sildenafil-citrate and Sexual-Dysfunctions--Psychological

'Female sexual dysfunction' (FSD) is an umbrella term comprising a range of common disorders, including hypoactive sexual desire, reduced subjective and/or physical genital arousal (poor sensation, vasocongestion, lubrication), sexual pain and inability to achieve orgasm/satisfaction, which are multidimensional by nature and often coexisting. Psychological and contextual factors have a significant influence on organic components of sexual response and behavior and a tailored medical approach to sexual symptoms is inevitably limited.. The paper reports the most recent advances in pharmacotherapy for women taking into account the biopsychosocial model. Hormone therapy, including estrogens, testosterone, tibolone and dehydroepiandrosterone, are discussed in term of efficacy and safety in postmenopausal women both for female sexual interest/arousal disorder (FSIAD) and genito-pelvic pain/penetration disorder. Ospemifene, a selective estrogen receptor modulator, approved to treat dyspareunia at menopause, is also discussed. Data on psychoactive agents for treatment of FSIAD in premenopausal women are discussed, including the potential use of on-demand combined hormonal (testosterone) and non-hormonal (buspirone or sildenafil) treatments to address possible neurophysiological profiles of women.. We are still waiting for an approved pharmacotherapy for FSD. This is not the result of gender inequality in sexual medicine, but it reflects the need of balancing benefits and risks in order to provide effective and safe treatments to women of any age.

Topics: Buspirone; Clinical Trials, Phase III as Topic; Estrogens; Female; Humans; Menopause; Norpregnenes; Piperazines; Purines; Selective Estrogen Receptor Modulators; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfonamides; Tamoxifen; Testosterone

Hypoactive sexual desire disorder (HSDD) affects nearly 1 in 10 women. Thus, it is essential for pharmacists and other health care providers to be comfortable when discussing a patient's sexual health to ensure appropriate triage so that the specific causes of HSDD can be identified and potential recommendations provided. HSDD is defined as the absence or deficiency of sexual interest and/or desire, leading to significant distress and interpersonal difficulties. As health care providers, pharmacists have a critical role in assessing the presence of HSDD and providing education on available treatment options. This article will review the potential causes of HSDD and low sexual desire, the screening tools available, and the significant role of health care professionals in communicating with patients about their sexual health. An overview of the importance of behavioral modifications, the current pharmacologic options being investigated, and the use of complementary and alternative therapies will also be explored. Currently, buproprion is the primary pharmacologic agent that has shown positive results in treating patients with HSDD. The use of testosterone therapy will not be addressed in this article, as this therapy is described in greater detail elsewhere.

Topics: alpha-MSH; Antidepressive Agents, Second-Generation; Benzimidazoles; Bupropion; Complementary Therapies; Female; Health Behavior; Health Communication; Humans; Peptides, Cyclic; Piperazines; Purines; Receptors, Melanocortin; Reproductive Health; Serotonin Antagonists; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Phosphodiesterase type 5 inhibitors (PDE5), such as sildenafil, tadalafil, and vardenafil, have revolutionized the treatment of erectile dysfunction. Few successes, in contrast, have been reported for the use of these agents in treatment of sexual arousal problems in women.. To review research examining efficacy of PDE5 in women, critique the methods and models employed, and integrate the findings within a broader, gender-specific understanding of female sexual response.. A conceptual and methodological review of all published studies examining PDE5 efficacy in female samples.. Study methods, populations, outcome measures, study results.. A total of 16 studies were reviewed. Studies using self-reported measures of sexual functioning showed mixed results whereas studies examining physiological effects of PDE5 on genital vasocongestion consistently report significant effects on genital sexual response.. The lack of efficacy of PDE5 treatment in women is likely attributable to gender differences in the concordance between physiological and psychological components of sexual response. Discordance between genital and subjective measures of sexual response in women may be augmented by PDE5 effects on genital vasocongestion in some populations, rendering successful treatment unlikely via pharmacological treatment alone.

Topics: Animals; Carbolines; Clitoris; Female; Humans; Imidazoles; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Purines; Sex Factors; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Vagina; Vardenafil Dihydrochloride; Women's Health

Female sexual arousal disorder (FSAD) is a common disorder encountered in clinical practice, with self-reported arousal difficulties reported in up to 26% of American women. Various oral therapies for FSAD have been studied, including sildenafil citrate, a phosphodiesterase inhibitor that is currently used to treat male erectile dysfunction. In vitro studies of sildenafil citrate have demonstrated smooth-muscle relaxation in clitoral tissue, and phosphodiesterase type-5 has been shown to be present in vaginal, clitoral and labial smooth muscle; these findings have led to theories that sildenafil citrate might be successful for treating FSAD. This Review discusses the data from clinical trials that have assessed sildenafil citrate for the treatment of FSAD; the trials show that sildenafil citrate is moderately effective. Sildenafil citrate may also be effective in women with FSAD secondary to multiple sclerosis, diabetes or antidepressant use; however, more trials in these patient populations are required to confirm these findings.

Topics: Animals; Cyclic Nucleotide Phosphodiesterases, Type 2; Female; Forecasting; Humans; Libido; Piperazines; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

To review the clinical data regarding the efficacy and safety of sildenafil for the treatment of female sexual dysfunction (FSD).. A MEDLINE search from 1950 to February 2009 was conducted using the key words sildenafil and female sexual dysfunction. Human studies and publication in English were used as primary limits. A combination of several publication-type limits was used to locate the clinical trials (eg, clinical trial, controlled clinical trial, randomized clinical trial). A bibliographic search was also performed of all located articles.. Clinical trials involving sildenafil treatment of premenopausal and postmenopausal women with FSD and women with FSD due to concomitant medications and/or disease states were reviewed.. An increasing number of clinical trials have been published regarding the treatment of FSD with sildenafil. Eight studies demonstrated a possible benefit from treatment for FSD in patients receiving sildenafil, regardless of dose, while 4 trials did not show any significant differences with treatment. It appears that sildenafil might be beneficial for women with FSD caused by diseases such as multiple sclerosis, type 1 diabetes, spinal cord injury, and use of antidepressant medications.. Although data suggest a possible role of sildenafil for the treatment of FSD, the information should be interpreted cautiously, as many of the studies included small sample sizes, used inappropriate statistical tests, and used nonvalidated assessment tools. A better FSD classification system and consistent use of validated assessment tools might help alleviate differences among clinical trials and provide a more cohesive foundation for assessing the safety and efficacy of sildenafil for the treatment of FSD.

Topics: Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Carcinogens; Female; France; Humans; Neoplasms; Orgasm; Piperazines; Purines; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents; Virilism

To review the pathophysiology of female sexual dysfunction (FSD) and the literature regarding the use of sildenafil in its treatment.. Literature was accessed through MEDLINE (1966-April 2006), Iowa Drug Information Service (1966-April 2006), EMBASE (1966-April 2006), and bibliographies of pertinent articles. Search terms included female sexual dysfunction; sexual dysfunction, psychological; phosphodiesterase inhibitors; and sildenafil.. The lack of a clear understanding of FSD contributes to the limited treatment options available. Studies regarding the safety and efficacy of the phosphodiesterase 5 inhibitor sildenafil in the management of FSD were evaluated. Many trials have been of poor quality, making clinical application of their results difficult. The current literature does not show sildenafil to be an effective treatment option for FSD.. Treatment of FSD should include both physical and psychological components. Based on the limited data available, it appears that sildenafil, while well tolerated, offers little or no benefit to most patients with FSD.

