Should women use sildenafil to reduce their risk of Alzheimer’s disease? Elizabeth Tracey reports

El Far M, El Motwally Ael G, Hashem IA,

Brand Name	Formulation	Dosage Options	Notes
Viagra Women	Oral tablet	25 mg, 50 mg	Off-label use, not approved by FDA
Female Arousal Gel	Topical gel	N/A	Claimed to enhance blood flow
Sildenafil Citrate	Generic oral tablet	25-100 mg	Widely used off-label in women
Custom Compounded	Customized formulations	Variable	Prescribed by special clinics

Bakry N (2009) Biochemical role of intravaginal sildenafil citrate

• Female sexual dysfunction affects millions worldwide, prompting research into treatments.
• Sildenafil is part of a broader conversation about women’s sexual health innovations.
• The role of sildenafil in improving orgasm quality is still being studied.
• It is essential to distinguish between clinical trial results and off-label use.
• Some women experience mood improvement alongside physical effects with sildenafil.
• Education about both benefits and risks is crucial for women considering sildenafil.

as a novel antiabortive agent in unexplained recurrent spontaneous

Side Effect	Severity	Frequency	Management Tips
Headache	Mild to moderate	Frequent	Hydration, pain relievers
Flushing	Mild	Common	Cooling measures
Nasal Congestion	Mild	Occasional	Decongestants
Dizziness	Mild	Less common	Sitting or lying down
Visual Disturbances	Rare	Rare	Seek medical attention

miscarriage: first clinical study of four case reports from Egypt.

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[17]; 13 of 19 (68%) subjects achieved a ≥50% increase in clitoral engorgement from baseline when administered sildenafil or placebo 30 minutes after dose administration. At 60 minutes after administration, 17/19 (89%) subjects receiving sildenafil and 16/19 (84%) subjects receiving placebo had responded (P value 0.3). [16] used self-reported measures of sexual function which showed mixed results whereas studies examining physiological effects of PDE5i on genital vasocongestion consistently report significant effects on genital sexual response. The improvnent in FSFI in-group A may be related to increase in androgen level as there might be a positive correlation between sildenafil intake and increase testosterone blood level [18]. Also it increases the pelvic blood flow which may give more improvement in lubrication and decrease pain during sexual act and increase overall sexual satisfaction.

Complementary and Alternative Options for Low Libido

[19] stated that sildenafil citrate only acts on the physical phenomena of arousal and does not completely respond to the complexity of female sexual arousal disorders (FSADs). In fact, encouraging results were achieved in specific groups of patients affected by secondary FSADs (e.g., diabetes mellitus, multiple sclerosis, chronic antidepressant users) in which the genital arousal disorder is clearly connected with a neurological or vascular injury. [20] reported only lubrication changes in vaginal and clitoral sensitivity in patients treated with sildenafil. When examining the effects of sildenafil on female sexual dysfunction, it was found that sildenafil may increase congestion of the vagina, but it has no effect on excitement. This difference in results can be attributed to the manner and extent of drug administration, assessment of sexual status, and cultural status of the subjects in the study.

Mohamed Alhefnawy1*, Abdulla Esawy2, Mohamed Abdelazeem1, Mohamed Elnamoury3, Ahmed Eissa4, Ahmed Zoair4, Ahmed Ghaith4, Ayman Hagras4 and Khaled Almekaty4

Moreover, in most studies, the sample size has been very small, which makes their validity questionable. The limitation of this study is that it was conducted on only Egyptian patients, so further well-designed studies are needed to see if the same conclusions apply to other races. On the other hand, points of strength include among others, the good sample size and the prospective randomized double-blinded study design. Sildenafil citrate seems to improve orgasm in a sample of Egyptian females with sexual dysfunction. Desilva P (1995) Sexual dysfunction in S.J.E Lindsay and G.E.Powell, The hand book of lineal and adult psychology. (2009) A randomised, double-blinded, placebo-controlled study of the phosphodiesterase

Parameter	Description	Typical Values	Notes
Absorption Rate	Time to reach peak plasma levels	30-120 minutes	Varies with food intake
Half-Life	Duration of drug activity	4 hours	Metabolized mainly in liver
Bioavailability	Percentage of drug absorbed	40-50%	Affected by gastric pH
Metabolism	Enzymes involved	CYP3A4	Liver metabolism mainly
Excretion	How drug is eliminated	Feces and urine	Mainly fecal excretion

type 5 inhibitor sildenafil for the treatment of preeclampsia.

