In this study, we tried to prospectively assess safety and efficacy of sildenafil citrate in treating FSD.

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Objective: This study aimed to evaluate the effect of sildenafil citrate on female sexual dysfunction. Subjects and methods: The study was conducted in the Andrology and Gynecology departments of Zagazig and Tanta University Hospitals during the period from April 2017 to August 2020. Fifty-two married female patients were included in this study. Group 1 included 26 patients, all received 50mg sildenafil on demand and group 2 included 26 patients who took placebo tablets. Results: There was no significant difference between the studied groups regarding the demographic data, and FSFI.

Key takeaways

There was significant difference between pre and post treatment of sexual dysfunction regarding the Sildenafil arm. There was no significant difference in post treatment results between the two studied groups as regard sexual dysfunction except in orgasm which showed superior improvement in the Sildenafil group. Conclusions: Sildenafil citrate seems to be effective in treating women who could not achieve orgasm. Abbreviations: FSD: Female Sexual Dysfunction; IRB: Institutional Review Board; FSFI: female sexual function index; SPSS: Statistical Package for Social Science Female Sexual Dysfunction (FSD) is a disturbance or dysfunction in the process of desire, arousal or orgasm, which can be a symptom of a biological condition, a psychological problem, an interpersonal issue or a combination of these factors [1]. Female Sexual Dysfunction is a multi-causal and a multi- dimensional medical problem that adversely affects physical health & emotional wellbeing. The study was conducted in the Andrology and gynecology departments of Zagazig and Tanta University Hospitals during the period from April 2017 to August 2020. Informed consents were taken from all participants.

Some women seek sildenafil for increasing genital blood flow and sensation.
The placebo effect can influence perceived benefits in women using sildenafil.
Women with cardiovascular risk should avoid sildenafil unless approved by a doctor.
Topical or alternative therapies might be considered alongside or instead of sildenafil.
Scientific consensus on sildenafil’s safety for women remains under development.
Proper dosing and medical oversight are key to minimizing risks.

Group A contained 26 patients who received 50mg sildenafil on demand. Group B received placebo tablets and also included 26 patients. The study was prospective, double-blinded and placebo controlled. The Institutional Review Board (IRB) provided ethical approval for this study (Institutional Review Board N° 1965) for Faculty of Medicine, Zagazig University, and Zagazig, Egypt on March 3, 2017.

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Married female patients complaining of sexual dysfunction for at least 6 months and not on drug therapy for the treatment of FSD. Patients with sexual dysfunction caused by local genital disorder, patients with retinal problem, patients with chronic debilitating diseases or hormonal disturbance, patients who cannot be treated with PDEs inhibitors type 5(sildenafil) as: Major hematological, renal or hepatic abnormalities, patients with major psychological disorders including major depression or psychosis, a history of stroke or myocardial infarction or any significant cardiovascular disease within the last 6 months, or concomitant treatment with nitrates.

Efficacy of Sildenafil Citrate on Female Sexual Dysfunction in A Sample of Egyptian Females, A Prospective Placebo Controlled Study

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Setting and Sample

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Exclusion Criteria

Why does Cialis take at least 12-14 hours to work? Viagra prescribing info & package insert (for Health Professionals) Sexual Dysfunction, SSRI Induced (53 questions, 171 members) Some benefits, especially in ability to achieve orgasm, were reported. Men and women who take selective or nonselective serotonin reuptake inhibitors (SRIs) commonly report sexual dysfunction; the main difficulties among women are orgasmic dysfunction and problems with arousal, including lubrication. Studies of selective phosphodiesterase type 5 inhibitors (sildenafil [Viagra], vardenafil [Levitra], and tadalafil [Cialis]) as therapy for women with sexual arousal disorder have produced mixed results. In this multisite trial, funded by sildenafil´s manufacturer, researchers enrolled 98 women (mean age, 37) who had normal sexual function before treatment for depression, were being treated successfully with SRIs (usually fluoxetine, sertraline, or paroxetine; mean treatment time, 28 months), and had substantial sexual dysfunction associated with antidepressant use; they were randomized to sildenafil (50-100 mg) or to placebo; drugs were taken 1 to 2 hours before anticipated sexual activity. All patients in the 2 groups were subjected to: Complete history taking: age, education, occupation, residence, age of marriage, special habits, history of medical diseases, surgical history and sexual history in the previous 6 months. Thorough general and local examination was also done. Routine laboratory investigations including complete blood count liver function tests renal function tests, blood sugar and lipid profiles; were done. Evaluation questionnaire used included 25 items designed by the investigators. Only some items selected from the female sexual function index (FSFI) [5], other questions were added to suit the purpose of study.

