Sexual Health

Should Viagra Be Available for Ladies?

Ever since its popularization in the early aughts, female erectile dysfunction (FSD) has been a firebrand issue, with drug companies and specific medical professionals (think the Berman sisters) heralding and deploying its own cause. All this interest makes sense; way back in 2005, the market for FSD merchandise was estimated at $1.7 billion.

To date, there’s been no pill approved by the FDA for the treatment of FSD.

However, believe me, no FDA approval is not for a lack of trying. To begin with, Pfizer attempted to demonstrate that its juggernaut drug Viagra could help with FSD. Secondly, in 2004, P&G attempted to sell the FDA on its testosterone patch, Intrinsa. The timing could not be worse. Fresh from the setback of Vioxx, a circumspect FDA cited concerns about Intrinsa’s clinical meaningfulness and security. Most recently–and to no avail–Sprout Pharmaceuticals tried to receive its own neurotransmitter-acting medication, flibanserin, approved.

In an effort to provide a comprehensive review of proposed treatments for FSD, I’ve had to analyze three interventions directed toward this condition in 3 distinct articles.  This article examines Viagra’s usage by girls, a second article examines the testosterone patch, and a third article examines flibanserin. Naturally, despite P&G quitting its trials on Viagra in women in 2004, along with the FDA shut down Intrinsa the exact same year, some physicians still prescribe Viagra off-label and testosterone treatments for women with FSD.

Flibanserin, however, has not yet been approved.

How Does Viagra Work?

Viagra is a phosphodiesterase type 5 (PDE5) inhibitor.which enriches the creation of guanosine monophosphate. Guanosine monophosphate relaxes smooth muscle tissues and vasodilates and increases blood flow to the genitals. As most of us know, in men, Viagra’s result is an erection.

But, PDE5 is also expressed in smooth muscle of the vagina, clitoris, and labia resulting in vaginal engorgement and clitoris erection. It is believed that in girls with an organic cause of FSD, blood flow to the genitals is diminished.  On a related note, study proves that in some women with atherosclerosis, blood circulation to the genitals is diminished.

Like all drugs, Viagra has adverse effects such as a headache, flushing, nausea, visual disturbance and so forth.  What’s more, individuals taking nitrates for the treatment of angina should prevent Viagra for fear of hypotension or dangerously low blood pressure.

Female Sexual Dysfunction (FSD) Definitions

Currently, any female usage of Viagra involves women with a particular kind of FSD known as female sexual interest/arousal disorder. This terminology is comparatively fresh and introduced in the DSM-5. Female sexual interest/arousal disorder could be defined as the following:

  • Distressing deficiency of (or much reduced) sexual interest and arousal sensations involving sexual fantasy. Sensual thoughts, interest in sex, physiological arousal, sex initiation etc;  
  • Lasting six or more months;
  • Not better clarified by other diseases or ailments;
  • Either lifelong or acquired;
  • Either generalized or situational;
  • Of moderate, moderate or severe severity.

As is sometimes the case with an emerging field of research, sooner postings in definitions of sexual ailments obfuscated research results. Especially, earlier studies involving female sex drugs went with earlier terminology which divide problems with arousal and problems with desire into two different groups: female sexual arousal disorder and hypoactive sexual desire disorder respectively. 

On a related note, other types of FSD contain female orgasmic disorder, genito-pelvic pain/penetration disorder, and substance/medication-induced erectile dysfunction.

(Evidently, the DSM loves slashes.)

Research on Viagra in Women

The most obvious research that indicates Viagra may benefit women with FSD was done by Dr. Jennifer Berman, a sex and relationship therapist, and Dr. Laura Berman, a sexual health expert and urologist, while they were in academia. Outcomes from their findings suggest that Viagra may enhance sexual function in women with arousal problems but not girls with want issues. Additionally, the results of this study were burdened by the heavy placebo effect.  

It should be said that the Berman sisters definitely have their critics such as Dr. Heather Hartley, a”people” and medical sociologist and women’s health advocate who famously contested the medicalization of sex. Regrettably, Hartley died at age 39. (Hartley’s has been a life cut short.)

In a 2006 article titled”The’Pinking’ of Viagra,” Hartley heavily criticizes the Berman sisters. She criticizes the sisters as”adept at using media to advertise their own industry.” Hartley also criticizes the Bermans’ marked taste for medicine over therapy. Moreover, she claimed that the Berman sisters'”continued insistence on prescribing Viagra and other’male’ sex drugs off-label for women illustrates the departure from a science-based clinic along with the embrace of a Viagra culture”

Lately, Hartley also paints a picture of the Berman sisters as opportunists charging exorbitant costs in their exceptionally commercial practices. Hartley claims that the Bermans’ success is fueled with a combined media perspicacity intent on nurturing”a sense of familiarity with their viewing public, as evidenced, for instance, by the link in their website to a’medically explicit’ movie of Jennifer’s elective cesarean birth, complete with her personal descriptions of her recovery procedure.”

In recent years, the Berman sisters have enjoyed a ubiquitous media presence. Presently, Jennifer Berman is one of The Physicians , and Laura Berman is tight with Oprah and  Dr. Oz.

With the notable exception of the Berman study, other studies show Viagra to be ineffective in treating arousal and desire issues. For instance, one randomized-control trial conducted by Basson and colleagues revealed that Viagra caused no substantial changes in bodily response during sexual activity in both premenopausal and postmenopausal women. Another study demonstrated that because of a lesser concentration of PDE5 from the vagina and clitoris as compared with the manhood, the effect of Viagra is reduced in women.

In the event that you or a loved one suffer from female sexual interest/arousal disease according to the DSM-5, you may be thinking about whether to take Viagra. With respect to the particular concern, I give you the conclusion of a 2014 commentary by Lo Monte and colleagues in the journal Drug Design, Development and Therapy:

“FSAD [female sexual interest/arousal disease ] is a intricate disorder, whose underlying cause is difficult to diagnose.  Preliminary evaluation of the sexual, psychological, and medical history is mandatory to exclude possible systemic diseases and also to identify the type of FSAD.  Generalists should pursue a worldwide strategy to the patient with sexual problems, while non-hormonal treatment like PDE5 inhibitors (eg, sildenafil citrate) [Viagra] should be kept as a last option.”

In other words, you may want to consider Viagra just as a last-line treatment after an intensive and multifactorial overview of your feminine sexual interest/arousal disorder by a primary care physician [or expert ].

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