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Kaplan SA, Reis RB, Kohn IJ (1999) Safety and

How Viagra Works

Wareing M, Myers JE, O Hara M, Baker PN (2005) Sildenafil citrate (Viagra) enhances vasodilatation in fetal growth restriction. Zoma WD, Baker RS, Friedman A, Clark KE (2004) Sildenafil citrate (Viagra) increases uterine blood flow and potentiates estrogen-induced vasodilation. Webb DJ, Freestone S, Allen MJ, Muirhead, GJ (1999) “Sildenafil citrate and blood-pressure-lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist”. (2007) A systematic review of experimental and clinical studies of sildenafil citrate for intrauterine growth restriction and pre-term labour. Roh CR, Budhraja V, Kim HS, Nelson DM, Sadovsky Y (2005) “Microarraybased identification of differentially expressed genes in hypoxic term human trophoblasts and in placental villi of pregnancies with growth restricted fetuses,” Placenta 26(4): 319-328. efficacy of sildenafil in postmenopausal women with sexual dysfunction.

Patients and Methods

(2004) Hypothesis: selective phosphodiesterase-5 inhibition improves outcome in preeclampsia. Warnes CA (2004) Pregnancy and pulmonary hypertension. Sher G, Fisch JD (2002) Effect of vaginal sildenafil on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development. (2001) “Monitoring of fetuses with intrauterine growth restriction: a longitudinal study,” Ultrasound Obstet Gynecol 18 (6): 564-570. Jerzak M, Kniotek M, Mrozek J, Baranowski W (2008) Sildenafil citrate decreased natural killer cell activity and enhanced chance of successful pregnancy in women with a history of recurrent miscarriage. Basson R, McInnes R, Smith MD (2000) Efficacy and safety of sildenafil

How should this medicine be used?

J Sex Med 7(2): 858-872. Leddy LS, Yang CC, Stuckey BG, Sudworth M, Haughie S, et al. (2012) Influence of sildenafil on genital engorgement in women with female sexual arousal disorder. Sildenafil increases serum testosterone levels by a direct action on the testes. Lo Monte G, Graziano A, Piva I, Marci R (2014) Women taking the blue pill (sildenafil citrate) such big deal.

Inclusion Criteria

(1999) Safety and efficacy of sildenafil in postmenopausal women with female sexual dysfunction. Email Us: info@lupinepublishers.com Call Us: +1 (914) 407-6109 57 West 57th Street, 3rd floor, New York - NY 10019, USA Department of Obstetrics & Gynecology, Tanta University, Egypt Received: October 03, 2018; Published: October 09, 2018 Corresponding author: Mohamed Nabih EL-Gharib, Professor of Obstetrics & Gynecology, Faculty of Medicine, Tanta University, Egypt Sildenafil citrate (SC) is a medicinal drug used to treat male erectile dysfunction and pulmonary hypertension. Sildenafil is a selective and potent competitive inhibitor of the cyclic guanosine monophosphate (cGMP) -specific phosphodiesterase-type 5 (PDE-5) enzymes, which, by preventing the breakdown of cGMP, potentiate the action of NO in tissues that contain PDE-5. Thus, increasing vasodilatation and potentiating the effects of nitrous oxide (NO) on the vascular smooth muscle [1-2]. SC increases uterine blood flow and potentiates sildenafil 130mg estrogen-induced vasodilatation [3].

