The Pharmaceutical Journal
Vol 272 No 7288 p241
28 February 2004

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Sildenafil does not work for postmenopausal women

POEM series

Clinical question Is sildenafil an effective treatment for sexual arousal disorder in postmenopausal women?

Bottom line Sildenafil was not effective as a treatment of acquired genital sexual arousal disorder in postmenopausal women taking hormone therapy.

Synopsis Many postmenopausal women and their doctors are asking if sildenafil (Viagra) might be helpful to them to treat sexual arousal disorder. This Canadian study recruited 34 postmenopausal volunteers who lacked genital responsivity despite preserved subjective sexual arousal from non-genital stimuli.

All women were taking oestrogen/progestogen hormone therapy, but not androgens, for at least six months before enrolment. The sample was homogeneous based on detailed structured interview. The study session was a 30-minute video of a heterosexual sexual encounter including foreplay and intercourse and use of a hand-held vibrator.

Women were randomly assigned to sildenafil 50mg or placebo given one hour before the session and then crossed over in a subsequent session. Two different videos with similar content were used in balanced random order. There were no differences in the proportion of women reaching orgasm, orgasm latency, or subjective sexual arousal. The women also underwent measurement of sexual responsiveness with a photoplethysmograph, a tool used in research on sexuality in women to measure genital vasocongestion. The authors made multiple subgroup comparisons and concluded that the subgroup of women with a low vaginal pulse amplitude response by photoplethysmograph may benefit from sildenafil. This group is clinically indistinguishable from the rest on the basis of interview characteristics.

Side effects occurred in the women in 59 per cent of sildenafil tests and 24 per cent of placebo tests. The most common complaints with sildenafil were flushing, headache and dizziness. One woman reported mild clitoral pain for 48 hours following the use of sildenafil.

Level of evidence 1b (individual randomised controlled trial with narrow confidence interval).

Reference Basson R, Brotto LA. Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: a randomised controlled trial. British Journal of Obstetrics and Gynecology 2003;110:1014–24.

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