Topics: Female; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

The frequency of female sexual dysfunction increases with age, and the menopausal transition has a negative effect on the sexuality. Pharmacological treatment options for female sexual dysfunction during the peri- and post-menopause include hormone therapy or sildenafil. A limited number of randomized, controlled trials have been conducted and evidence suggests that systemic hormone therapy with estrogen, estrogen/progesterone, estrogen/testosterone and tibolone have a positive impact on sexual dysfunction during the peri- and postmenopause. Further, there is evidence that treatment with local estrogen relieves vaginal dryness and dyspareunia. Recent knowledge on side effects related to hormone therapy necessitates careful evaluation of the indication for hormone therapy and the duration of postmenopausal hormone therapy should be as short as possible. Long-term side effects of testosterone have not yet been fully investigated. A positive effect of sildenafil has been observed in a limited group of women; those with arousal problems but with no desire problems. The results suggest an intensified focus on new pharmaceutical products for the treatment of female sexual dysfunction in the postmenopause. For the time being the effect of testosterone therapy and tibolone on female sexual dysfunction is being investigated. Sexual dysfunction in women (Female Sexual Dysfunction, FSD) is multi-factorial and influenced by physiological, psychological, social and emotional factors. FSD is defined in four diagnostic groups: desire-, arousal-, orgasm- and pain problems. Recently, it has been suggested that the woman herself should assess the dysfunction as distressful to be diagnosed as having a sexual dysfunction [1]. There are only a limited number of well-conducted population surveys on the prevalence of FSD. Further, relatively few randomized, controlled trials of pharmacological treatment of FSD have been carried out.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Androgen Antagonists; Estradiol; Estrogen Replacement Therapy; Estrogens; Female; Humans; Menopause; Middle Aged; Norpregnenes; Perimenopause; Piperazines; Purines; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone; Vagina

Topics: Antipsychotic Agents; Erectile Dysfunction; Female; Humans; Male; Monoamine Oxidase Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Purines; Randomized Controlled Trials as Topic; Research; Research Design; Schizophrenia; Selegiline; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

What is the current knowledge concerning the pharmacologic treatment of human sexual dysfunction? A number of interventions, including oral phophodiesterase inhibitors and intracorporeal agents with vasodilatory effects, are available to treat male erectile disorder. Serotonergic drugs have been shown to be effective in the treatment of rapid ejaculation. Various lines of research suggest that high dosages of androgenic agents may eventually have a role in the treatment of decreased libido in females. There may be a role for phophodiesterase inhibitors in the treatment of a subgroup of women with arousal disorders. Normal sexual function involves successful integration of biological, psychological, and interpersonal influences. Clinical psychiatry with its biopsychosocial model should incorporate the treatment of human sexual dysfunction within its purview.

Topics: Female; Humans; Male; Piperazines; Purines; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Female sexual dysfunction (FSD) is defined as a disorder of sexual desire, arousal, or orgasm, and/or sexual pain, which results in personal distress and has an impact on quality of life and interpersonal relationships. It is a compilation of problems that has both biologic and psychosocial components and is multifactorial in etiology. Improved understanding of the structures and substances involved in normal sexual function, as well as age-related changes, helps practitioners proactively evaluate and appropriately manage women with FSD. Addressing FSD in a clinical setting should begin with an open discussion about relational, situational, and psychological issues. Clinicians should emphasize nonpharmacologic and behavioral therapies with the goal of achieving satisfying and pleasurable experiences. The continued quest to understand female sexual function and dysfunction requires more education and research on treatment of underlying medical conditions and use of pharmacologic therapies.

Topics: Adult; Dyspareunia; Female; Gonadal Steroid Hormones; Humans; Middle Aged; Piperazines; Postmenopause; Psychophysiology; Purines; Sex Counseling; Sexual and Gender Disorders; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone; Vasodilator Agents; Women's Health

Topics: Clinical Trials as Topic; Erectile Dysfunction; Female; Humans; Male; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Women experience two to three times the rate of depression that men do. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for many conditions other than depression, such as anxiety disorders, premenstrual dysphoric disorder, pain syndromes, impulse control disorders, and personality disorders, some of which are more common in women. Increasing awareness of sexual side effects has tempered the initial enthusiasm with which SSRIs were greeted. Men taking SSRIs report higher rates of sexual side effects than women taking them, however, women seem to experience more severe sexual dysfunction. In this article, we discuss the epidemiology of sexual dysfunction and describe treatments with sildenafil.

Topics: Adult; Depressive Disorder, Major; Female; Humans; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Sexual dysfunction and dissatisfaction are common symptoms associated with depression. Optimal antidepressant treatment should result in remission of the symptoms of the underlying illness and minimize the potential for short- and long-term adverse effects, including sexual dysfunction. Sexual dysfunction and dissatisfaction are frequently persistent or worsen with the use of some antidepressant medications; this sexual dysfunction and dissatisfaction can have negative impact on adherence to treatment, quality of life, and the possibility of relapse. Successful management of sexual complaints during antidepressant treatment should begin with a systematic approach to determine the type of sexual dysfunction, potential contributing factors, and finally management strategies that should be tailored to the individual patient. The basic physiologic mechanisms of the normal sexual phases of libido, arousal, and orgasm and how these mechanisms may be interrupted by some antidepressants provide a framework for the clinician to utilize in order to minimize sexual complaints when initiating and continuing antidepressant treatment. This article provides guidelines, based upon this type of model, for the assessment, management, and prevention of sexual side effects associated with antidepressant treatment.

Topics: Antidepressive Agents; Bupropion; Buspirone; Central Nervous System Stimulants; Depressive Disorder; Drug Administration Schedule; Female; Humans; Male; Patient Compliance; Piperazines; Purines; Quality of Life; Secondary Prevention; Serotonin Antagonists; Sexual Dysfunctions, Psychological; Sexuality; Sildenafil Citrate; Sulfones

Since the March 27, 1998 introduction of sildenafil, opportunities for sex therapists have expanded, primarily in three ways: 1) public education, 2) colleague education, and 3) treatment. Primary care physicians and urologists learned that incorporating sex therapy techniques improved the effectiveness of sildenafil; furthermore, sex therapists discovered that integrating adjunctive use of sildenafil with sex therapy accelerated the therapy process and improved outcome. As new pharmaceuticals are developed and approved for men and women, opportunities for medical and nonmedical sex therapists will only increase. In fact, sex therapists are playing an increasingly important consultative role to industry in the research and development of new sexual pharmaceuticals. However, optimism for nonphysician sex therapists is tempered by recognition of the continuing trend toward medicalization of sexual dysfunction.

Topics: Combined Modality Therapy; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sex Counseling; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Sexual functioning is generally impaired during depression. Interest in the relationship between sexual dysfunction and depression has risen substantially, prompted primarily by 1) the 1998 Food and Drug Administration approval of sildenafil citrate as the first oral therapy of erectile dysfunction, and 2) the widespread clinical use of selective serotonin reuptake inhibitors, which prominently impair orgasm, and possibly libido and arousal. In this paper, we first review the phenomenology of sexual dysfunction and important contributing factors, such as age and illness, and then focus on the clinical assessment and therapeutic interventions used for sexual dysfunction in depressed individuals.

Topics: Age Factors; Antidepressive Agents; Comorbidity; Depressive Disorder, Major; Health Status; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Cause of Death; Drug Interactions; Erectile Dysfunction; Female; Heart Diseases; Hemodynamics; Humans; Male; Penile Erection; Phosphodiesterase Inhibitors; Piperazines; Product Surveillance, Postmarketing; Purines; Risk Factors; Safety; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

To review the literature describing female orgasmic disorder and impaired sexual desire disorder by selective serotonin reuptake inhibitors (SSRIs) and their treatment, including the use of sildenafil.. Literature reviews of all available published articles on this topic from 1989 to 1996 were done. This paper also includes a sample case of a 38-year old woman who suffers from fluoxetine-induced arousal and orgasmic disturbance.. Treatment approaches include the use of "antidotes," such as cyproheptadine, yohimbine, amantadine, granisetron and ginkgo biloba. This article also reports a case of successful female use of sildenafil, which was released by the Food and Drug Administration in March 1998 for erectile dysfunction in men.. Sildenafil is beneficial in reversing female sexual dysfunction induced by SSRIs. This paper also discusses sildenafil's action in the background of nitric oxide and cyclic guaninosine monophosphate in penile/clitoral erection.

