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Dec 17, 2021
6 min read

Viagra for women: what you need to know

Viagra (active ingredient sildenafil) is FDA-approved to treat erectile dysfunction (ED) and has been used off-label to treat sex drive and arousal issues in women. But, while it treats some physical arousal issues, it does not increase sexual desire. Some people use the term “female Viagra” to refer to two medications recently approved to help with arousal: flibanserin (brand name Addyi) and bremelanotide (brand name Vyleesi). These drugs act on brain chemistry to increase sex drive. Each has potential side effects, and overall efficacy is limited.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Even if it’s only a temporary thing, mismatched libidos can strain a relationship and leave both parties feeling like their needs are unmet. These situations have left some wondering if Viagra for women is an option. 

While Viagra treats some physical arousal issues in women, it does not increase sexual desire. But there are other drugs on the market that may improve your sexual desire and arousal. Read on to learn more about why a healthcare provider might prescribe Viagra to a woman and what other options on the market are available. 

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What is Viagra? 

Viagra (also known as the “little blue pill”) is the brand name of sildenafil (see Important Safety Information). This PDE5 inhibitor relaxes muscles in the penis and improves blood flow to treat erectile dysfunction (more commonly called ED). ED affects 30–50 million men in the U.S., and PDE5 inhibitors are the most common treatment options (Sooriyamoorthy, 2021).

Can women take Viagra?

Some healthcare providers give sildenafil to women off-label to improve low sex drive, a form of sexual dysfunction

Sexual dysfunction is increasingly common as we age, and it’s estimated up to 40-50% of women may experience it at some point in their lives. Female sexual dysfunction (FSD) is often due to a combination of biological and psychosocial factors. It encompasses things like low sex drive or hypoactive sexual desire disorder (HSDD), arousal difficulties, trouble having an orgasm, and pain with sex (Weinberger, 2019). 

Several small studies have looked at using sildenafil to treat female sexual dysfunction conditions like HSDD and female sexual arousal disorder (FSAD). 

FSAD refers to the occasional or reoccurring experience of being unable to get or maintain adequate lubrication and genital swelling long enough for sexual activity. (It’s just one of several conditions that fall under the umbrella term female sexual dysfunction or FSD). However, the data on sildenafil in females is limited and often shows conflicting results—it’s nowhere near as effective for FSD as it is for erectile dysfunction (Weinberger, 2019). 

While arousal is physical, desire is multi-faceted. Emotional and mental health both play into desire, neither of which Viagra addresses. The medicine also doesn’t affect your hormones, which play a role in sex drive. Overall, whether Viagra is an effective treatment for women is still up for debate.

It’s also important to note that Viagra is not without side effects. Anyone taking Viagra may experience common side effects of the medicine, such as headache, nausea, flushing, stuffy nose, and visual symptoms (DailyMed, 2020).

What is female sexual interest/arousal disorder (FSIAD)?

Female sexual interest/arousal disorder (FSIAD) is a diagnosis that merges two conditions: hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD). In the past, these conditions were treated as separate entities. However, FSIAD is sometimes still referred to as HSDD (English, 2017).

Diagnosis of FSIAD involves having at least three of the following symptoms for a minimum of six months (Both, 2017):

  • Reduced or lack of interest in sex
  • No or reduced erotic thoughts or fantasies
  • Limited or absent initiation of sexual activity and being unreceptive to your partner’s attempts to initiate
  • Reduced or lack of sexual excitement or pleasure during sex
  • Absent or reduced sexual interest or arousal in response to erotic cues
  • No or limited reduced genital sensations during sex

For FSIAD, these symptoms need to be distressing to the individual and not result from other factors, like serious relationship issues or significant stressors. FSIAD may affect up to 46% of premenopausal women and around 10% of postmenopausal women (English, 2017).

Viagra alternatives for women

Other prescription medications have emerged as targeted treatments for some of the issues women face in their sexual health. 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’re both aimed at addressing low sexual desire in women that is not caused by a medical or psychological condition.

One thing to keep in mind is that these medications are not like Viagra. Viagra is generally prescribed to people who want to have sex but have physical problems (i.e., erection trouble) that prevent sexual activity. Addyi and Vyleesi affect your brain chemistry to help with the first part of sex: wanting to have sex.