Bremelanotide (Vyleesi)

Sildenafil citrate is metabolized is in the liver by cytochrome P450, the metabolites are: N-desmethylsildenafil (about 50% potency for PDE5). The biological half-life is from 3 to 4 hours, it is excreted in feces and in urine [4]. Sildenafil is developing as a potential applicant for the treatment of intrauterine growth retardation and for premature labor [5]. Sildenafil has also been proposed as a potential therapeutic strategy to maintain placental function in pre-eclampsia [6]. Should sildenafil citrate possess vasodilatory effects in the feto-placental circulation, this would significantly enhance its therapeutic use in treating placental insufficiency. in estrogenized women with sexual dysfunction

• Sildenafil works by relaxing blood vessels, increasing blood flow to genital areas.
• Female sexual arousal disorder may potentially be treated with sildenafil.
• Research shows mixed results regarding sildenafil's effectiveness in women.
• Sildenafil is not approved by the FDA specifically for women’s sexual problems.
• Possible risks for women include headaches and low blood pressure.
• Always consult a healthcare provider before trying sildenafil for women.

associated with female sexual arousal disorder.

The bottom line

SC has recently been demonstrated not to alter the contractile response to vasoconstrictors or to endothelial dependent vasodilators. In non-pregnant females, SC causes uterine artery vasodilation therefore it also be employed to treat menstrual pain and muscle spasms [7]. SC is increasingly used in the pregnant patient for the treatment of pulmonary hypertension [8]. Its safety and efficacy combined with its lack of teratogenic or feto-toxic effects mean that its use for the treatment of pulmonary hypertension in pregnancy is likely to increase [9]. The most common adverse effects of sildenafil citrate use include: headache, flushing, indigestion, nasal congestion, and impaired vision, including photophobia and blurred vision.

What is FSAD?

In July 2005, the FDA found that sildenafil could lead to vision impairment in rare cases [and several studies have linked sildenafil use with non-arteritic anterior ischemic optic neuropathy [10]. The FDA announced that all PDE5 inhibitors, including sildenafil, required a more prominent warning of the potential risk of sudden hearing loss [11]. Vaginal sildenafil might be an interesting therapeutic option before conception in women with histories of reproductive failure [12]. In addition, intravaginal sildenafil citrate tablets used as suppositories might be a new, interesting, safe antiabortive option in the treatment of threatened miscarriage in patients with a history of unexplained recurrent spontaneous abortion. The dose intravaginal sildenafil citrate is 25 tablets given 3- 4 times daily [13]. Rosen R, Riley A, Wagner G (1999) The international index of

Does Viagra work for women?

London and New York rout ledge (2): 199-288. Jaafapour M, Khani A, Khajavikhan J, Suhrabi Z (2013) Female sexual dysfunction, prevalence and risk factor and Journal of clinical and diagnostic research 7(12): 2877-2880. (2006) Sildenafil improve sexual functioning in premenopausal women with type 1 diabetes who are affected by sexual arousal disorder. (2003) Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder. Journal of Urology 170(6): 2333-2338.

Effects on sexual dysfunction

(2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. (2014) Prevalence Survey of Sexual Dysfunction among Women in the Reproductive Age. (2007) Female sexual dysfunction in Lower Egypt. El Gelany S, Moussa O (2013) Reproductive health awareness among educated young women in Egypt. Spector IP, Carey MP and Steinberg L (1996) The sexual desire inventory: Development factor, structure, and evidence of reliability.

What side effects can low dose sildenafil cause?

(2011) Sexual dysfunction and difficulties in Denemark: Prevelance and associated socio-demographic factors. Arch sex behave 40(1): 121-132. Abdallah I Y, AbdelrahmanSh (2014) female sexual dysfunction in relation to the age of marriage .thesis submitted for fulfillment of master degree in dermatology and Andrology in Banha city, Banha University, Egypt. Omidi A, Ahmedvand A, Najarzadan MR, Mehrzad F (2016) Compairing the effect of treatment with sildenafil and cognitive-behavioral therapy on treatment of sexual dysfunctioninwomen: arandomized controlled clinical trials. Chivers MI, Rosen RC (2010) Phosphodiesterase type 5 and female sexual response. erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction.