Sildenafil citrate for the management of fetal growth restriction and oligohydramnios

(2007) Female sexual dysfunction in Lower Egypt. El Gelany S, Moussa O (2013) Reproductive health awareness among educated young women in Egypt.

• Sildenafil may improve blood flow to the clitoris, aiding arousal.
• Use caution with grapefruit or grapefruit juice, which can affect drug levels.
• Document any pre-existing medical conditions before starting sildenafil.
• Sildenafil may cause dizziness; avoid activities requiring alertness.
• Women with liver or kidney impairment should consult a physician first.
• The drug is not a hormone; it works on blood vessels.
• Patients should report any sustained erections or discomfort.
• Combining sildenafil with certain antidepressants may alter effectiveness.
• Keep track of any changes in sexual satisfaction or function.
• Sildenafil should be used as part of a comprehensive treatment plan.
• Avoid using sildenafil with recreational drugs that affect the cardiovascular system.
• Always follow up with your healthcare provider for ongoing assessment.

Spector IP, Carey MP and Steinberg L (1996) The sexual desire inventory: Development factor, structure, and evidence of reliability. (2011) Sexual dysfunction and difficulties in Denemark: Prevelance and associated socio-demographic factors.

• Sildenafil citrate is a phosphodiesterase type 5 inhibitor.
• It may help women with sexual arousal disorder by increasing blood flow.
• Discuss mental health factors affecting libido with a healthcare specialist.
• Be aware of possible nasal congestion after taking sildenafil.
• Avoid using expired medication, as effectiveness may diminish.
• The effectiveness varies among women; results are individual.
• Use sildenafil responsibly to minimize potential adverse effects.
• Women should inform providers of all medications taken regularly.
• Sildenafil is not a cure for sexual dysfunction, only a symptomatic aid.
• Adequate sexual education can improve understanding and expectations.
• Proper dosage and timing are important for safety and efficacy.
• Sex therapy or counseling may complement medication use effectively.

Arch sex behave 40(1): 121-132. Abdallah I Y, AbdelrahmanSh (2014) female sexual dysfunction in relation to the age of marriage .thesis submitted for fulfillment of master degree in dermatology and Andrology in Banha city, Banha University, Egypt. Omidi A, Ahmedvand A, Najarzadan MR, Mehrzad F (2016) Compairing the effect of treatment with sildenafil and cognitive-behavioral therapy on treatment of sexual dysfunctioninwomen: arandomized controlled clinical trials. Chivers MI, Rosen RC (2010) Phosphodiesterase type sildenafil 100g 5 and female sexual response. J Sex Med 7(2): 858-872. Leddy LS, Yang CC, Stuckey BG, Sudworth M, Haughie S, et al. (2012) Influence of sildenafil on genital engorgement in women with female sexual arousal disorder. Sildenafil increases serum testosterone levels by a direct action on the testes. Lo Monte G, Graziano A, Piva I, Marci R (2014) Women taking the blue pill (sildenafil citrate) such big deal. (1999) Safety and efficacy of sildenafil in postmenopausal women with female sexual dysfunction. Given the success of medicines to treat trouble getting and keeping an erection, called erectile dysfunction, companies have looked for a medicine to help women with sex. Viagra even has been tried as a treatment for sexual dysfunction in women. But the U.S. Food and Drug Administration (FDA) hasn't approved this use of Viagra.

For years there were no FDA-approved medicines for treating problems with sexual arousal or sexual desire in women. Yet 4 in 10 women report having sexual concerns. The FDA now has approved two medicines.

Mechanism of action

(2003) Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder. Journal of Urology 170(6): 2333-2338. (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Diagnostic and Statistical Manual of Mental Disorders. (2014) Prevalence Survey of Sexual Dysfunction among Women in the Reproductive Age. The FDA has approved a daily pill called flibanserin (Addyi) to treat low sexual desire in women before menopause. This medicine started as a treatment for depression. Addyi may boost sex drive in women with low sexual desire.

It's for women who are not happy with their low sex drive.

What other drugs will affect sildenafil?

In the treatment arm of the present study, there was improvement in sexual dysfunction particularly in sexual desire, maintenance of lubrication, orgasm and satisfaction. Regarding the desire, the obvious change was in patients with no desire weekly pretreatment to improve from zero to 61.5% post-treatment. The orgasm differences in women who achieved orgasm less than half the time were 38.5% versus 84.6% pre- and post-treatment respectively (Table 2). Indeed these results were opposite to the study of Dasgupta et al. [14] which included 19 women completed the 2 arms of the double-blind phase and 12 completed the optional open label extension phase.

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Statistically significant improvement following sildenafil was only reported in the lubrication domain of sexual function during the double-blind phase. There was no overall change in quality of life after sildenafil. [15] found that efficacy was shown on only one sexual function measure and only in a small subsample of women who had no associated hypoactive sexual desire disorder (HSDD) and had sufficient estradiol and free testosterone concentration or were receiving estrogen and/ or androgen replacement therapy. Proposed reasons for the unconvincing efficacy of sildenafil in women have included failure to adequately characterize the study populations, differences in the physiologic response to sildenafil in men and women, and the mechanism of action of the drug needing to be central and not peripheral. It is also possible that lack of concordance between physiological and subjective aspects of women’s sexual experiences need to be further investigated [16]. Possible serious side effects include low blood pressure, dizziness and fainting.

