Sildenafil Citrate as a Potential Therapy for Clitoral Vascular Insufficiency

This can be attributed to customs and traditions which to some extent discourage sexual education especially among females.

Further information

No significant differences were found between both studied groups regarding the demographic data (Table1). Also, the pretreatment baseline sexual function domains were comparable between both arms as shown in Table1. There were significant improvements in group A (the sildenafil group) particularly in the desire, lubrication, orgasm and the overall satisfaction domains (Table2).When compared to the placebo group, the treatment group was superior only in the post-treatment orgasm domain (Table 2). Sexual dysfunction is any disturbance in sexual response over the counter drugs containing sildenafil cycle [6].The family as the center and core of all human societies is based on the sexual instinct [7]. Female sexual problems have not received much attention as men’s sexual problems especially in Arab countries [8].

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The current study was conducted to evaluate the effect of sildenafil citrate on the female sexual dysfunction. The included sample was composed of 52 women complaining of sexual dysfunction. They were randomized into 2 equal groups “sildenafil group and placebo group” as mentioned in the methodology section. Overall, most of patients who received sildenafil were living in urban areas (53%). All patients of this study were educated, varying between secondary and university levels. [12] found that sexual satisfaction seemed to be associated with residence as (26.4%) and (39.1%) of participants living in town were

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very and moderately sexually satisfied compared to (18.2%) and (20.5%) of women living in villages who were very and moderately sexually satisfied.

Sildenafil vs. Alternatives	Effectiveness	Side Effects	Notes
Sildenafil	Moderate to high	Mild to moderate	Widely studied, affordable
Tadalafil	Longer duration	Similar	Once-daily dosing possible
Vardenafil	Rapid onset	Similar	Similar to sildenafil
Female-specific products	Limited data	Limited data	Emerging options, variable efficacy

Regarding masturbation (17.3%) of town residents practiced it before marriage versus (11.4%) of those living in a village and (59%) of

Other uses for this medicine

In this study, we tried to prospectively assess safety and efficacy of sildenafil citrate in treating FSD. The study was conducted in the Andrology and gynecology departments of Zagazig and Tanta University Hospitals during the period from April 2017 to August 2020. Informed consents were taken from all participants. Group A contained 26 patients who received 50mg sildenafil on demand. Group B received placebo tablets and also included 26 patients.

Super P Force

The study was prospective, double-blinded and placebo controlled. The Institutional Review Board (IRB) provided ethical approval for this study (Institutional Review Board N° 1965) for Faculty of Medicine, Zagazig University, and Zagazig, Egypt on March 3, 2017. Married female patients complaining of sexual dysfunction for at least 6 months and not on drug therapy for the treatment of FSD. Patients with sexual dysfunction caused by local genital disorder, patients with retinal problem, patients with chronic debilitating diseases or hormonal disturbance, patients who cannot be treated with PDEs inhibitors type 5(sildenafil) as: Major hematological, renal or hepatic abnormalities, patients with major psychological disorders including major depression or psychosis, a history of stroke or myocardial infarction or any significant cardiovascular disease within the last 6 months, or concomitant treatment with nitrates. All patients in the 2 groups were subjected to: Complete history taking: age, education, occupation, residence, age of marriage, special habits, history of medical diseases, surgical history and sexual history in the previous 6 months. participants living in town and (54.5%) of participants living in rural areas stated that they did not know what masturbation is.

• Proper storage extends the shelf life of sildenafil tablets.
• Use caution when combining sildenafil with blood pressure medications.
• Female response to sildenafil can depend on psychological factors.
• Always disclose all health conditions before starting therapy.
• The medication may help improve quality of sexual experiences.
• Some women may experience no noticeable change; individual variation exists.
• Sildenafil can create a temporary sense of increased arousal.
• Keep a journal to track effects and side effects.
• Use sildenafil as part of a broader approach to sexual health.
• Avoid taking more than the recommended dose.
• Some evidence indicates sildenafil may reduce sexual pain in women.
• Considering alternative therapies may be beneficial if sildenafil is ineffective.

This study revealed no significant differences between both groups regarding their baseline sexual desire or orgasm (Table 2).

• Sildenafil may improve blood flow to the clitoris, aiding arousal.
• Use caution with grapefruit or grapefruit juice, which can affect drug levels.
• Document any pre-existing medical conditions before starting sildenafil.
• Sildenafil may cause dizziness; avoid activities requiring alertness.
• Women with liver or kidney impairment should consult a physician first.
• The drug is not a hormone; it works on blood vessels.
• Patients should report any sustained erections or discomfort.
• Combining sildenafil with certain antidepressants may alter effectiveness.
• Keep track of any changes in sexual satisfaction or function.
• Sildenafil should be used as part of a comprehensive treatment plan.
• Avoid using sildenafil with recreational drugs that affect the cardiovascular system.
• Always follow up with your healthcare provider for ongoing assessment.

On the same side, the study carried by Omidi et al.

Side Effects

There was significant difference between pre and post treatment of sexual dysfunction regarding the Sildenafil arm. There was no significant difference in post treatment results between the two studied groups as regard sexual dysfunction except in orgasm which showed superior improvement in the Sildenafil group. Conclusions: Sildenafil citrate seems to be effective in treating women who could not achieve orgasm. Abbreviations: FSD: Female Sexual Dysfunction; IRB: Institutional Review Board; FSFI: female sexual function index; SPSS: Statistical Package for Social Science Female Sexual Dysfunction (FSD) is a disturbance or dysfunction in the process of desire, arousal or orgasm, which can be a symptom of a biological condition, a psychological problem, an interpersonal issue or a combination of these factors [1]. Female Sexual Dysfunction is a multi-causal and a multi- dimensional medical problem that adversely affects physical health & emotional wellbeing.