What is Addyi (flibanserin)?

Flibanserin (brand name Addyi) is a prescription pill that you can take 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 is not for low libido due to other 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 the Addyi is broken down by the liver (DailyMed, 2021-a). 

This concern is so high that the FDA has issued a boxed warning (the most serious caution statement) to warn people against taking Addyi within two hours of drinking alcohol or using CYP3A4 inhibitors. If you have liver problems that would prevent you from metabolizing this drug normally, the FDA says you should not take Addyi (DailyMed, 2021-a). 

What is Vyleesi (bremelanotide)?

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 due to other factors like medication use, severe life stressors, etc. (DailyMed, 2021-b).

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

Vyleesi is an injection that, like Viagra for ED, is taken in preparation for a sexual encounter. 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. You can drink alcohol if you take Vyleesi (DailyMed, 2021-b).

When to see your healthcare provider

If you are having trouble with your sex drive, seek advice from your healthcare provider. Desire and arousal involve a complicated interplay of physical, emotional, and social factors—your troubles may not be due to just one thing. Your provider can help you identify issues and explore treatment options. 

References

  1. Berman, J. R., Berman, L. A., Toler, S. M., Gill, J., & Haughie, S. (2003). Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder: a double-blind, placebo controlled study. Journal of Urology, 170(6), 2333–2338. doi: 10.1097/01.ju.0000090966.74607.34. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14634409/
  2. Both S. (2017). Recent developments in psychopharmaceutical approaches to treating female sexual interest and arousal disorder. Current Sexual Health Reports, 9(4), 192–199. doi:10.1007/s11930-017-0124-3. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29225554/
  3. DailyMed. (2020). Viagra- sildenafil citrate tablet, film-coated. Retrieved on Dec. 13, 2021 from https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a2a9f459-e692-4e85-83b0-a35fbf35e91b
  4. DailyMed. (2021-a). Addyi- flibanserin tablet, film coated. Retrieved on Dec. 13, 2021 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3819daf3-e935-2c53-c527-e1d57922f394
  5. DailyMed. (2021-b). Vyleesi- bremelanotide injection. Retrieved on Dec. 13, 2021 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9146ae05-918b-483e-b86d-933485ce36eb
  6. English, C., Muhleisen, A., & Rey, J. A. (2017). Flibanserin (Addyi): the first fda-approved treatment for female sexual interest/arousal disorder in premenopausal women. P & T : A Peer-Reviewed Journal for Formulary Management, 42(4), 237–241. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358680/
  7. Kingsberg, S. A., Clayton, A. H., Portman, D., Williams, L. A., Krop, J., Jordan, R., et al. (2019). Bremelanotide for the Treatment of Hypoactive Sexual Desire Disorder: Two Randomized Phase 3 Trials. Obstetrics and Gynecology, 134(5), 899–908. doi: 10.1097/AOG.0000000000003500. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31599840/
  8. Lewis, R. W., Fugl‐Meyer, K. S., Bosch, R., Fugl‐Meyer, A. R., Laumann, E. O., Lizza, E., & Martin‐Morales, A. (2004). Epidemiology/risk factors of sexual dysfunction. The Journal of Sexual Medicine, 1(1), 35–39. doi: 10.1111/j.1743-6109.2004.10106.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16422981/
  9. Monte, G. L., Graziano, A., Piva, I., & Marci, R. (2014). Women taking the “blue pill” (sildenafil citrate): such a big deal? Drug Design, Development and Therapy, 2251. doi: 10.2147/dddt.s71227. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25422584/
  10. Sooriyamoorthy, T., & Leslie, S. W. (2021). Erectile dysfunction. [Updated Aug. 12, 2021]. In: StatPearls [Internet]. Retrieved on Dec. 13, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK562253/
  11. Weinberger JM, Houman J, Caron AT, Anger J. (2019). Female sexual dysfunction: a systematic review of outcomes across various treatment modalities. Sexual Medicine Reviews, 7(2):223-250. doi: 10.1016/j.sxmr.2017.12.004. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29402732/