Cialis for women: does it work?

Cialis (tadalafil) is not approved for use in women by the US Food and Drug Administration (FDA), but some healthcare providers may prescribe Cialis for women off-label to treat sexual dysfunction. Early research suggests it may help in some cases, although studies are limited.

Here is what to know about Cialis for women, including whether it works and what other treatment options are available.

Cialis may help some women with certain types of female sexual dysfunction (FSD), but research is limited and the medication is not approved for this use. Women can take Cialis only off-label, meaning a healthcare provider prescribes it for a purpose the FDA has not approved.

In men, Cialis works by blocking an enzyme called phosphodiesterase type 5 (PDE5), which helps increase blood flow to the penis. Researchers think tadalafil may have a similar effect on the genital area in women. Good blood flow to the vaginal area is important for arousal and sexual response, including engorgement and increased sensitivity of the clitoris. Increased blood flow also supports natural lubrication.

Tadalafil also has mild vasodilatory effects throughout the body, which may cause a temporary drop in blood pressure, according to the Cialis prescribing information. For this reason, it should  not be taken with nitrate medications (such as nitroglycerin).

 Research on Cialis for women is minimal, with few large-scale studies looking directly at how it affects sexual function in women. Studies in specific groups of women include:

• In women who take antidepressants and experience sexual side effects, a 20 mg dose of tadalafil may help reduce sexual problems, according to a small case series.

• A small 2012 study without a placebo group found that daily tadalafil (5 mg) improved arousal and other measures of sexual function in premenopausal women with type 1 diabetes and sexual genital arousal disorder.

• A 2017 narrative review of tadalafil for sexual dysfunction in midlife and older women, including menopausal and postmenopausal women, suggested that tadalafil may help with several types of FSD. The authors noted that evidence on the best treatment approach is limited.

• A 2017 randomized, placebo-controlled study found that daily treatment with a low dose of tadalafil was effective in treating overactive bladder in women, a condition separate from sexual dysfunction.

FSD is complex, involving psychological, social, and physical components beyond blood flow. As such, it is unclear whether Cialis would address aspects of FSD, such as sexual desire (libido), arousal, or physical barriers to sexual satisfaction caused by aging or other medical conditions. Larger clinical trials are needed to understand whether Cialis is a safe and effective option.

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Because clinical trials of Cialis were conducted in men, it is not fully known whether women would experience the same side effects. The FDA reports the following common potential side effects in men:

• Headache

• Indigestion

• Back pain

• Muscle aches

• Flushing

• Stuffy or runny nose

• Pain in the arms or legs

Talk to a healthcare provider if you experience any of these side effects.

In rare instances, serious side effects can occur, including:

• Vision loss

• Hearing loss

• Allergic reaction (hives, rash, swollen lips or tongue, trouble breathing or swallowing)

Stop taking Cialis and seek medical attention right away if any of these more serious side effects occur. This is not a full list of possible side effects. For a more comprehensive list, read the FDA drug label. 

Do not take Cialis if you use nitrate medications (such as nitroglycerin) for chest pain, because the combination can cause a dangerous drop in blood pressure. Taking Cialis with certain blood pressure medications or a lot of alcohol can also lower blood pressure. 

Women who take nitrate medications or have certain heart conditions should not take Cialis, based on safety information for men. No guidelines regarding Cialis exist specifically for women, because Cialis is not FDA approved for use in women.

Cialis is approved by the FDA for men with erectile dysfunction (ED) or an enlarged prostate, and it is not indicated for use in women or children. A healthcare provider can help decide whether off-label Cialis is right for you.

There is not enough research on the use of Cialis during pregnancy, so it is unclear whether it could harm a fetus. The FDA label also notes there is no information on whether tadalafil passes into human breast milk, so it is unclear whether Cialis is safe to use while breastfeeding.

Cialis is approved for use in men, so the safety recommendations are based on male patients. Because the underlying health risks are not specific to sex, these precautions may also apply to women. Cialis may not be safe for women who:

• Have certain heart conditions or issues with low blood pressure

• Take nitrate medications

• Take riociguat, a medication for certain types of pulmonary hypertension

• Drink excessive amounts of alcohol

• Have severe liver or kidney disease

In general, before taking Cialis, share all health conditions and medications with a healthcare provider, who can help determine whether Cialis is safe and what dose may be appropriate.

Understanding what is causing FSD or female sexual arousal disorder is key to treating it properly.

Healthcare providers who treat FSD often take a holistic approach, addressing psychological concerns, interpersonal issues, and physical or medical conditions.

Psychological and interpersonal issues can be addressed through psychotherapy or sex therapy. Couples therapy may help improve communication about sexual preferences and desires. A 2008 review suggests that mindfulness, acupuncture, and yoga may have therapeutic value for FSD.

Certain medications may help improve FSD symptoms, including:

• Estrogen therapy, usually as a low-dose vaginal cream, tablet, insert, or ring

• Testosterone applied to the skin (such as a cream or gel), usually short-term and for postmenopausal women

• Ospemifene (Osphena) for pain during sex

• Bupropion (Wellbutrin) for people who experience sexual side effects from antidepressants

• Addyi (flibanserin) for hypoactive sexual desire disorder (HSDD), or low libido, in women younger than 65

• Vyleesi (bremelanotide), an injectable medication for HSDD in premenopausal women

Women who experience genital pain, pelvic pain, or pain during intercourse may benefit from an in-person visit with a healthcare provider who specializes in women’s health. They can perform a physical examination, diagnose the problem, and discuss treatment options. Pain during sex can have both psychological and physical components.

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Cialis may help some women with sexual dysfunction, but the evidence is early and limited.

• Cialis is not FDA-approved for women, so any use is off-label and depends on a healthcare provider’s assessment of benefits and risks.

• Cialis is thought to work in women by increasing blood flow to the genitals, which may support physical arousal. It is not designed to increase sexual desire.

• Small studies suggest possible benefits for women with type 1 diabetes or sexual side effects from antidepressants, but larger trials are needed.

• Treatment for FSD depends on the cause and may include estrogen therapy, testosterone applied to the skin, bupropion, FDA-approved medications for low libido, or individual, sex, or couples therapy.