Topics: Adult; Antidepressive Agents, Second-Generation; Female; Fluoxetine; Humans; Male; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Erectile dysfunction is a common but underreported condition. It is to be expected that the number of patients consulting their physician with the complaint of erectile dysfunction will increase considerably with the introduction of sildenafil (Viagra), the first oral drug that enhances penile erection. Sildenafil is an inhibitor of the enzyme phosphodiesterase type 5. It causes erection of the penis by allowing the relaxation of the smooth musculature of the cavernous body to persist. The first clinical results indicate that the treatment with sildenafil is safe and effective in the hands of a sexologically qualified physician. An erection disorder is essentially not more than a symptom which primarily requires causal therapy.

Topics: Adult; Aged; Enzyme Inhibitors; Erectile Dysfunction; Female; Humans; Male; Middle Aged; Penis; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

In women, low sexual desire and/or sexual arousal can lead to sexual dissatisfaction and emotional distress, collectively defined as female sexual interest/arousal disorder (FSIAD). Few pharmaceutical treatment options are currently available.. To investigate the efficacy and safety of 2 novel on-demand pharmacologic treatments that have been designed to treat 2 FSIAD subgroups (women with low sensitivity for sexual cues and women with dysfunctional over-activation of sexual inhibition) using a personalized medicine approach using an allocation formula based on genetic, hormonal, and psychological variables developed to predict drug efficacy in the subgroups.. 497 women (21-70 years old) with FSIAD were randomized to 1 of 12 8-week treatment regimens in 3 double-blinded, randomized, placebo-controlled, dose-finding studies conducted at 16 research sites in the United States. Efficacy and safety of the following on-demand treatments was tested: placebo, testosterone (T; 0.5 mg), sildenafil (S; 50 mg), buspirone (B; 10 mg) and combination therapies (T 0.25 mg + S 25 mg, T 0.25 mg + S 50 mg, T 0.5 mg + S 25 mg, T 0.5 mg + S 50 mg, and T 0.25 mg + B 5 mg, T 0.25 mg + B 10 mg, T 0.5 mg + B 5 mg, T 0.5 mg + B 10 mg).. The primary efficacy measure was the change in satisfying sexual events (SSEs) from the 4-week baseline to the 4-week average of the 8-week active treatment period after medication intake. For the primary end points, the combination treatments were compared with placebo and the respective monotherapies on this measure.. In women with low sensitivity for sexual cues, 0.5 mg T + 50 mg S increased the number of SSEs from baseline compared with placebo (difference in change [Δ] = 1.70, 95% CI = 0.57-2.84, P = .004) and monotherapies (S: Δ = 1.95, 95% CI = 0.44-3.45, P = .012; T: Δ = 1.69, 95% CI = 0.58-2.80, P = .003). In women with overactive inhibition, 0.5 mg T + 10 mg B increased the number of SSEs from baseline compared with placebo (Δ = 0.99, 95% CI = 0.17-1.82, P = .019) and monotherapies (B: Δ = 1.52, 95% CI = 0.57-2.46, P = .002; T: Δ = 0.98, 95% CI = 0.17-1.78, P = .018). Secondary end points followed this pattern of results. The most common drug-related side effects were flushing (T + S treatment, 3%; T + B treatment, 2%), headache (placebo treatment, 2%; T + S treatment, 9%), dizziness (T + B treatment, 3%), and nausea (T + S treatment, 3%; T + B treatment, 2%).. T + S and T + B are promising treatments for women with FSIAD.. The data were collected in 3 well-designed randomized clinical trials that tested multiple doses in a substantial number of women. The influence of T + S and T + B on distress and the potentially sustained improvements after medication cessation were not investigated.. T + S and T + B are well tolerated and safe and significantly increase the number of SSEs in different FSIAD subgroups. Tuiten A, van Rooij K, Bloemers J, et al. Efficacy and Safety of On-Demand Use of 2 Treatments Designed for Different Etiologies of Female Sexual Interest/Arousal Disorder: 3 Randomized Clinical Trials. J Sex Med 2018;15:201-216.

Topics: Adult; Aged; Arousal; Buspirone; Cues; Double-Blind Method; Female; Humans; Inhibition, Psychological; Libido; Middle Aged; Randomized Controlled Trials as Topic; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Testosterone; Young Adult

Selective serotonin reuptake inhibitors (SSRIs) are known to cause sexual dysfunction, such as decreased sexual motivation, desire, arousal, and orgasm difficulties. These SSRI-induced sexual complaints have a high prevalence rate, while there is no approved pharmacological treatment for SSRI-induced sexual dysfunction. It is hypothesized that a polymorphisms in the androgen receptor gene, encoded by the nucleotides cysteine, adenine, and guanine (CAG), influence the effect of testosterone on sexual functioning. In an explorative, randomized, double-blind, placebo-controlled, crossover study we investigated the possible effects of sublingual testosterone combined with a serotonin (5-HT)1A receptor agonist, and of sublingual testosterone combined with a phosphodiesterase type 5 inhibitor (PDE5-i) on sexual functioning in women with SSRI-induced sexual dysfunction. Furthermore, we did an exploratory analysis to assess if the CAG polymorphism influences this effect. 21 pre- and postmenopausal women with SSRI-induced sexual dysfunction participated and underwent the following interventions: a combination of testosterone (0.5 mg) sublingually and the PDE5-i sildenafil (50 mg) and a combination of testosterone (0.5 mg) sublingually and the 5-HT1A receptor agonist buspirone (10 mg). The results show that women who use a low dose of SSRI and have relatively long CAG repeats report a marked improvement in sexual function in response to both treatments compared to placebo. This explorative study and preliminary results indicate that in women with SSRI-induced sexual dysfunction, a combination of testosterone sublingually and a PDE5-i or testosterone sublingually and a 5-HT1A receptor agonist might be promising treatments for certain subgroups of women with this condition.

Topics: Administration, Sublingual; Adult; Buspirone; Cross-Over Studies; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Phosphodiesterase 5 Inhibitors; Polymorphism, Single Nucleotide; Receptors, Androgen; Selective Serotonin Reuptake Inhibitors; Serotonin 5-HT1 Receptor Agonists; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Testosterone; Young Adult

Among other causes, low sexual desire in women may result from dysfunctional activation of sexual inhibition mechanisms during exposure to sex. Administration of sublingual 0.5 mg testosterone (T) increases the sensitivity of the brain to sexual cues, which might amplify sexual inhibitory mechanisms further in women already prone to sexual inhibition. Sexual stimulation might elicit a prefrontal cortex (PFC)-mediated phasic increase in sexual inhibition, in which activity of 5-hydroxytryptamine (5-HT, serotonin) is involved. A single dose of 5-HT receptor agonist (5-HT(1A)ra) might reduce the sexual stimulation induced PFC-mediated sexual inhibition during a short period after administration. Consequently, treatment with a single dose of T+5-HT(1A)ra might enhance sexual responsiveness, particularly in women exhibiting sexual inhibition.. To investigate if treatment with a single dosage of T+5-HT(1A)ra will produce improvement in sexual functioning in women with Hypoactive Sexual Desire Disorder (HSDD) as the result of dysfunctional high sexual inhibition.. Fifty-four women were divided on the basis of their excitatory or inhibitory responses during T+phosphodiesterase type 5 inhibitor (PDE5i) in low (N = 26) and high inhibitors (N = 28). Physiological and subjective indices of sexual functioning were measured in a participant-controlled ambulatory psychophysiological experiment at home (the first week of each drug treatment). In a bedroom experiment (the subsequent 3 weeks), sexual functioning was evaluated by event, week, and monthly diaries.. Subjective: sexual satisfaction, experienced genital arousal, sexual desire. Physiological: vaginal pulse amplitude.. Women with high inhibition show a marked improvement in sexual function in response to treatment with T+5-HT ra relative to placebo and relative to T+PDE5i.. The present study demonstrated that on-demand T+5-HT ra is a potentially promising treatment for women with HSDD, particularly for those women who are prone to sexual inhibition.

