UCSF School of Pharmacy

medicine question of the month: viagra

February 2003

What is female sexual dysfunction (FSD)?

Female sexual dysfunction (FSD) is a disturbance in sexual desire or a change in sexual response.

Symptoms of FSD include:

• low sex drive (low desire or interest in sexual activities)
• orgasmic disorders (e.g., inability to have an orgasm)
• pain or discomfort during sexual intercourse
• vaginal dryness
• increased time required for arousal
• decreased clitoral sensation

FSD can also affect mental health by resulting in anxiety, stress and problems with a partner in a relationship.

Whom does FSD affect?

It is estimated that up to 43% of women between 18 and 59 years of age in the United States will develop some form of sexual dysfunction during their lifetimes. [7]

Contributing Factors

Factors which can contribute to female sexual dysfunction include:

• increased age
• menopause
• hysterectomy (removal of the uterus)
• blood vessel disease
• medications

Risk Factors

The risk for female sexual dysfunction is higher for women who:

• smoke
• have high blood pressure
• do not eat a healthy diet
• do not exercise

What is Viagra?

Viagra is not an aphrodisiac, meaning that it does not affect your libido or sexual desire. Viagra is a prescription medication used to treat impotence, a problem in which a man's penis is unable to get erect and stay erect for sexual intercourse. This problem is known clinically as "male erectile dysfunction," which is sometimes abbreviated as ED. Scientists believe that Viagra works in men by increasing nitric oxide levels, which relaxes the muscle in the shaft of the penis. This helps the penis fill with blood to cause an erection. It is hypothesized that nitric oxide might also increase blood flow to the vulva and clitoris to treat sexual dysfunction in women.

Is Viagra effective for women?

After clinical trials demonstrated its effectiveness with men, the United States Food and Drug Administration approved Viagra -- for men only -- in March 1998. Since then, researchers have focused on whether Viagra also works for women.

University of Catania Study, 2001

In 2001, a 12-week study by the University of Catania [3] evaluated the effects of Viagra in premenopausal women who suffered from sexual arousal disorder. The study included 53 women aged 22 to 28. Participants ingested 25 mg and 50 mg tablets of Viagra before sexual activity. Arousal and orgasm was self-reported and documented. The researchers concluded that Viagra might improve sexual performance by improving arousal or orgasm in women affected by FSD.

University of Amsterdam Study, 2002

In 2002, an 8-week study by the University of Amsterdam [6] evaluated whether Viagra or a placebo could improve vaginal engorgement and therefore improve sexual arousal in women without FSD. Twelve premenopausal women participated. The researchers found that Viagra increased vaginal engorgement in the Viagra group compared with placebo, but there was no effect on sexual arousal.

Basson et al. Study, 2002

As of February 2003, the largest study involved 577 premenopausal and peri-menopausal women with sexual dysfunction associated with FSD [2]. The women were between 18 and 55 years of age and had some type of sexual dysfunction disorder for 6 or more months. The women received placebo or Viagra tablets in 10 mg, 50 mg, or 100 mg doses, taken as required but not more than once daily, one hour before sexual activity. Overall, the women receiving Viagra did not have an improved sexual response. There was an increase in the number of headaches and flushing at the higher Viagra doses.

What does this mean for you?

Based on the 3 studies that have evaluated the use of Viagra for women, it is not clear if Viagra is useful for treating sexual dysfunction in women. It is possible that Viagra will prove useful for certain women and not others. For example, Viagra may be useful in women whose primary problem is decreased vaginal blood flow. More research studies involving women taking Viagra are needed, and they are currently under way.

Common Causes For Sexual Problems in Women

For now, if you believe you have a sexual dysfunction, speak with your physician about the most common causes for sexual problems:

1. Physical Changes - Sexual interest most frequently decreases between 50 and 60 years of age. [8] As women approach menopause, declining estrogen levels often result in vaginal dryness and diminished blood flow to the vagina, affecting sexual arousal. Vaginal estrogen cream, estrogen replacement therapy, and vaginal lubricants are often used to help support the tissue in the vagina and to improve vaginal dryness. Viagra may have a role in improving blood flow to the vagina, possibly helping to improve sexual response. [9]

   Diabetes, blood vessel disease, and other conditions can contribute to sexual dysfunction. [8] Treating these conditions may help to alleviate sexual dysfunction. Unfortunately, some of the medications used to treat these conditions can also contribute to sexual dysfunction. This includes prescription medications, over-the-counter medications, and drugs of abuse including alcohol, marijuana, and others.

