Expert Commentary

Sildenafil for anorgasmia

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THE QUESTION:
Is sildenafil an effective treatment for arousal disorder in premenopausal women?

Past studies:

These have shown that sildenafil is not as promising in women as in men. However, previous trials examined its usefulness in postmenopausal women. Little research has been conducted in premenopausal women.

This study:

The benefits of sildenafil treatment were examined in 53 women, ages 22 to 38, who had developed arousal disorders and were unable to achieve orgasm. Included in the trial, were heterosexual women who had been incapable of experiencing vaginal lubrication or genital sensation for a period of 6 months or more. Normal ovarian function was documented by ultrasonography. Women on oral contraceptives or hormone therapy and those who did not have a sexual partner were excluded from the trial. Also, women with medical conditions, including hypertension, diabetes, cancer, alcohol abuse, and liver disease, could not enroll in the study.

In a double-blind crossover study design, patients were followed monthly for 3 months and treated with 25 mg of sildenafil, 50 mg of sildenafil, and placebo in a randomized fashion. Each participant took either dose of sildenafil or placebo 1 hour before planned intercourse. The researchers used a 5-point scale to detect changes in sexual behavior. The results: Women reported increased sexual arousal, enjoyment, and frequency of sexual fantasies with both doses of sildenafil compared with placebo (4.2 versus 2.6, respectively). The frequency of orgasm also improved significantly with both doses of sildenafil compared with placebo (3.8 versus 2.4, respectively).

Find this study:

June 2001 issue of British Journal of Obstetrics and Gynaecology; abstract online at www.elsevier.com.

Who may be affected by these findings?

Healthy young women with normal hormones and libido experiencing sexual arousal disorders. Additionally, postmenopausal women with normal sexual desire, steady partners, and hormones replaced to normal levels may respond well to sildenafil. Clearly, future research is needed in this postmenopausal population.

Expert commentary:

As female sexual dysfunction is discussed more widely on the talk show circuit, women are being encouraged to seek medical attention and treatment for this complex problem. Unfortunately, little research exists to better understand and treat sexual dissatisfaction among women, specifically arousal and orgasmic disorders. This trial, however, is one step toward the development of effective therapeutic strategies to combat these issues. The researchers successfully isolated arousal deficiencies from desire and orgasmic disorders in a group of young premenopausal women. The participants responded well to a treatment series of sildenafil. The medication regulates smooth muscle contractions by selectively blocking phosphodiesterase type 5. It also permits vasodilation, resulting in subsequent clitoral, vulvar, and vaginal erectile tissue engorgement.

The results of this trial are most interesting in that previous trials of sildenafil did not demonstrate any improvement in postmenopausal women with sexual dysfunction. However, those trials did not define arousal disorder as strictly as the authors of this study. Based on sildenafil’s mechanism of action, postmenopausal women with vascular disease, hypertension, and diabetes—a population similar to males with erectile dysfunction—who have normal libido and hormones, may be ideal candidates for sildenafil therapy.

Caveats:

In this study, 4 women stopped taking sildenafil 50 mg, 2 women stopped taking sildenafil 25 mg, and 2 women stopped taking placebo due to vision problems, headaches, and fear of adverse reactions.

The bottom line:

Physicians may consider prescribing 25 to 50 mg of sildenafil to premenopausal women with normal hormones and libido who experience difficulty with arousal, lubrication, and genital sensation.

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