For dosage and safety guidance	Essential for off-label use

These findings support earlier open-label reports involving women with SRI-associated sexual dysfunction and builds on the results of previous trials involving men, with benefits not limited to erectile function, and including delayed ejaculation or orgasm and satisfaction.11 These findings are important not only because women experience major depressive disorder at nearly double the rate of men5 and because they experience greater resulting sexual dysfunction than men31 but also because it establishes that selective phosphodiesterase type 5 inhibitors are effective in both sexes for this purpose. By treating this bothersome treatment-associated adverse effect in patients who have been effectively treated for depression, but need to continue on their medication to avoid relapse or recurrence, patients can remain antidepressant-adherent, reduce the current high rates of premature medication discontinuation, and improve depression disease management outcomes. Baseline pituitary, thyroid, adrenal, ovarian hormone, and sex hormone–binding globulin levels were within normal limits and were not different to a statistically significant extent between groups. It should be noted that the endocrine levels, especially those of the menstrual cycle, are estimates of general levels because they were taken in the follicular phase, when levels are at their nadir.32 Within this restriction, there were treatment differences due to assignment suggesting phosphodiesterase type 5 inhibitor treatment likely benefitted women with SRI-associated sexual dysfunction by reducing some of the confounds that women encountered in other trials; for example, low free-testosterone and hypoactive sexual desire,15 low estrogen–decreasing secretory lubrication,13 exogenous estrogen–increasing sex hormone–binding globulin and decreasing free testosterone, hypothyroid hyperprolactinemia–inhibiting neuronal nitric oxide–cyclic guanine monophosphate,33,34 mixed menopausal status, and other conditions that reportedly interfere with nitric-oxide synthase isoforms activating nitric oxide–cyclic guanine monophosphate and phosphodiesterase type 5 in female genital tissue.35 Independent of treatment assignment, a positive treatment response was associated with higher free testosterone and thyroxine. Secondary efficacy measures revealed improved orgasm delay with sildenafil treatment, which is considered a central feature of SRI-associated sexual dysfunction.

5. Tips

By treating this bothersome treatment-associated adverse effect in patients who have been effectively treated for depression, but need to continue on their medication to avoid relapse or recurrence, patients can remain antidepressant-adherent, reduce the current high rates of premature medication discontinuation, and improve depression disease management outcomes. Baseline pituitary, thyroid, adrenal, ovarian hormone, and sex hormone–binding globulin levels were within normal limits and were not different to a statistically significant extent between groups. It should be noted that the endocrine levels, especially those of the menstrual cycle, are estimates of general levels because they were taken in the follicular phase, when levels are at their nadir.32 Within this restriction, there were treatment differences due to assignment suggesting phosphodiesterase type 5 inhibitor treatment likely benefitted women with SRI-associated sexual dysfunction by reducing some of the confounds that women encountered in other trials; for example, low free-testosterone and hypoactive sexual desire,15 low estrogen–decreasing secretory lubrication,13 exogenous estrogen–increasing sex hormone–binding globulin and decreasing free testosterone, hypothyroid hyperprolactinemia–inhibiting neuronal nitric oxide–cyclic guanine monophosphate,33,34 mixed menopausal status, and other conditions that reportedly interfere with nitric-oxide synthase isoforms activating nitric oxide–cyclic guanine monophosphate and phosphodiesterase type 5 in female genital tissue.35 Independent of treatment assignment, a positive treatment response was associated with higher free testosterone and thyroxine. Secondary efficacy measures revealed improved orgasm delay with sildenafil treatment, which is considered a central feature of SRI-associated sexual dysfunction. Orgasm function has received far less attention than sexual arousal, perhaps due to erectile dysfunction being the only FDA indication and primary marketing focus for selective phosphodiesterase type 5 inhibitors.