Raynaud's phenomenon

Also impaired sexual function can have damaging effects on the self-esteem, sense of wholeness and interpersonal relationships of women. It is often emotionally distressing and can affect reproduction or even end up with separation or divorce [2]. Selective type 5 phosphodiesterase (PDE5) inhibitors as sildenafil, which acts by inhibiting cyclic GMP specific PDE5 may improve the sexual health of women affected by sexual difficulties such as arousal disorders and may indirectly improve other aspects of sexual life [3]. Sildenafil was effective and well-tolerated in post-menopausal women with sexual arousal disorder without concomitant hypoactive sexual desire disorder or contributory emotional relationship or historical abuse issues [4]. However, studying FSD is lacking in the literature especially in the Arab and middle east region. [13] in Iran compared the two groups in terms of primary mean scores of sexual function, sexual satisfaction, and marital satisfaction showed similarities in terms of factors and prevalence of disorders at the beginning of the study.

Related/similar drugs

This may be due to better level of education, sexual knowledge or socioeconomic factors. [11] concluded that men and women who had trouble in paying their bills were twice as likely to report sexual dysfunctions compared with peers without such economic troubles. In women, there was also a statistically significant trend of increasing sexual dysfunction prevalence with decreasing income. As regard masturbation practice before marriage, it was more common among participants living in cities. In the current study 53.85% of participants living in towns and 46.15% in villages; about 80.76% of them stated that they did not know what masturbation is. In the treatment arm of the present study, there was improvement in sexual dysfunction particularly in sexual desire, maintenance of lubrication, orgasm and satisfaction.

• Sildenafil citrate can be prescribed off-label for female sexual dysfunction.
• Consult a doctor before using sildenafil citrate tablets for women.
• Side effects in women may include headache, flushing, or nasal congestion.
• Sildenafil works by increasing blood flow to enhance female arousal.
• Dosage for women varies; always follow medical advice.
• Sildenafil tablets may interact with other medications, like nitrates.
• Not approved by FDA specifically for female sexual dysfunction.
• Use with caution in women with heart conditions or high blood pressure.
• Possible benefits include improved libido and vaginal blood flow.
• Sildenafil should be taken on an empty stomach for best results.
• Long-term safety of sildenafil in women is not well established.
• Store sildenafil citrate tablets in a cool, dry place out of children’s reach.

Regarding the desire, the obvious change was in patients with no desire weekly pretreatment to improve from zero to 61.5% post-treatment.

Proper Use

Thorough general and local examination was also done. Routine laboratory investigations including complete blood count liver function tests renal function tests, blood sugar and lipid profiles; were done. Evaluation questionnaire used included 25 items designed by the investigators. Only some items selected from the female sexual function index (FSFI) [5], other questions were added to suit the purpose of study. The FSFI domain has maximum possible total scores of 36 as in (Table 1).

Patient resources

The FSFI, a 19-item questionnaire, has been developed as a brief, multidimensional self-report instrument for assessing the key dimensions of sexual function in women. It is psychometrically sound, easy to administer, and has demonstrated ability to discriminate between clinical and nonclinical populations. The questionnaire described was designed and validated for assessment of female sexual function and quality of life in clinical trials or epidemiological studies. In addition, depression questionnaire was added to exclude the major psychological depressive disorder and its result put with the evaluation questionnaire as one item only (Table 2). The collected data were statistically analyzed using SPSS program (Statistical Package for Social Science) version 18.0.SPSS Inc., Chicago, IL, US. The orgasm differences in women who achieved orgasm less than half the time were 38.5% versus 84.6% pre- and post-treatment respectively (Table 2).

• Sildenafil citrate is a phosphodiesterase type 5 inhibitor.
• It may help women with sexual arousal disorder by increasing blood flow.
• Discuss mental health factors affecting libido with a healthcare specialist.
• Be aware of possible nasal congestion after taking sildenafil.
• Avoid using expired medication, as effectiveness may diminish.
• The effectiveness varies among women; results are individual.
• Use sildenafil responsibly to minimize potential adverse effects.
• Women should inform providers of all medications taken regularly.
• Sildenafil is not a cure for sexual dysfunction, only a symptomatic aid.
• Adequate sexual education can improve understanding and expectations.
• Proper dosage and timing are important for safety and efficacy.
• Sex therapy or counseling may complement medication use effectively.

Indeed these results were opposite to the study of Dasgupta et al. [14] which included 19 women completed the 2 arms of the double-blind phase and 12 completed the optional open label extension phase.

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Well-educated women from urban areas gave accurate answers as compared to those from conservative families, rural areas with lower education because the latter suffers from lack of access to information and lower level of awareness. [9] concluded that high education level, exposure to the media, and living in modernized cities were the main contributing factors to a high awareness of reproductive health issues. Both studied groups were comparable regarding the pretreatment FSFI with its all domains. As for the unprovoked desire to have sex, no statistically significant difference between both groups was found. This means that the demographic data has no particular effect on the female sexuality and both groups were at the same baseline pretreatment parameters. Statistically significant improvement following sildenafil was only reported in the lubrication domain of sexual function during the double-blind phase.

Detection in biological fluids

This agrees with the conclusion of Spector et al. [10] who stated that the sexual desire, which is an aspect of a person’s sexuality, varies significantly from one person to another, and varies depending on the surrounding circumstances at a particular time. Comparing the effect of residence on female sexuality, the study showed higher figures in urban areas regarding coital frequency, ability to reach orgasm, overall satisfaction with sexual life, practice of premarital masturbation and knowledge about it. However, frequency of experiencing unprovoked desire seemed to be unaffected by residence. These results mean that sexual function of women resident in cities is better than those living in villages.