The launch of Viagra in the late 1990s was a watershed moment for the treatment of erectile dysfunction in men and helped to improve the lives of millions of people in the process.
It was the most effective, relevant and positive example of medicalisation, where the social condition known colloquially as impotence was found to have a root medical cause that could in a lot of cases be treated with a simple blue pill.
With cheap sildenafil on the market now thanks to the expiring of exclusive patents on the PDE5 inhibitor, the vast majority of men who have erectile dysfunction or issues with their sex life have an easy, manageable solution.
Such is the appeal of sildenafil, and ED medications with similar actions such as tadalafil, vardenafil and finasteride that a prevalent question asked about the female equivalent.
Given that the orgasm gap, its causes and potential solutions have been points of debate for decades, it is a valid question to ask why, if the sex lives of men can be fixed with one pill, where the “Female Viagra” to refresh women’s sex lives is.
The answer is complex, in no small part because the reasons for sexual dysfunctions in men and women are somewhat different in practice, which means that any medication to fix it will need to use a very different mechanism.
Can Women Take Viagra?
Whenever talking about “Female Viagra”, the first question that is commonly asked is whether women can take sildenafil at all and if it has any benefits or effects.
Sildenafil is not licensed for use in women, but it has been prescribed as an off-label drug to treat some specific causes of sexual dysfunction in women.
Theoretically, it can increase sensitivity in the same way it does with men by stimulating blood flow to the vagina, which can theoretically help with sexual arousal, lubrication and orgasm in some women.
There is a very small study (with a conflict of interest due to being funded by Pfizer, the manufacturer behind Viagra) that claimed it could help with reversing sexual dysfunction that was caused by the side effect of certain medications, but further evidence of this has been of limited quality.
There have been so few studies on the effect of sildenafil on women but whilst there do seem to be some people who benefit from it, a lot of women do not seem to find any benefit, either pre or post-menopause.
Why is this the case, and what would a “Female Viagra” need to treat?
Not Treating The Same Condition
In the vast majority of cases of erectile dysfunction, the cause is related to blood flow to the penis, which can be affected by medication, as PDE5 inhibitor medication has proven. It is a treatable physiological condition.
There are other causes of ED, including injury, blood pressure, diabetes, hormonal imbalances, and depression, anxiety or a combination of both.
ED can treat some of these conditions directly, whilst in complex cases where the cause is both physiological and psychological, it can treat the former which can in turn help the latter.
However, what sildenafil and similar medication cannot do is treat hyposexuality or a lack of desire to have sex, and this is part of the reason why Viagra does not work the same for women as it does for men.
The main cause of sexual dysfunction in women is female sexual arousal disorder, which is divided into three main subtypes:
- Genital Arousal Disorder
- Subjective Sexual Arousal Disorder
- Combined Genital And Subjective Arousal Disorder
It is a complex condition with a wide range of interlinked underlying causes, each of which requires very different treatment pathways based on the underlying cause of sexual dysfunction.
Low sexual desire in both men and women can have a wide range of causes, including psychological, pharmacological, neurological as well as physiological, and medication to treat low sex drive needs to work on multiple levels to be effective for a wide group of people.
The closest analogue to a “Female Viagra” is flibanserin, sold under the trade name Addyi in the United States (and not in the UK), which originally began as an antidepressant and works as a neurological disinhibitor to increase the release of the movement hormone norepinephrine and the reward and pleasure hormone dopamine.
It is a somewhat contentious medication, because whilst some women have found significant benefits from it, others have not found it helpful, it is a medication that only works slightly better than a placebo, and as a solution to sexual dysfunction is seen as overly simplistic.
A lot more research needs to be undertaken on the medical basis of female sexual dysfunction to find the basis of a medication that is as effective for women as sildenafil has been for men.
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