Topics: Adult; Androgens; Buspirone; Cognition; Cross-Over Studies; Cues; Double-Blind Method; Drug Therapy, Combination; Erotica; Female; Humans; Phosphodiesterase 5 Inhibitors; Photoplethysmography; Piperazines; Purines; Serotonin 5-HT1 Receptor Agonists; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Testosterone; Vagina

Low sexual desire in women may result from a relative insensitivity of the brain for sexual cues. Administration of sublingual 0.5 mg testosterone (T) increases the sensitivity of the brain to sexual cues. Sexual stimulation in the brain is necessary for phosphodiesterase type 5 inhibitor (PDE5i)-mediated increase in genital sexual response. Accordingly, a single dose of T+PDE5i might enhance sexual responsiveness, especially in women with low sensitivity for sexual cues.. To assess the hypothesis that treatment with on-demand use of T+PDE5i improves sexual functioning, particularly in women who suffer from Hypoactive Sexual Desire Disorder (HSDD) as the result of a relative insensitivity for sexual cues.. In a randomized, double-blind, placebo-controlled, crossover design, 56 women with HSDD underwent three medication treatment regimes (placebo, T+PDE5i, and T with a serotonin receptor agonist; see also parts 1 and 3), which lasted 4 weeks each. In a participant-controlled ambulatory psychophysiological experiment at home (the first week of each drug treatment), physiological and subjective indices of sexual functioning were measured. In a bedroom experiment (the subsequent 3 weeks), sexual functioning was evaluated following each sexual event after the self-administration of study medication. Subjective evaluation of sexual functioning was also measured by weekly and monthly reports.. Subjective: sexual satisfaction, experienced genital arousal, sexual desire. Physiological: vaginal pulse amplitude. Cognitive: preconscious attentional bias.. T+PDE5i, as compared with placebo, significantly improved physiological and subjective measures of sexual functioning during ambulatory psychophysiological lab conditions at home and during the sexual events, in women with low sensitivity for sexual cues.. The present study demonstrated that on-demand T+PDE5i is a potentially promising treatment for women with HSDD, particularly in women with low sensitivity for sexual cues.

Topics: Administration, Sublingual; Adult; Analysis of Variance; Androgens; Cognition; Cross-Over Studies; Cues; Double-Blind Method; Drug Therapy, Combination; Erotica; Female; Humans; Phosphodiesterase 5 Inhibitors; Photoplethysmography; Piperazines; Purines; Serotonin 5-HT1 Receptor Agonists; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Testosterone; Vagina

We previously described dynamic, noncontrast magnetic resonance imaging (MRI) of the female genitalia as a reproducible, nonintrusive, objective means of quantifying sexual arousal response in women without sexual difficulties. These studies showed an increase in clitoral engorgement ranging from 50 to 300% in healthy women during sexual arousal.. This study sought to evaluate the genital arousal response in women with female sexual arousal disorder (FSAD) after administration of sildenafil and placebo. We performed a multicenter, double-blind, placebo-controlled, cross-over study to assess the clitoral engorgement response using dynamic MRI in women with FSAD after administering sildenafil and placebo followed by audiovisual sexual stimulation (AVSS).. Nineteen premenopausal women with FSAD underwent two MRI sessions. Subjects were randomized to receive either (i) sildenafil 100 mg during the first session followed by placebo during the second session, or (ii) placebo followed by sildenafil. During each session, baseline MR images were obtained while subjects viewed a neutral video. Subjects then ingested sildenafil or placebo. After 30 minutes, a series of MRIs were obtained at 3-minute intervals for 10 time points while subjects viewed AVSS.. A positive sexual arousal response was achieved if clitoral volume increased ≥50% from baseline.. Thirteen 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 0.3173).. Sildenafil did not augment the genital response in women with FSAD. Secondarily, a majority of women in this study did not have impaired clitoral engorgement as measured by MRI, suggesting that FSAD is not predominantly a disorder of genital engorgement.

Topics: Adult; Arousal; Clitoris; Cross-Over Studies; Double-Blind Method; Female; Humans; Magnetic Resonance Imaging; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Double-blind, placebo-controlled, flexible-dose study.. To evaluate the efficacy, safety and tolerability of oral sildenafil in women with female sexual arousal disorder as a result of SCI (paraplegia/tetraplegia).. The study was conducted at clinical practice sites in North America (n =23), 11 European countries (n =23), Australia (n =4) and South Africa (n =2).. 129 women were randomized and treated with sildenafil or matching placebo. A 4-week baseline period was followed by 12 weeks of treatment, which could be increased from 50 to 100 mg or decreased to 25 mg once during the treatment period, depending on efficacy and tolerability. By use of an event log, sexual activity was monitored between screening and the end of treatment. The Sexual Function Questionnaire, the Sexual Quality of Life Questionnaire-Female, a global efficacy question and Sexual Distress Question were also assessed.. Sildenafil-treated women and placebo-treated women had an increase in their percentage of sexual activities throughout the course of the study, with no statistically significant difference between groups in the percentage of successful sexual activities at end of treatment versus baseline. There were also no statistically significant differences between sildenafil- and placebo-treated women on the aforementioned measures. The most common adverse events included headache and vasodilatation.. The results of this study are similar to other reports regarding a lack of clinically meaningful benefit of sildenafil in other populations of women.. This study was sponsored by Pfizer Inc.

Topics: Adult; Double-Blind Method; Female; Humans; Middle Aged; Paraplegia; Phosphodiesterase 5 Inhibitors; Piperazines; Placebo Effect; Purines; Quadriplegia; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Spinal Cord Injuries; Sulfones; Young Adult

Not all males undergoing phallometric testing for assessment of deviant sexual interests respond adequately to test stimuli. As poor response may be linked to hormonal, neurologic, vascular, or psychogenic causes, we studied the ability of sildenafil, an effective proerectile agent, to increase penile blood flow during phallometric testing. Twenty-two males completed this double-blind, placebo-controlled trial of sildenafil (100 mg). Each participant underwent phallometric testing with and without sildenafil. On average, each subject's peak response was 50 percent greater in the sildenafil condition than it was in the placebo condition (p < .05). Correlations between participants' penile response to human stimulus categories, with or without treatment, were all very high (r = 0.77-0.89) and statistically significant, thus indicating excellent reliability between the two test conditions. These results support earlier findings that sildenafil significantly increases phallometric response among middle-aged males. Moreover, pharmacologic treatment did not compromise the reliability of phallometric diagnosis.

Topics: Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Humans; Male; Middle Aged; Penile Erection; Piperazines; Purines; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents

To analyze the effects of sildenafil citrate on clitoral blood flow and sexual response in postmenopausal women with orgasmic dysfunction.. In this randomized, double-blind, placebo-controlled trial 22 women received a 50-mg dose of sildenafil (n=11) or placebo (n=11) daily for 15 days. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was used for subjective evaluation of the sexual-response cycle. Clitoral blood flow was measured by color and pulse Doppler at baseline, after 1 hour of taking the first dose, and after 15 days of treatment.. Blood flow was significantly more improved in the sildenafil than in the placebo group (P<0.05), and a positive correlation between Doppler values and GRISS scores was noted in the sildenafil group after only 15 days of treatment.. Sildenafil may improve clitoral blood flow and increase the GRISS scores in postmenopausal women with orgasmic dysfunction.