   Certain medications like antidepressants and blood pressure medications are commonly associated with causing sexual dysfunction. [8] Talk with your physician if you have questions about your medications and sexual dysfunction.

2. Psychological Factors - Mood disorders such as depression, anxiety, and schizophrenia can also lead to sexual dysfunction. Treating these conditions or the underlying cause may improve sexual function.

   Stress, such as unemployment, work stress, parenting, and financial worries, can lead to a decrease in sex drive and can contribute to sexual difficulties. [8] Relaxation, exercise, and stress management are possible solutions to improving sexual function in this case.

   Body weight and body image can have a significant impact on self-perceived sexuality. In some cases, this can lead to reduced interest in sex. [9, 10] Women who are obese tend to report a loss of interest in sexual intimacy. Although not all obese women will experience this, it is important to recognize the symptoms and speak to a therapist who can help.

3. Past Sexual Experiences - Sexual abuse and rape can also contribute to a low desire for sex and an aversion to sexual activities that were part of the abuse. [8] This can lead to problems with trust, communication, and commitment in a couple's relationship, which can contribute to sexual problems. [8, 9, 10] Speaking to a therapist may be helpful in dealing with the trauma and the symptoms such as flashbacks, nightmares, and other emotional issues.

   Sexual incompatibility where one partner desires sexual practices that the other does not can also lead to sexual dysfunction. Communicating with your partner regarding your needs and interests is essential.

If you feel you are suffering from sexual dysfunction, you are not alone. Speak to a healthcare provider or therapist who can provide education and recommendations for changing your sexual health.

Viagra is a registered trademark of Pfizer Inc.

Nelson Chee, PharmD Candidate, Class of 2003
UCSF School of Pharmacy

Katherine Wen, PharmD Candidate, Class of 2003
UCSF School of Pharmacy

Candy Tsourounis, PharmD
Associate Clinical Professor
UCSF School of Pharmacy

References

1. Steidle CP. Sexual Dysfunction: male and female issues. International Journal of Fertility and Women's Medicine, 2002. v.47, i.1, pp.32-36.
2. Basson R et al. Efficacy and safety of sildenafil citrate in women with sexual dysfunction associated with female sexual arousal disorder. Journal of Women's Health & Gender-Based Medicine, May 2002. v.11, i.4, pp.367-377.
3. Caruso S et al. Premenopausal women affected by sexual arousal disorder treated with sildenafil: a double-blind, cross-over, placebo-controlled study. British Journal of Obstetrics and Gynaecology, 2001. v.108, i.6, pp.623-628.
4. Moynihan R. The making of a disease: female sexual dysfunction. BMJ, January 4, 2003. i.326, pp.45-47.
5. Bancroft J. The medicalization of female sexual dysfunction: the need for caution. Archives of Sexual Behavior, 2002. v.31, i.5, pp.451-455.
6. Laan E et al. The enhancement of vaginal vasocongestion by sildenafil in healthy premenopausal women. Journal of Women's Health & Gender-Based Medicine, May 2002. v.11, i.4, pp.357-365.
7. Cohen PG. Sexual dysfunction in the United States. JAMA, Oct 6, 1999. v.282, i.13, p.1229.
8. Barton D et al. Psychosocial aspects of sexual disorders. Australian Family Physician, June 2000. v.29, i.6, pp.527-531.
9. Pariser S et al. Sex and the mature woman. Journal of Women's Health, September 1998. v.7, i.7, pp.849-859.
10. Kingsbert SA. The impact of aging on sexual function in women and their partners. Archives of Sexual Behavior, October 2002. v.31, i.5, pp. 431-437.

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through the
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UCSF School of Pharmacy

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