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The site is secure. For years, phosphodiesterase type 5 inhibitors have been used for the treatment of erectile dysfunctions. The results are still conflicting and the drug is not devoid of adverse effects.
Furthermore, female sexual arousal disorder is a heterogeneous condition whose underlying causes are difficult to diagnose and appropriate treatment requires a thorough sexual, psychological, and medical history along with specialist consultations.
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The clinician should pursue a global approach to the patient with sexual difficulties, while non-hormonal treatment such as phosphodiesterase type 5 inhibitors ie, sildenafil citrate should be kept as the last option.
In clinical practice, not only gynecologists but also generalists are often asked to solve specific questions about sexual diseases. On the contrary, women have begun to complain about sexual troubles only recently and have caught their doctors off-guard.
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How should FSD be diagnosed and treated? A more thorough understanding of female sexual problems is needed to ensure appropriate clinical management of sexual difficulties. FSAD is traditionally defined as a persistent or recurrent inability to attain or maintain adequate lubrication and genital swelling until completion of sexual activity. In fact, genital congestion and lubrication strictly depend on the hormonal balance ie, arousal disorders during the menopausal transition and require adequate vascular function and an efficient nerve transmission of mechanical stimuli.
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However, a modern definition of FSDs should not focus only on genital phenomena without considering the psychological aspect of arousal. However, in most cases, both factors contribute to FSAD combined. In smooth muscle cells, nitric oxide activates the guanylate cyclase enzyme which converts guanosine triphosphate into cyclic guanosine monophosphate.
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This molecule promotes the relaxation of the smooth muscle cells, causes vasodilatation, and increases blood flow in genital organs. The engorgement of penile corpora cavernosa in men and clitoris and labia minora in women are the main modifications of genital organs during sexual arousal. Furthermore, the ultrafiltration of plasma through capillary vaginal vessels contributes to vaginal lubrication.
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According to emerging data, PDE5 is expressed in vaginal, clitoral, and labial smooth muscles. However, there are presently very few data regarding the use of sildenafil in women and the results are still conflicting.
In a randomized double-blind study, Berman et al administered sildenafil to postmenopausal women with a primary diagnosis of FSAD and possibly associated secondary FSDs. Patients randomly received 12 weeks of treatment with sildenafil citrate 50 mg or placebo.
A significant improvement of arousal sensation, lubrication, and orgasm was reported in the study group affected by primary FSAD.
Was this helpful. If approved, the provider will issue a prescription. If we combine this information with viagraa protected health information, we best viagra for women wwomen all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices.
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On the contrary, women affected by different types of FSDs eg, hypoactive sexual disorder, dyspareunia due to vaginal dryness did not experience any significant improvement in desire, pain, or enjoyment.
It can be speculated that sildenafil citrate only acts on the physical phenomena of arousal and does not completely respond to the complexity of FSAD.
In fact, encouraging results were achieved in specific groups of patients affected by secondary FSADs eg, diabetes mellitus, multiple sclerosis, chronic antidepressant users in which the genital arousal disorder is clearly connected with a neurological or vascular injury. Firstly, women affected by FSADs do not benefit from sildenafil citrate as much as men with erectile dysfunction as a result of a lower concentration of PDE5 in vaginal and clitoral tissues than in penile corpora cavernosa.
In fact, no significant changes in physical response during sexual activity were reported in either group of women.
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The most common adverse events reported in all studies were headache, flushing, nausea, rhinitis, and visual disturbances. The combination of testosterone and vardenafil caused an improvement in genital response ie, vaginal pulse amplitude at vaginal photoplethysmography , especially in a group that initially had low attention for sexual cues.
A daily dose of tadalafil 5 mg treatment seemed to improve subjective sexual aspects.
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It was suggested that this treatment may be effective in improving clitoral blood flow as well as the clitoral functional system, consisting of smooth muscle cells and vascular spaces. There are a few things that a generalist should bear in mind when addressing a woman with FSAD. Firstly, which type of women may suffer from FASD? Especially postmenopausal patients in whom lubrication and swelling are physiologically impaired. However, even psychological and cultural factors due to aging ie, change in the familial structure, departure of the siblings, retirement should be taken into account when addressing an elderly woman with sexual difficulties.
In fact FSAD, as a complex disease, may depend on several underlying medical conditions that need to be appropriately diagnosed and treated. Therefore, the general practitioner should immediately exclude chronic antidepressant treatments, surgical procedures, or radiotherapy of the pelvis and ascertain the presence of possible systemic pathologies such as endocrine, vascular, and neurological disorders.
In these cases, the patient should be referred to the appropriate specialist eg, endocrinologist, surgeon, neurologist. Nevertheless, in the absence of any evident systemic pathology, a generalist should propose both a gynecological and psychological consultation.