Topics: Blood Flow Velocity; Clitoris; Double-Blind Method; Female; Humans; Middle Aged; Personal Satisfaction; Piperazines; Postmenopause; Purines; Regional Blood Flow; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Pulsed; Vasodilator Agents

To investigate the effect of improvement in erectile dysfunction (ED) on sexual function and satisfaction measures in heterosexual couples in which the woman reports that sexual intercourse is unsatisfactory at least half of the time.. Multicentre, double-blind, placebo-controlled study.. Outpatient medical clinics.. Hundred and eighty men with ED and their female partners in whom sexual intercourse was satisfactory about half the time or less (score of < or =3 on the Female Partner of ED Subject Questionnaire question 3 [FePEDS Q3]).. Men were randomised to flexible-dose sildenafil (25, 50, and 100 mg) or placebo as needed for 12 weeks.. Primary: FePEDS Q3 ('Over the past four weeks, when you had sexual intercourse, how often was it satisfactory for you?') scored as 0 (no sexual activity) and 1 (almost never or never) to 5 (almost always or always). Secondary, partners: Sexual Function Questionnaire, Female Sexual Function Index (FSFI), and ED Inventory of Treatment Satisfaction (EDITS) partner version (EDITS-Partner). Secondary, men: International Index of Erectile Function (IIEF), General Efficacy Questions, event log data, Self-Esteem And Relationship questionnaire, and EDITS. Secondary, partners and men: Dyadic Adjustment Scale.. The intention-to-treat population included 85 sildenafil recipients (mean age 59 +/- 12 years) and 91 placebo recipients (mean age 57 +/- 11 years). Most partners (aged 20-79 years; mean, 54 years) were postmenopausal. Sildenafil compared with placebo couples had greater improvement in the primary outcome (FePEDS Q3 [P < 0.0001]) and in sexual function, intercourse success rates, and secondary sexual satisfaction measures (FSFI satisfaction domain [P < 0.0001] and IIEF satisfaction domains [P < 0.001]) and had higher treatment satisfaction (EDITS and EDITS-Partner; P < 0.0001). Several predictors of improvement were identified, and improvement in one member of the couple correlated positively with improvement in the other member.. The interdependence of sexual function and sexual satisfaction measures between members of couples consisting of men with ED and sexually healthy women reporting infrequent satisfactory sexual intercourse underscores the importance of including partners in ED treatment discussions.

Topics: Adult; Aged; Coitus; Double-Blind Method; Erectile Dysfunction; Female; Heterosexuality; Humans; Male; Middle Aged; Personal Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sexual Partners; Sildenafil Citrate; Sulfones

To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD).. Double-blind, crossover, placebo-controlled study.. Gynecological diabetic outpatient clinic and sexual clinic.. Thirty-six type 1 premenopausal diabetic women affected by SAD.. Two 8-week periods of sildenafil 100 mg, washout, and placebo, by two possible sequences.. Each woman submitted blood samples to measure HbA(1c), and T, free T (FT), and PRL. Efficacy was assessed [1] subjectively by the Personal Experiences Questionnaire based on the 5-point Likert scale, quantifying arousal, desire, orgasm, enjoyment of sexual activities, and frequency of sexual relationships; and [2] objectively by translabial color Doppler ultrasound to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity of clitoral arteries.. Thirty-two women completed the study. The mean HbA(1c) value was 8.0% +/- 1.8%, and plasma concentrations of T, FT, and PRL were normal. Sildenafil seems to improve arousal, orgasm and sexual enjoyment, and dyspareunia in women affected by type 1 diabetes. However, by flowmetric measurements, the mean RI was significantly lower and both the mean PI and PSV of the clitoral arteries were significantly higher compared with baseline and placebo.. Sildenafil seems to improve subjective sexual aspects and can be used to treat objectively genital arousal disorder of premenopausal women with type 1 diabetes.

Topics: Adult; Cross-Over Studies; Diabetes Mellitus, Type 1; Double-Blind Method; Female; Humans; Male; Middle Aged; Piperazines; Placebo Effect; Premenopause; Purines; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

To develop a model to explore the dose-response of sildenafil citrate in patients with female sexual arousal disorder (FSAD) based on telephone sexual activity daily diary (TSADD) data obtained in double-blind, placebo controlled clinical studies.. Data were available on 614 patients with FSAD. A parametric model (Weibull distribution) was developed to describe the probability density function of the time between sexual events. Orgasm satisfaction scores and overall sexual satisfaction scores were simultaneously modeled as ordered categorical variables. Simulations were performed to evaluate the expected clinical response in patients with FSAD.. The expected time between sexual events was approximately 3.5 days. Satisfaction scores increased with time to achieve a plateau after 3 to 4 weeks on treatment. The expected probability of satisfying orgasm (score of 3 and higher) ranged from 34.7% for placebo to 41.6% for 100 mg sildenafil citrate. Treatment effect (difference from placebo) was 6.9% for 100 mg sildenafil citrate, ranging from 0.6 to 24.7% for testosterone levels of 0.1 to 4.0 pg/ml. The treatment effect in postmenopausal women was larger than in premenopausal women.. A modeling and simulation framework to support drug development in FSAD was developed. Sildenafil citrate demonstrated a dose-dependent effect in patients with FSAD.

Topics: Adult; Algorithms; Computer Simulation; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Middle Aged; Models, Psychological; Models, Statistical; Orgasm; Phosphodiesterase Inhibitors; Piperazines; Postmenopause; Purines; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Software; Sulfones; Telephone

To study the efficacy of Viagra combined with behavior therapy against premature ejaculation (PE).. Sixty PE patients were divided into two groups randomly: control group (behavior therapy alone) and the group of Viagra combined with behavior therapy. Intra-vaginal ejaculation latency time (IELT) and the coitus satisfaction of the patient and the partner were recorded before and after treatment.. The IELTs of the two groups were 0.80 +/- 0.20 and 0.73 +/- 0.24 minutes respectively before treatment, and 1.82 +/- 0.54 and 3.63 +/- 0.55 minutes respectively after treatment. As for IELT and satisfaction degree, Viagra produced better result than behavior therapy.. During this clinical trial, Viagra combined with behavior therapy prolonged IELT, which suggests that Viagra may be helpful for the treatment of premature ejaculation.

Topics: Adult; Behavior Therapy; Ejaculation; Humans; Male; Middle Aged; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

To investigate the value of sildenafil in the treatment of prostatitis-related sexual dysfunction.. Two hundred and eighty patients with chronic prostatitis complicated by sexual dysfunction were radomized into two groups, on treated with sildenafil, and the other with Quinolone. Results were analyzed by comparing the chronic prostatitis symptoms (CPSI score), sexual dysfunction symptoms (PSFI score) and anxiety symptoms (SAS score) between pre-treatment and post-treatment groups.. The degree of prostatitis-related sexual dysfunction was not correlated with that of prostatitis symptoms. The prostatitis symptoms and sexual function were improved after sildenafil treatment compared with the control (P < 0.05), and anxiety score after treatment was significantly lower than the control (P < 0.05).. Sildenafil not only works on prostatitis-related sexual dysfunction but also improves the symptoms of prostatitis and anxiety.