Medication Type	Interaction Effect	Risk Level	Notes
Nitrates	Severe hypotension	High	Contraindicated
Alpha-Blockers	Increased risk of hypotension	Moderate	Dose adjustment may be needed
CYP3A4 Inhibitors	Increased sildenafil levels	Moderate to high	Watch for adverse effects
CYP3A4 Inducers	Decreased effectiveness	Moderate	Alternative treatments considered

The FSFI domain has maximum possible total scores of 36 as in (Table 1). The FSFI, a 19-item questionnaire, has been developed as a brief, multidimensional self-report instrument for assessing the key dimensions of sexual function in women.

How does it work?

From baseline to 8 weeks, sildenafil-treated women reported a mean improvement of 1.9 points on a global sexual function scale (range, 1-7 points) compared with 1.1 points for those who received placebo — a statistically and clinically significant difference. Only 28% of sildenafil-treated women noted no improvement, compared with 73% of those who received placebo. Treatment also resulted in significant improvement in ability to achieve orgasm as measured on three additional scales, as well as near-significant improvements in several measures of satisfaction and enjoyment. Significant nitric oxide (NO) and NO synthase activity has been found in female genital tissue, suggesting a plausible biological explanation for how drugs such as sildenafil, which are used in erectile dysfunction, could also affect female sexual function. These results are more positive than those in prior studies, so further replication will be required before these drugs can be recommended for off-label use.

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CLICK HERE for Journal Watch subscription information. 2008;7(7) © 2008 Massachusetts Medical Society Cite this: Sildenafil and Sexual Dysfunction in Women Who Take Antidepressants - Medscape - Jul 23, 2008. Submission: October 15, 2021; Published: February 28, 2022 *Corresponding author: Mohamed Alhefnawy, Urology department, Benha University, Egypt How to cite this article: Mohamed A, Abdulla E, Mohamed A, Mohamed E, Ahmed E, et al. Efficacy of Sildenafil Citrate on Female Sexual Dysfunction in A Sample of Egyptian Females, A Prospective Placebo Controlled Study. J Gynecol Women’s Health 2022: 23(1): 556105.

Inclusion Criteria

DOI: 10.19080/JGWH.2022.23.556105 Background: Sexual dysfunction is a problem that occurs during the sexual response cycle that prevents the individual from experiencing satisfaction from sexual activity. The assessment of sexual function in women is frequently confounded by many factors, including depressed mood and other comorbid medical and psychiatric disorders. Sildenafil is selective type 5 phosphodiesterase (PDE5) inhibitors, taken orally and effective for men with erectile dysfunction. Previous studies suggested that sildenafil may improve the sexual health of women affected by sexual difficulties such as arousal disorders and may indirectly improve other aspects of sexual life. Sildenafil was effective and well tolerated in postmenopausal women with sexual arousal disorder without sildenafil citrate tablets 150 mg concomitant hypoactive sexual desire disorder or contributory emotional relationship or historical abuse issues. It is psychometrically sound, easy to administer, and has demonstrated ability to discriminate between clinical and nonclinical populations.

Doctors may prescribe sildenafil off-label for women based on individual assessment.
Patient education about realistic expectations is essential when using sildenafil.
Sildenafil’s mechanism involves enhancing nitric oxide signaling in blood vessels.
Women with liver or kidney problems need careful evaluation before sildenafil use.
Viagra was initially tested for women before focusing on men’s erectile issues.
Alternative options like vaginal lubricants are also common for female sexual problems.

The questionnaire described was designed and validated for assessment of female sexual function and quality of life in clinical trials or epidemiological studies. In addition, depression questionnaire was added to exclude the major psychological depressive disorder and its result put with the evaluation questionnaire as one item only (Table 2). The collected data were statistically analyzed using SPSS program (Statistical Package for Social Science) version 18.0.SPSS Inc., Chicago, IL, US.

Are there other medications that can result in sexual enhancement for women?

Also impaired sexual function can have damaging effects on the self-esteem, sense of wholeness and interpersonal relationships of women. It is often emotionally distressing and can affect reproduction or even end up with separation or divorce [2]. Selective type 5 phosphodiesterase (PDE5) inhibitors as sildenafil, which acts by inhibiting cyclic GMP specific PDE5 may improve the sexual health of women affected by sexual difficulties such as arousal disorders and may indirectly improve other aspects of sexual life [3]. Sildenafil was effective and well-tolerated in post-menopausal women with sexual arousal disorder without concomitant hypoactive sexual desire disorder or contributory emotional relationship or historical abuse issues [4]. However, studying FSD is lacking in the literature especially in the Arab and middle east region. No significant differences were found between both studied groups regarding the demographic data (Table1).