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In fact, objective FSAD reduced genital physical response to sexual stimuli may be a sign of various gynecological disorders. As reduced lubrication can cause pain during sexual intercourse, it should be differentiated from other possible causes of dyspareunia such as endometriosis, vulvar vestibulitis syndrome, and recurrent genital or urinary infections.
On the contrary, preserved physical response with reduced emotional involvement probably indicates a psychological disturbance that can benefit from cognitive behavioral therapy or traditional sex therapy. However, in most cases, the reasons for FSAD are mixed and difficult to identify. Thus, such a disturbance may persist over time and require the continuous assistance a generalist can provide, unlike a specialist.
FSAD is a complex disease, whose underlying cause is difficult to diagnose. Preliminary evaluation of the sexual, psychological, and medical history is mandatory to exclude possible systemic diseases and to identify the type of FSAD. Generalists should pursue a global approach to the patient with sexual difficulties, while non-hormonal treatment such as PDE5 inhibitors eg, sildenafil citrate should be kept as the last option.
They also concurred to design, prepare, draft, and revise the final version of the manuscript.
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RM has substantially contributed to critical literature revision, preparation, drafting, and revising the final version of the manuscript. He also gave extremely important intellectual support and ensured the general supervision of the research group.
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All authors read and approved the final manuscript. As a library, NLM provides access to scientific literature. Drug Des Devel Ther. Published online Nov 7. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
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Abstract For years, phosphodiesterase type 5 inhibitors have been used for the treatment of erectile dysfunctions. Keywords: phosphodiesterase type 5 inhibitors, female sexual arousal disorder FSAD , sildenafil citrate. Background In clinical practice, not only gynecologists but also generalists are often asked to solve specific questions about sexual diseases.
Table 1 Categories of female sexual arousal disorder.
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Type of female sexual arousal disorder Description 5 Subjective arousal disorder Absence of or markedly diminished feelings of sexual arousal sexual excitement and sexual pleasure from any type of sexual stimulation. Vaginal lubrication or other signs of physical response still occur. Genital arousal disorder Complaints of absent or impaired genital sexual arousal.
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Self-report may include minimal vulvar swelling or vaginal lubrication from any type of sexual stimulation and reduced sexual sensations from caressing genitalia. Subjective sexual excitement still occurs from non-genital sexual stimuli. Combined arousal disorder Absence of or markedly diminished feelings of sexual arousal sexual excitement and sexual pleasure from any type of sexual stimulation as well as complaints of absent or impaired genital sexual arousal vulvar swelling lubrication.
Open in a separate window. Rationale for the use of sildenafil in the treatment of FSAD In smooth muscle cells, nitric oxide activates the guanylate cyclase enzyme which converts guanosine triphosphate into cyclic guanosine monophosphate.
Figure 1.
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Mechanism of action of sildenafil citrate. Practical advice for clinicians There are a few things that a generalist should bear in mind when addressing a woman with FSAD.
Conclusion FSAD is a complex disease, whose underlying cause is difficult to diagnose. Disclosure The authors report no conflicts of interest in this work. References 1. J Sex Med. American Psychiatric Association.
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Graziottin A, Leiblum SR. Biological and psychosocial pathophysiology of female sexual dysfunction during the menopausal transition. Expression of messenger ribonucleic acid encoding for phosphodiesterase isoenzymes in human female genital tissues. Licht MR. Sildenafil Viagra for treating male erectile dysfunction. Cleve Clin J Med. J Urol.
Sildenafil improves sexual functioning in premenopausal women with type 1 diabetes who are affected by sexual arousal disorder: a double-blind, crossover, placebo-controlled pilot study. Fertil Steril.
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Efficacy of sildenafil in the treatment of female sexual dysfunction due to multiple sclerosis. Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial.
Efficacy and safety of sildenafil citrate in women with sexual dysfunction associated with female sexual arousal disorder. Schoen C, Bachmann G. Sildenafil citrate for female sexual arousal disorder: a future possibility?
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Nat Rev Urol. The influence of testosterone combined with a PDE5-inhibitor on cognitive, affective, and physiological sexual functioning in women suffering from sexual dysfunction. Tadalafil 5 mg daily treatment for type 1 diabetic premenopausal women affected by sexual genital arousal disorder.
Sexual Medicine in Clinical Practice. New York, NY: Springer; Copy Download. Absence of or markedly diminished feelings of sexual arousal sexual excitement and sexual pleasure from any type of sexual stimulation.
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Complaints of absent or impaired genital sexual arousal. Absence of or markedly diminished feelings of sexual arousal sexual excitement and sexual pleasure from any type of sexual stimulation as well as complaints of absent or impaired genital sexual arousal vulvar swelling lubrication.
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