Topics: Adult; Anxiety; Humans; Male; Middle Aged; Piperazines; Prostatitis; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Selective serotonin reuptake inhibitor (SSRI)-induced ejaculatory delay is a common problem that has no treatment with established efficacy. Sildenafil citrate is effective for erectile dysfunction and appears to be safe at doses up to 200 mg.. We enrolled men who were in remission from depression according to DSM-IV criteria and who reported that they had developed new-onset ejaculatory delay in the setting of SSRI treatment. Enrolled patients were instructed to use 25 mg of sildenafil 1 hour prior to sexual activity on at least 2 occasions. If this was not effective for the ejaculatory delay, they were instructed to increase the dose progressively up to a maximum of 200 mg. We compared baseline sexual functioning to 2 phases of open treatment: low-dose phase (sildenafil 25-100 mg) and high-dose phase (sildenafil 150-200 mg). The primary outcome measure was a modified, self-report Clinical Global Impressions (CGI) scale that was specific for erectile (CGI-EF) and ejaculatory (CGI-EJF) aspects of sexual function.. Twenty-one men (mean age = 56 years) with major depressive disorder (MDD) in remission and SSRI-associated ejaculatory delay enrolled in the study and received sildenafil. At baseline, 14 of 21(67%) had comorbid erectile dysfunction. At the low-dose phase follow-up assessment, 12 of 14 achieved full erectile dysfunction remission, and 4 of 21 achieved ejaculatory delay remission. Sixteen patients with persistent ejaculatory delay were eligible for the high-dose phase: 5 withdrew from the study, 4 increased to a maximum dose of 150 mg, and 6 increased to a maximum dose of 200 mg. The 1 patient who had clinically significant erectile dysfunction and ejaculatory delay reported improvement of both conditions after the high-dose phase. Of the 10 patients who had ejaculatory delay without significant erectile dysfunction and who chose to take high-dose sildenafil, 9 reported a significant clinical improvement in ejaculatory delay (CGI-EJF improvement score of 1 or 2) and 7 achieved full remission (CGI-EJF severity score of 1 or 2 and CGI-EJF improvement score of 1 or 2).. In this open clinical trial with men who had SSRI-induced ejaculatory delay, high-dose sildenafil appeared to be effective in reducing ejaculatory latency.

Topics: Adult; Aged; Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Ejaculation; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Psychiatric Status Rating Scales; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

We evaluated the efficacy and safety of sildenafil citrate in spontaneously or surgically postmenopausal women with female sexual arousal disorder (FSAD).. Sildenafil (a 50 mg dose adjustable to 100 or 25 mg) was evaluated in a 12-week, double-blind, placebo controlled study in 202 postmenopausal women with FSAD who had protocol specified estradiol and free testosterone concentrations, and/or were receiving estrogen and/or androgen replacement therapy. Patients were excluded if emotional, relationship or historical abuse issues contributed significantly to sexual dysfunction. Primary end points were questions 2 (increased genital sensation during intercourse or stimulation) and 4 (increased satisfaction with intercourse and/or foreplay) from the Female Intervention Efficacy Index (FIEI). Secondary end points were the remaining questions from this index, the Sexual Function Questionnaire and sexual activity event log questions.. Significant improvements in FIEI questions 2 (p = 0.017) and 4 (p = 0.015) were noted with sildenafil compared with placebo. For women with FSAD without concomitant hypoactive sexual desire disorder (HSDD) sildenafil was associated with significantly greater improvement in 5 of 6 FIEI items compared with placebo (p <0.02). No significant improvements were shown for women with concomitant HSDD. Most adverse events were mild to moderate with headache, flushing, rhinitis, nausea and visual symptoms reported most frequently.. Sildenafil was effective and well tolerated in postmenopausal women with FSAD without concomitant HSDD or contributory emotional, relationship or historical abuse issues. All patients had protocol specified estradiol and free testosterone concentrations or were receiving estrogen and/or androgen replacement therapy.

Topics: Adult; Aged; Double-Blind Method; Estradiol; Female; Humans; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Postmenopause; Purines; Sexual Behavior; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone

Sildenafil citrate (Viagra Pfizer, New York, NY) is indicated for the treatment of erectile dysfunction in men. The nitric oxide-cyclic guanosine monophosphate pathway (NO-cGMP) involved in penile erection and enhanced by sildenafil may also play a role in some components of the female sexual arousal response. The efficacy and safety of sildenafil were evaluated in estrogenized and estrogen-deficient women with sexual dysfunction that included female sexual arousal disorder (FSAD).. Patients were randomized to receive 10-100 mg sildenafil or matching placebo. To assess efficacy, patients completed two global efficacy questions (GEQ), the Life Satisfaction Checklist (LSC), an event log of sexual activity, and a 31-item sexual function questionnaire (SFQ). To assess safety, adverse event (AE) data were recorded.. A total of 577 estrogenized and 204 estrogen-deficient women were randomized to treatment. All were diagnosed with FSAD, but it was the primary presenting symptom in only 46% and 50% of women, respectively. Differences in efficacy between sildenafil and placebo were not significant for any patient or partner end points (e.g., the two GEQ, the sexual event logs, the LSC, and the SFQ). The main AE were headache, flushing, rhinitis, nausea, visual disturbances, and dyspepsia, which were generally mild to moderate in nature.. Any genital physiological effect of sildenafil was not perceived as improving the sexual response in estrogenized or estrogen-deficient women with a broad spectrum of sexual dysfunction that included FSAD. Whether more specific subgroups of women with FSAD could potentially benefit from treatment with sildenafil is an area for future research.

Topics: Adult; Analysis of Variance; Dose-Response Relationship, Drug; Double-Blind Method; Dyspepsia; Estradiol; Estrogen Replacement Therapy; Female; Flushing; Headache; Humans; Middle Aged; Nausea; Piperazines; Purines; Rhinitis; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Statistics as Topic; Sulfones; Surveys and Questionnaires; Treatment Outcome; Vasodilator Agents; Vision Disorders

To verify whether sildenafil is effective in young premenopausal women affected by arousal disorder.. A double-blind cross-over study.. Centre for Sexological Research, Department of Microbiological and Gynaecological Science, University of Catania, Italy.. Fifty-three volunteer women aged 22-28 years affected by arousal disorders.. The study consisted of three 4-week periods: sildenafil, washout, placebo, by six possible sequences. sildenafil was used at 25 mg or 50 mg.. Efficacy was assessed at baseline and once monthly by the Personal Experiences Questionnaire based on the 5-point Likert scale. The questionnaire quantified subjective arousal (primary endpoint), and orgasm, enjoyment, sexual frequency, and the number of sexual fantasies.. Fifty-one women completed the study. Mean (SD) usage of sildenafil 25mg and 50mg was, respectively, 2.8 (0.8) and 2.7 (1.3) times weekly, while mean usage of placebo was 2.8 (1.6) times weekly. During both sildenafil dosages, arousal and orgasm improved with respect to placebo (P < 0.001). Therapeutically significant differences were not noted during the treatment with both 50 mg and 25 mg of sildenafil for arousal and orgasm. The frequency of sexual fantasies and of sexual intercourse, and enjoyment, improved in the women treated with sildenafil (P < 0.05).. Our study suggests that sildenafil may improve sexual performance of women affected by sexual difficulties such as arousal disorder, and may indirectly improve other aspects of sexual life. Moreover, further studies need to define the use of PDE type 5 inhibitors in this sexual pathophysiology.

Topics: Adult; Analysis of Variance; Cross-Over Studies; Double-Blind Method; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Premenopause; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

To evaluate the effect of sildenafil on iatrogenic serotonergic antidepressant-induced sexual dysfunction.. Four outpatients (2 men, 2 women) who developed sexual dysfunction (erectile impotence, anorgasmia) during treatment with a serotonin reuptake inhibitor antidepressant for psychiatric disorder were selected. Each subject was initially prescribed sildenafil 50 mg to be taken approximately 1 hour before sexual activity. The dose was increased to 100 mg for a partial or failed response.. Four cases are detailed in case report fashion. All 4 had rapid reversal of their sexual dysfunction, usually with the first dose. Reversal equates to 1 successful use of sildenafil in each of 2 patients and 3 uses in 2 patients.. Sildenafil may be an effective treatment for serotonergic antidepressant-induced sexual dysfunction and deserves further evaluation in randomized placebo-controlled studies.

Topics: Adult; Ambulatory Care; Depressive Disorder; Drug Administration Schedule; Enzyme Inhibitors; Female; Humans; Iatrogenic Disease; Male; Middle Aged; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

In an open study, sildenafil (Viagra) was prescribed for nine women outpatients who reported sexual dysfunction induced by antidepressant medication, primarily selective serotonin reuptake inhibitors. A 50 mg dose of sildenafil was prescribed, and patients were instructed to take it approximately one hour before sexual activity. They were told to increase the dose to 100 mg on the next occasion if they experienced a partial response or a lack of response to sildenafil. The nine patients, all of whom had experienced either anorgasmia or delayed orgasm with or without associated disturbances, reported significant reversal of sexual dysfunction, usually with the first dose of 50 mg of sildenafil.

