Sildenafil for women patients with antidepressant-induced sexual dysfunction

All patients of this study were educated, varying between secondary and university levels.

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J Gynecol Women’s Health 2022: 23(1): 556105. DOI: 10.19080/JGWH.2022.23.556105 Background: Sexual dysfunction is a problem that occurs during the sexual response cycle that prevents the individual from experiencing satisfaction from sexual activity. The assessment of sexual function in women is frequently confounded by many factors, including depressed mood and other comorbid medical and psychiatric disorders. Sildenafil is selective type 5 phosphodiesterase (PDE5) inhibitors, taken orally and effective for men with erectile dysfunction. Previous studies suggested that sildenafil may improve the sexual health of women affected by sexual difficulties such as arousal disorders and may indirectly improve other aspects of sexual life.

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Sildenafil was effective and well tolerated in postmenopausal women with sexual arousal disorder without concomitant hypoactive sexual desire disorder or contributory emotional relationship or historical abuse issues. Objective: This study aimed to evaluate the effect of sildenafil citrate on female sexual dysfunction. Subjects and methods: 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. Fifty-two married female patients were included in this study. Group 1 included 26 patients, all received 50mg sildenafil on demand and group 2 included 26 patients who took placebo tablets. 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.

Area of Research	Focus	Expected Outcomes	Challenges
Larger clinical trials	Efficacy and safety validation	Better approval pathway	Funding, recruitment difficulties
Combination therapies	Sildenafil with hormonal or psychological treatments	Enhanced effects	Interaction management
Delivery methods innovations	Topical, transdermal, or implantable forms	Increased convenience	Development complexity
Long-term safety studies	Effects of prolonged use	Safety confirmation	Ethical and logistical hurdles

[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.

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This means that the demographic data has no particular effect on the female sexuality and both groups were at the same baseline pretreatment parameters. This agrees with the conclusion of Spector et al.

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Female sexual problems have not received much attention as men’s sexual problems especially in Arab countries [8]. 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 sildenafil uk price group” as mentioned in the methodology section. Overall, most of patients who received sildenafil were living in urban areas (53%). [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.

• Some studies have shown mild improvements in female sexual distress.
• The drug may help women with orgasmic disorder by increasing sensation.
• Women should report any unusual symptoms to a healthcare professional.
• Alternative treatments include counseling and hormonal therapy.

However, frequency of experiencing unprovoked desire seemed to be unaffected by residence.

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However, studying FSD is lacking in the literature especially in the Arab and middle east region. 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.

Definition and classification of female sexual disorders

Group B received placebo tablets and also included 26 patients. 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 sildenafil from canada 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. These results mean that sexual function of women resident in cities is better than those living in villages. 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.

Treatment Information

The collected data were statistically analyzed using SPSS program (Statistical Package for Social Science) version 18.0.SPSS Inc., Chicago, IL, US. 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 cycle [6].The family as the center and core of all human societies is based on the sexual instinct [7]. In women, there was also a statistically significant trend of increasing sexual dysfunction prevalence with decreasing income.

Materials and Methods:

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. 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.

Exclusion Criteria

The FSFI domain has maximum possible total scores of 36 as in (Table 1). 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). As regard masturbation practice before marriage, it was more common among participants living in cities.

• Sildenafil is being studied for female sexual dysfunction.
• It may improve blood flow to vaginal tissues.
• Not officially approved for women in many countries.
• Side effects can include headaches and flushing.

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.

• Sildenafil’s interaction with other medications is an important consideration.
• It has a different impact depending on individual health conditions.
• Data on long-term effects of sildenafil in women are inconclusive.
• Use only under medical supervision to minimize risks.

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

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Results: There was no significant difference between the studied groups regarding the demographic data, and FSFI. 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].

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Female Sexual Dysfunction is a multi-causal and a multi- dimensional medical problem that adversely affects physical health & emotional wellbeing. 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]. [12] found that sexual satisfaction seemed to be associated with residence as (26.4%) and (39.1%) of participants living in town were very and moderately sexually satisfied compared to (18.2%) and (20.5%) of women living in villages who were very and moderately sexually satisfied.

User Name	Reported Effects	Side Effects Experienced	Usage Frequency	Overall Satisfaction
Jenny	Noticed increased sensitivity but mild headaches	Headache, flushes	Weekly	Moderately satisfied
Maria	Felt more aroused, no side effects	None	Occasionally	Satisfied
Lisa	No significant effect	Nausea, dizziness	Rarely	Dissatisfied
Karen	Improved orgasm intensity	Flushing, mild headache	Regular	Satisfied