Female Sexual Dysfunction
Sexual disorders and dysfunctions, described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as the impairment in normal sexual functioning, are believed to be among the more prevalent psychological disorders in the general population. This impairment can present as the inability to perform or reach an orgasm, painful sexual intercourse, a strong repulsion of sexual activity, or an exaggerated sexual response cycle or sexual interest.
Female sexual dysfunction (FSD) may be due to physical or psychological factors. In the United States, about 43% of women report sexual problems, and 12% report that these problems are the cause of distress. Female-specific diagnoses of sexual dysfunctions include female orgasmic disorder, female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), dyspareunia, and vaginismus.
Treatment Options for FSD
Treatment choices for female sexual dysfunction should be specific to the diagnoses, as well as underlying physical and psychological factors. Successful management most often utilizes non-drug therapies that focus on counseling, lifestyle changes, improving body image, lubricants and moisturizers, and devices. The use of drug therapy such as hormones (androgens, estrogens, ospemifene, tibolone), phosphodiesterase inhibitors (Viagra, Cialis, Levitra), psychotropic agents (apomorphine, bupropion, buspirone, flibanserin), and herbal supplements have shown limited and conflicting evidence of usefulness, and are associated with side effects.
Viagra, Levitra, Cialis for Women with FSAD
Phosphodiesterase inhibitors (PDE5-inhibitors) such as Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil) are thought to improve blood flow to clitoral and vaginal tissues through a similar response to that found in male genitalia. While the use of PDE5-inhibitors has revolutionized the treatment of male sexual dysfunction, their true place in treating female sexual dysfunction has yet to be confirmed. Although there are various reports of the success of Viagra, Cialis, and Levitra for improved sexual performance in women, there is limited data to support these claims.
The majority of available studies evaluated using PDE5-inhibitors in women diagnosed with female sexual arousal disorder (FSAD) — a specific physical condition that limits lubrication and swelling response in female genitalia despite the desire to engage in sexual activity. Improvement in genital sensation, lubrication, ability to have an orgasm, and overall sexual experience were experienced with Viagra use in younger women as well as those women diagnosed specifically with FSAD without hypoactive sexual desire disorder (HSDD). Success in treating HSDD was reported when Levitra was combined with testosterone. PDE5-inhibitors were also successful in treating FSAD caused by type 1 diabetes, multiple sclerosis, and antidepressant use.
One study of PDE5-inhibitors in healthy females reported success in improving arousal, orgasm, and enjoyment.
Despite the reports of successful treatment of FSAD with PDE5-inhibitors there are numerous trials reporting no success with these drugs. Women receiving estrogen replacement therapy (ERT) and estrogen-deficient women, spinal injury patients, as well as those reporting childhood sexual abuse found no benefit with PDE5-inhibitor use. MRI scans of female genitalia did not show improvement in clitoral blood flow with treatment either.