Topics: Adult; Ambulatory Care; Antidepressive Agents; Depressive Disorder; Drug Administration Schedule; Female; Humans; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sex Factors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

Topics: Adolescent; Adult; Ambulatory Care; Antidepressive Agents; Anxiety Disorders; Depressive Disorder; Drug Administration Schedule; Female; Humans; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

An advantage of sexuality after 60 years of age is the increased need for couple involvement to promote desire, pleasure, eroticism, and satisfaction inherent to the healthy aging process. This case study clinically explores the complex psychobiosocial interactions for understanding, assessing, and treating sexual problems for couples age 60 years and older, emphasizing the Good Enough Sex approach of variable, flexible, and shared sexual pleasure. Aging couples are discouraged from appraising their sexual experiences within the parameters of the pass/fail binary of the traditional individual performance model and are instead encouraged to embrace the evolving elasticity of their sexual experiences. The Good Enough Sex model espouses an approachable and satisfying alternative for the promotion of sexual function and satisfaction throughout the life span, with particular interest in late adulthood sexual health.

Topics: Age Factors; Aged; Combined Modality Therapy; Erectile Dysfunction; Female; Humans; Libido; Male; Medication Adherence; Qualitative Research; Quality of Life; Recurrence; Self Concept; Sex Counseling; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate

For years, phosphodiesterase type 5 inhibitors have been used for the treatment of erectile dysfunctions. Due to the similarities between male and female sexual response, several studies have assessed the effects of sildenafil citrate (Viagra(®)) in women affected by female sexual arousal disorder. The results are still conflicting and the drug is not devoid of adverse effects. Furthermore, female sexual arousal disorder is a heterogeneous condition whose underlying causes are difficult to diagnose and appropriate treatment requires a thorough sexual, psychological, and medical history along with specialist consultations. The clinician should pursue a global approach to the patient with sexual difficulties, while non-hormonal treatment such as phosphodiesterase type 5 inhibitors (ie, sildenafil citrate) should be kept as the last option.

Topics: Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfonamides

Pedalium murex Linn. has been used as Vajikaran Rasayana (aphrodisiac) in traditional Indian medicine to treat male sexual dysfunction and impotency.. The aim of this study was to investigate effects of P. murex fruits extract on sexual behaviors and testosterone level of male rats during and past withdrawal of treatment.. The extract (50, 100,150mg/kg body weight/day) and sildenafil citrate (5mg/kg body weight/day) were administered orally by gavages for 28 days to male Wistar albino rats. Penile erection index (PEI), mount latency (ML), intromission latency (IL), ejaculation latency (EL), mounting frequency (MF), intromission frequency (IF), post ejaculatory interval (PEjI) and serum testosterone levels were studied at day 0, 15, 28 during treatment. They were further evaluated after day 7 and 15 past discontinuation of the treatment. In-vitro nitric oxide release activity was also investigated in human corpus cavernosal cell line.. The ethanolic extract significantly reduced the ML, IL, EL and PEjI (p<0.05). There was a significant increase in the PEI, MF and IF and serum testosterone level (p<0.05) throughout the period of study. Ethanolic extract produced a significant effect on sexual behavior and serum testosterone level past withdrawal of the treatment. In-vitro nitric oxide release was significantly higher in extract and sildenafil citrate compared to the control group.. Present findings provide experimental in-vivo and in-vitro evidence that the ethanolic extract of P. murex fruits possesses aphrodisiac property. Study lends growing support for the traditional use of P. murex as a sexual stimulating agent and offers a significant potential for studying the effect on male sexual response and its dysfunctions. The findings justify the concept of Rasayana as rejuvenative tonics and support their role in prevention or delay of the aging process.

Topics: Animals; Aphrodisiacs; Copulation; Ejaculation; Erectile Dysfunction; Female; Fruit; Male; Medicine, Ayurvedic; Nitric Oxide; Pedaliaceae; Penile Erection; Phytotherapy; Piperazines; Plant Extracts; Purines; Rats; Rats, Inbred Strains; Sexual Behavior, Animal; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone; Vasodilator Agents

Abstract While historically sex has been seen primarily as the prerogative of the young, more recently, the emphasis has been on the maintenance of active sexuality as a marker of successful ageing. A new cultural consensus appears to have emerged which not only emphasises the importance of continued sexual activity across the lifespan, but links sexual function with overall health and encourages increased self-surveillance of, and medical attention to, late-life sexuality. Drawing on historical accounts, clinical research, popular science reporting and health promotion literatures, I explore several key shifts in models of sexual ageing, culminating in the contemporary model of gender, sexuality and ageing that has made ageing populations a key market for biotechnologies aimed at enhancing sexual function. Two central concepts frame my analysis: 'virility surveillance', where age-related changes in sexual function are taken as indicative of decline, and the 'pharmaceutical imagination', where sexual lifecourses are reconstructed as drug effects revise standards of sexual function. After consideration of how narratives emerging from qualitative research with older adults challenge the narrow depiction of sexual functionality promoted by pharmaculture, conclusions call for continued critical inquiry into the biomedical construction of sex and age.

Topics: Age Factors; Aged; Aging; Biotechnology; Erectile Dysfunction; Health Status; Humans; Life Style; Male; Phosphodiesterase Inhibitors; Piperazines; Prejudice; Purines; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sexuality; Sildenafil Citrate; Social Perception; Sulfones

Topics: Adjuvants, Immunologic; Adult; Antidepressive Agents, Second-Generation; Atrophy; Benzimidazoles; Bupropion; Clinical Trials, Phase III as Topic; Dehydroepiandrosterone; Dopamine Uptake Inhibitors; Female; Gels; Humans; Libido; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Placebos; Postmenopause; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone; United States; United States Food and Drug Administration; Vagina; Vasodilator Agents

Topics: Antidepressive Agents, Second-Generation; Female; Humans; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Highly selective inhibitors of phosphodiesterase type 5 (PDE5I) have been commercially available for over a decade. Our knowledge of these drugs continues to expand.. To review recent (since 2007) developments on the utilization of PDE5I in clinical practice. The focus of this manuscript is on the use of PDE5I for sexual concerns. Also reviewed are recent reports of rare but potentially serious toxicity.. Pubmed search utilizing the search terms "phosphodiesterase type 5 inhibitor," "PDE5 inhibitor,""sildenafil," "vardenafil," and "tadalafil." Articles were screened for their relevance to the clinical practice of sexual medicine and/or PDE5I toxicity. Publications on routine dose PDE5I for penile rehabilitation, lower urinary tract symptoms, and stuttering priapism are summarized in a separate manuscript in this series.. Peer-reviewed publications since the last major update on PDE5I published in the medical literature.. Recent investigations have suggested a number of interventions to potentially improve patient compliance with PDE5I therapy. Additionally, the approval in the past year of tadalafil as a daily medication signifies a potential paradigm shift in our concept of this disorder. Daily dosing may be useful in some men; however, the other available PDE5I continue to show excellent efficacy in the management of erectile dysfunction (ED). In addition to direct effects on ED, several recent reports highlight the use of PDE5I for improvement of premature ejaculation, sexual relationship status, and sexual function in women. There have also been several recent reports of rare but serious toxicity, particularly ototoxicity, associated with PDE5I use.. Recent studies have suggested new ways to optimize utilization of PDE5I not only for the management of ED but also for other sexual concerns in both men and women. Rare but serious toxicities have been reported with PDE5I and, therefore, judicious counseling is indicated before prescribing these medications.