What should I know about storage and disposal of this medication?

This study revealed no significant association between both groups in comparison of post treatment regarding sexual dysfunction assessment except in orgasm less than half times, which become (84.6%) versus (30.8%) in sildenafil group and placebo group respectively. These results can be supported by the study of Leddy et al. [17]; 13 of 19 (68%) subjects achieved a ≥50% increase in clitoral engorgement from baseline when administered sildenafil or placebo 30 minutes after dose administration. At 60 minutes after administration, 17/19 (89%) subjects receiving sildenafil and 16/19 (84%) subjects receiving placebo had responded (P value 0.3). [16] used self-reported measures of sexual function which showed mixed results whereas studies examining physiological effects of PDE5i on genital vasocongestion consistently report significant effects on genital sexual response.

Sildenafil may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

The improvnent in FSFI in-group A may be related to increase in androgen level as there might be a positive correlation between sildenafil intake and increase testosterone blood level [18]. Also it increases the pelvic blood flow which may give more improvement in lubrication and decrease pain during sexual act and increase overall sexual satisfaction. [19] stated that sildenafil citrate only acts on the physical phenomena of arousal and does not completely respond to the complexity of female sexual arousal disorders (FSADs). In fact, encouraging results were achieved in specific groups of patients affected by secondary FSADs (e.g., diabetes mellitus, multiple sclerosis, chronic antidepressant users) in which the genital arousal disorder is clearly connected with a neurological or vascular injury. [20] reported only lubrication changes in vaginal and clitoral sensitivity in patients treated with sildenafil. These side effects are more likely to happen if the medicine is mixed with alcohol. The FDA says not to drink alcohol if you take this medicine. Experts suggest that you stop taking the medicine if your sex drive doesn't improve after eight weeks. The FDA also has approved a medicine given as a shot to treat low sexual desire in women before menopause.

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[11] concluded that men and women who had trouble in paying their bills were twice as likely to report sexual dysfunctions compared with peers without such economic troubles. In women, there was also a statistically significant trend of increasing sexual dysfunction prevalence with decreasing income. As regard masturbation practice before marriage, it was more common among participants living in cities. In the current study 53.85% of participants living in towns and 46.15% in villages; about 80.76% of them stated that they did not know what masturbation is. This can be attributed to customs and traditions which to some extent discourage sexual education especially among females.

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[12] found that sexual satisfaction seemed to be associated with residence as (26.4%) and (39.1%) of participants living in town were very and moderately sexually satisfied compared to (18.2%) and (20.5%) of women living in villages who were very and moderately sexually satisfied. Regarding masturbation (17.3%) of town residents practiced it before marriage versus (11.4%) of those living in a village and (59%) of participants living in town and (54.5%) of participants living in rural areas stated that they did not know what masturbation is. This study revealed no significant differences between both groups regarding their baseline sexual desire or orgasm (Table 2). On the same side, the study carried by Omidi et al. [13] in Iran compared the two groups in terms of primary mean scores of sexual function, sexual satisfaction, and marital satisfaction showed similarities in terms of factors and prevalence of disorders at the beginning of the study. Bremelanotide (Vyleesi) is injected under the skin in the belly or thigh at least 45 minutes before having sex. It should not be used more than once a day or more than eight times a month. Side effects can include nausea, headache, vomiting and reactions at the site of the shot. Talk with your healthcare professional to see if this medicine might be right for you.

Sexual problems may be due to trouble with arousal, a lack of desire or both.

What happens if I miss a dose?

When examining the effects of sildenafil on female sexual dysfunction, it was found that sildenafil may increase congestion of the vagina, but it has no effect on excitement. This difference in results can be attributed to the manner and extent of drug administration, assessment of sexual status, and sildenafil citrate tablets 200mg cultural status of the subjects in the study. Moreover, in most studies, the sample size has been very small, which makes their validity questionable. The limitation of this study is that it was conducted on only Egyptian patients, so further well-designed studies are needed to see if the same conclusions apply to other races. On the other hand, points of strength include among others, the good sample size and the prospective randomized double-blinded study design.

Professional resources

Sildenafil citrate seems to improve orgasm in a sample of Egyptian females with sexual dysfunction. Desilva P (1995) Sexual dysfunction in S.J.E Lindsay and G.E.Powell, The hand book of lineal and adult psychology. London and New York rout ledge (2): 199-288. Jaafapour M, Khani A, Khajavikhan J, Suhrabi Z (2013) Female sexual dysfunction, prevalence and risk factor and Journal of clinical and diagnostic research 7(12): 2877-2880. (2006) Sildenafil improve sexual functioning in premenopausal women with type 1 diabetes who are affected by sexual arousal disorder. Many factors can affect sexual desire in women. Many women find that the stresses of daily life lower their desire for sex.