Viagra (sildenafil) for women: what you need to know

Mismatched libidos are a common source of conflict in relationships, and sometimes leave both parties feeling like their needs aren’t met. Situations like this may have some wondering–is Viagra (sildenafil) for women an option? 

Some healthcare providers do prescribe Viagra for women as an off-label treatment for issues with physical arousal (for example, natural lubrication). However, Viagra does not increase sexual desire in women. Fortunately, there are other drugs on the market that may improve your sexual desire and arousal. Continue reading to learn why a healthcare provider might prescribe Viagra for women and what other options are available to increase libido. 

Viagra is the brand name of sildenafil (which is the name of the active ingredient in Viagra). This popular erectile dysfunction (ED) medication belongs to a class of drugs called PDE-5 inhibitors, which relax the muscles in the penis to improve blood flow and, subsequently, erections. ED affects 30–50 million men in the US, and PDE-5 inhibitors are the most commonly used treatment option (Sooriyamoorthy, 2022).

Some healthcare providers prescribe Viagra for women off-label to improve low sex drive, a form of sexual dysfunction. 

Sexual dysfunction becomes more common as we age. It's estimated that around 45% of women may experience female sexual dysfunction (FSD) at some point in their lives. FSD is often due to a combination of biological and psychosocial factors. Low sex drive, hypoactive sexual desire disorder (HSDD), arousal difficulties, trouble having an orgasm, and pain during sex are all elements of FSD (Thomas, 2018). 

Several small studies have researched sildenafil to treat FSD and female sexual arousal disorder (FSAD), which refers to occasional or recurring inability to get or maintain adequate lubrication and genital swelling for sexual activity. 

Unfortunately, the data on sildenafil to treat FSD and FSAD is limited and often shows conflicting results—but we know sildenafil is nowhere near as effective for FSD as it is for erectile dysfunction (Shields, 2006). 

While arousal is physical, desire is multi-faceted. Emotional and mental health both contribute to desire, neither of which Viagra addresses. The medicine also doesn't treat hormonal imbalances, which play a role in sex drive. More research is needed to understand if Viagra is an effective treatment for women.

It’s important to note that Viagra is not without side effects, no matter who’s taking it. Anyone taking Viagra may experience common side effects of the medicine, including headaches, nausea, flushing, stuffy nose, and changes to vision (DailyMed, 2017).

Other prescription medications have entered the market as treatments for FSD and FSAD. Flibanserin (brand name Addyi) and bremelanotide (brand name Vyleesi) are FDA-approved medications created to treat female sexual interest/arousal disorder. Though Addyi is an oral medication and Vyleesi is an injection, they both address low sexual desire in women that is not caused by a medical or psychological condition.

Keep in mind that these medications are not just the “women’s” equivalent of Viagra. Viagra is generally prescribed to people who want to have sex but have physical problems getting or maintaining an erection that prevent sexual activity. Addyi and Vyleesi change your brain chemistry to help increase sexual desire.

Flibanserin (brand name Addyi) is a prescription pill used to treat HSDD in premenopausal women. You take it once nightly at bedtime. It is not FDA-approved for those who have already gone through menopause or for men. Also, it does not enhance sexual performance. This drug does not treat low libido caused by factors like medication use, severe life stressors, etc. (DailyMed, 2021-a). 

Although scientists don't understand the exact mechanism for how Addyi works, the drug affects the brain chemicals (neurotransmitters) serotonin, norepinephrine, and dopamine. These all play a role in desire and arousal. 

Effectiveness

An overall analysis of the FDA clinical trials showed that approximately 10% of people taking Addyi reported a "much improved" or "very much improved" status (English, 2017).

Side effects

The most common side effects of Addyi include (DailyMed, 2021-a):

• Dizziness

• Sleepiness

• Nausea

• Fatigue

• Trouble sleeping (insomnia)

• Dry mouth

Less often, serious adverse effects like low blood pressure, fainting, and sedation can occur. The likelihood of these side effects goes up if you take Addyi within two hours of drinking alcohol or with certain medications (called CYP3A4 inhibitors) that affect how Addyi is broken down by the liver (DailyMed, 2021-a). 

Bremelanotide (brand name Vyleesi) is an injection that, like Viagra for ED, you take 45 minutes before sex. It is FDA-approved to treat HSDD in premenopausal women. Vyleesi is not for people who have already gone through menopause or for men. Like Addyi, it does not enhance sexual performance, and it is not meant to improve low sexual desire caused by external factors (DailyMed, 2021-b).

Like Addyi, experts don't know how Vyleesi helps with HSDD, but studies show that it activates the melanocortin receptor, which is present in neurons in the nervous system (DailyMed, 2021-b). 

Effectiveness

Two independent randomized, double-blind, placebo trials showed a statistically significant improvement in sexual desire and decreased distress about sexual dysfunction among people who used Vyleesi (Kingsberg, 2019).

Side effects

The most common side effects of Vyleesi include (DailyMed, 2021-b):

• Nausea and vomiting

• Flushing and hot flashes

• Skin irritation or rash at the injection site

• Headaches

• Cough

• Fatigue

• Dizziness

You should not take more than one dose of Vylessi in a 24-hour period or more than eight doses a month.

Vyleesi can cause a temporary increase in blood pressure, so you should not use it if you have uncontrolled high blood pressure. Some people, especially those with dark skin, may develop darkening of the skin (hyperpigmentation) in the face, gums, or breasts—this occurred in 1% of people in the clinical trials. It is safe to drink alcohol if you take Vyleesi (DailyMed, 2021-b).

If you experience low sex drive or issues with physical arousal that prevent you from having the sex life you desire, seek advice from your healthcare provider. Desire and arousal involve a complicated interplay of physical, emotional, and social factors—your troubles may not be caused by just one thing. Your provider can help you identify potential causes and explore safe and effective treatment options. 

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Current version

November 11, 2022

Written by

Linnea Zielinski

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.