Related treatment guides

Significant improvement in orgasm function found in this trial is consistent with findings of improved orgasm in trials involving premenopausal and postmenopausal women with sexual arousal disorder,14,15,17 in open-label studies reporting reversal of delayed orgasm in SRI-associated sexual dysfunction,18,19 in trials involving men with erectile dysfunction,9 in trials that include treated or untreated depression,10,11 and in reports showing that enhanced nitergic activity (direct or indirect) can improve inadequate smooth muscle relaxation involved in orgasm delay with SRIs and serotonin norepinephrine reuptake inhibitors.36 Another consideration is whether the dose range of 50 mg to 100 mg of phosphodiesterase type 5 inhibitor was sufficient because reports on treating ejaculatory delay in men with SRI-associated sexual dysfunction suggest that higher doses of between 100 mg and 200 mg can be more effective.37,38 Independent of a significant effect on arousal in women with SRI-associated sexual dysfunction, it would seem unlikely for sexual function to globally improve without some effect on physiological sexual arousal, ie, lubrication, or tumescence. This sildenafil 20 mg prescription study may not be generalizable to women who did not meet the criteria of this study. The specific entry criteria requirements in this trial, including study participation, which can contribute to encouraging sexual interest, selecting women with SRI-associated sexual dysfunction who were highly motivated to improve, including improved relationship changes, can promote differences between treatment measures. Lack of a significant sildenafil treatment effect for sexual desire is consistent with reports that selective phosphodiesterase type 5 inhibitors do not directly enhance libido or that it might reflect a bias for selecting patients highly motivated to recover preexisting sexual function that attenuates effects on desire.39 The limitation of the trial to 8 weeks is also a consideration and it is unknown whether women would be willing to continue treatment over time. Although the protocol designs between this trial and the trial involving men with SRI-associated sexual dysfunction11 share features and limitations (eg, lack of biological criterion for female sexual dysfunction, assessment instruments with high correlation, and use of analysis-of-variance models for samples assigning integers to ordinal categories of an outcome measure when the phenomenon in question has an underlying continuous scale),40 the mechanism of action or specific treatment effects cannot be assumed to be the same. Orgasm function has received far less attention than sexual arousal, perhaps due to erectile dysfunction being the only FDA indication and primary marketing focus for selective phosphodiesterase type 5 inhibitors. Significant improvement in orgasm function found in this trial is consistent with findings of improved orgasm in trials involving premenopausal and postmenopausal women with sexual arousal disorder,14,15,17 in open-label studies reporting reversal of delayed orgasm in SRI-associated sexual dysfunction,18,19 in trials involving men with erectile dysfunction,9 in trials that include treated or untreated depression,10,11 and in reports showing that enhanced nitergic activity (direct or indirect) can improve inadequate smooth muscle relaxation involved in orgasm delay with SRIs and serotonin norepinephrine reuptake inhibitors.36 Another consideration is whether the dose range of 50 mg to 100 mg of phosphodiesterase type 5 inhibitor was sufficient because reports on treating ejaculatory delay in men with SRI-associated sexual dysfunction suggest that higher doses of between 100 mg and 200 mg can be more effective.37,38 Independent of a significant effect on arousal in women with SRI-associated sexual dysfunction, it would seem unlikely for sexual function to globally improve without some effect on physiological sexual arousal, ie, lubrication, or tumescence. This sildenafil 20 mg prescription study may not be generalizable to women who did not meet the criteria of this study. The specific entry criteria requirements in this trial, including study participation, which can contribute to encouraging sexual interest, selecting women with SRI-associated sexual dysfunction who were highly motivated to improve, including improved relationship changes, can promote differences between treatment measures. Lack of a significant sildenafil treatment effect for sexual desire is consistent with reports that selective phosphodiesterase type 5 inhibitors do not directly enhance libido or that it might reflect a bias for selecting patients highly motivated to recover preexisting sexual function that attenuates effects on desire.39 The limitation of the trial to 8 weeks is also a consideration and it is unknown whether women would be willing to continue treatment over time.

Methods and Objectives

Independent of treatment assignment, a comparison of women whose sexual function improved with those whose sexual function did not improve showed higher mean baseline levels of free testosterone (P ≤ .01) and thyroxine (P ≤ .01) among SRI-associated sexual dysfunction treatment responders. At study end, 76.9% (30 of 39) of women took a mean (SD) dose of 91.7 (19.8) mg of sildenafil and 86.5% (32 of 37) took 93.1 (17.5) mg of placebo. The maximum dose for the study sildenafil 100mg lowest price was 100 mg. The mean (SD) number of doses per 2-week interval was 5.0 (2.5) mg for sildenafil and 5.2 (2.5) for placebo, which supports the notion that the lack of efficacy in placebo patients was not due to a lack of attempts (P = .67). The most common adverse event was headache, reported by 43% of women taking sildenafil and 27% taking placebo (P = .09).

Osphenia (Ospemifene)

Less frequent were flushing, 24% vs 0% (P<.001); dyspepsia, 12% vs 0% (P = .01); nasal congestion, 37% vs 6% (P<.001); and transient visual disturbances, 14% vs 2% (P = .03), respectively. Adverse events more common in the placebo group than in the sildenafil group were nausea 16% vs 2% (P = .01) and anxiousness 6% vs 2% (P = .31). No serious adverse events related to trial medication were reported (Table 4). To our knowledge, this is the first randomized trial to demonstrate a significant reduction in adverse sexual effects, measured by the Clinical Global Impression sexual function, that compared sildenafil with placebo among women with SRI-associated sexual dysfunction, specifically including delayed orgasm responses and inadequate lubrication, while continuing stable-dose antidepressant treatment. These findings support earlier open-label reports involving women with SRI-associated sexual dysfunction and builds on the results of previous trials involving men, with benefits not limited to erectile function, and including delayed ejaculation or orgasm and satisfaction.11 These findings are important not only because women experience major depressive disorder at nearly double the rate of men5 and because they experience greater resulting sexual dysfunction than men31 but also because it establishes that selective phosphodiesterase type 5 inhibitors are effective in both sexes for this purpose. Although the protocol designs between this trial and the trial involving men with SRI-associated sexual dysfunction11 share features and limitations (eg, lack of biological criterion for female sexual dysfunction, assessment instruments with high correlation, and use of analysis-of-variance models for samples assigning integers to ordinal categories of an outcome measure when the phenomenon in question has an underlying continuous scale),40 the mechanism of action or specific treatment effects cannot be assumed to be the same. Both trials relied on scoring based on subjective responses to different questions for men and women, so the roles of expectations and adverse effects, as well as treatment response, influencing subjective report measures cannot be ruled out. However, it seems clear that effective evidence-based treatments for treatment-associated adverse effects can lead to improved outcomes for major depressive disorder and other conditions requiring extended medication treatment.

What special precautions should I follow?

Sildenafil (Viagra) is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men.

Some women report increased genital sensitivity after sildenafil.
Research suggests possible benefits for women with vascular sexual dysfunction.
Its use is still controversial and not widely recommended.
Women should evaluate risks and benefits with their doctor.

Sildenafil (Liqrev, Revatio) is used to improve the ability to exercise in adults (Liqrev, Revatio) and children 1 year of age and older (Revatio) with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness).

6. Response and effectiveness

Sildenafil is in a class of medications called phosphodiesterase (PDE) inhibitors. Sildenafil treats erectile dysfunction by increasing blood flow to the penis during sexual stimulation. This increased blood flow can cause an erection. Sildenafil treats PAH by relaxing the blood vessels in the lungs to allow blood to flow easily. If you are taking sildenafil to treat erectile dysfunction, you should know that it does not cure erectile dysfunction or increase sexual desire.