Topics: Carbolines; Clitoris; Education, Medical, Continuing; Female; Hearing Disorders; Humans; Imidazoles; Impotence, Vasculogenic; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sexuality; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Vardenafil Dihydrochloride

Topics: Congresses as Topic; Dyspareunia; Erectile Dysfunction; Female; Humans; Male; Periodicals as Topic; Phosphodiesterase Inhibitors; Piperazines; Purines; Sex Counseling; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Societies, Medical; Sulfones; Vasodilator Agents

Topics: Antidepressive Agents; Depression; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Women's Health

Topics: Bupropion; Estrogens; Female; Humans; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone

Honeymoon impotence can be defined as the failure to be successfully involved in sexual intercourse at the beginning of marriage, particularly in the first few nights. While its exact causes are not yet elucidated, many studies recognize this problem as related to performance anxiety.. The aim of this study was to report the outcome of management of patients with honeymoon impotence.. This study included 100 consecutive patients presenting to our department complaining of failed sexual intercourse since the beginning of their marriage. History taking, completion of the abridged form of the International Index of Erectile Function (IIEF-5) questionnaire, and combined intracavernous injection and stimulation and nocturnal penile tumescence monitoring were performed. Penile duplex was performed to elucidate vascular insufficiency. All psychogenic patients with erectile dysfunction (ED) were treated with sildenafil and sex therapy. All organic ED patients were treated either with sildenafil alone or combined therapy with either intracavernous prostaglandin E1 or vacuum constriction device.. Seventy-four patients had psychogenic ED and 26 patients had vasculogenic ED. All psychogenic ED patients were treated successfully with sildenafil and sex therapy. Twenty-two patients with vasculogenic ED were treated successfully with sildenafil or combined therapy, while four patients needed venous surgery. Minimal side effects of all treatment modalities occurred throughout the study.. Management of honeymoon impotence requires profound diagnosis of its causative factors. Treating physicians in areas with high prevalence of this condition should be ready to manage this problem with vigilant systematic overture. A combined approach of sildenafil and sex therapy proved highly effective in treatment of honeymoon impotence of psychogenic origin; however, controlled studies are needed. Other patients showing functional erectile abnormalities should be treated accordingly.

Topics: Adult; Coitus; Erectile Dysfunction; Humans; Impotence, Vasculogenic; Male; Penile Erection; Penis; Piperazines; Purines; Sex Education; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome; Vasodilator Agents

Topics: Adult; Androgens; Anxiety; Bupropion; Cabergoline; Citalopram; Depressive Disorder; Dopamine Agonists; Dopamine Uptake Inhibitors; Ergolines; Female; Fluoxetine; Humans; Male; Monoamine Oxidase Inhibitors; Piperazines; Plants, Medicinal; Purines; Selective Serotonin Reuptake Inhibitors; Selegiline; Sertraline; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sleep Initiation and Maintenance Disorders; Sulfones; Testosterone; Time Factors; Treatment Outcome; Vasodilator Agents

Topics: Drug Approval; Female; Humans; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; United States; United States Food and Drug Administration

The history of sexual medicine in the United Kingdom since the 19th century is reviewed, with particular reference to masturbation, homosexuality, contraception, and in the past four decades, the treatment of sexual dysfunction. The medical profession's tendency to deal with sexual issues according to the sociopolitical and moral issues of the time is emphasized, and whereas "sex negativism" has prevailed within the medical profession for most of this historical period, there has been a succession of individuals within the profession who have presented a more positive approach to defining and promoting sexual health. Four tracks within sexual medicine over the past 30 years are described: the psychoanalytic approach of the Institute of Psychosexual Medicine, modern "sex therapy," psychophysiological sex research, and the involvement of andrology in the assessment and treatment of erectile dysfunction. The impact of Viagra is seen as the most recent chapter in this history.

Topics: History, 19th Century; History, 20th Century; History, 21st Century; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexology; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; United Kingdom

Topics: Drug Approval; Drug Labeling; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

With the assumption that infertility and related diagnostic and therapeutic processes are stressful, an uncontrolled pilot study was designed to evaluate the effect of sildenafil citrate on sexual compliance and reproductive outcome. A group of sexually healthy men were studied after the administration of 50 mg sildenafil before semen collection for intrauterine artificial insemination (n = 25) or planned intercourse for a postcoital test (n = 12). We demonstrated that sexual dysfunction is highly prevalent in patients undergoing diagnostic procedures for infertility, and that sildenafil is effective in reversing stress-induced transitory impotence. Furthermore, sildenafil improved some seminal parameters, such as the percentage of spermatozoa with linear progressive motility, as well as the number of spermatozoa penetrating the cervical mucus. Two pregnancies were obtained after sildenafil administration.

Topics: Adult; Humans; Infertility, Male; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Clinical Trials as Topic; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; International Classification of Diseases; Interpersonal Relations; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Diagnosis, Differential; Education, Medical; Erectile Dysfunction; Female; Humans; Male; Physician-Patient Relations; Phytotherapy; Piperazines; Plant Extracts; Purines; Sexual Dysfunctions, Psychological; Sexuality; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Clinical Trials as Topic; Cyclic Nucleotide Phosphodiesterases, Type 5; Female; Humans; Male; Phosphodiesterase Inhibitors; Phosphoric Diester Hydrolases; Piperazines; Purines; Sex Factors; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

Topics: Female; Humans; Piperazines; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Vasodilator Agents

Despite the high prevalence of sexual problems in women, relatively few clinical trials have been conducted to date of either vasoactive drugs (e.g., sildenafil, apomorphine) or hormone replacement therapy or a combination of the two on sexual function problems in women. This article addresses the key conceptual and methodological issues to be addressed in clinical trials, particularly in the area of response outcomes or efficacy assessment. In particular, the use of self-report questionnaires and event-log or diary-based responses as primary outcome variables or endpoints in clinical trials is considered. Physiological measures, such as the vaginal photoplethysmograph probe, are being used in early proof of concept studies. There may be some value in the use of these measures for proof-of-concept and early dose-finding studies. Physiological measures are not used in large-scale, multicenter clinical trials, where patient-based or diary measures are clearly preferable. Clinical trials in this area should also make use of the new consensus classification system for female sexual dysfunction in determining inclusion and exclusion criteria for the trial.

Topics: Female; Humans; Piperazines; Plethysmography; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Vasodilator Agents

Topics: Adult; Advertising; Humans; Male; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Television; Vasodilator Agents

Sildenafil reinvigorated sex therapy, expanding the number and range of individuals restored to sexual health. Sildenafil used adjunctively with sex therapy accelerated therapy and improved outcome in treating erectile dysfunction (ED). For women, sildenafil initially was used "off label" as a primary treatment for female sexual dysfunction (FSD). However, sildenafil could also be used in conjunction with sex therapy for dysfunctional male partners of women with FSD, so that his ED does not sabotage her treatment. This article describes an integrated treatment, where adjunctive sildenafil use was an important strategic component in the sex therapy of a couple's unconsummated marriage in which the wife's vaginismus, dyspareunia, and anorgasmia was complicated by her husband's ED and retarded ejaculation (RE).

Topics: Adult; Erectile Dysfunction; Female; Humans; Male; Marital Therapy; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Erectile dysfunction is a prevalent and distressing problem. The availability of sildenafil citrate has significantly altered the way in which erectile dysfunction is treated. While this medication is extremely effective in restoring erectile function, it is often necessary to ensure that the partner is actively involved in treatment since many men are in relationships characterized by sexual apathy and avoidance as well as relationship conflict. These problems, if left untreated, can thwart the transition from sexual abstinence to sexual intimacy. Suggestions are offered for evaluating and intervening with men and their partners who are planning to resume a sexual life with sildenafil treatment for erectile dysfunction.

Topics: Aged; Erectile Dysfunction; Female; Humans; Male; Marital Therapy; Marriage; Menopause; Middle Aged; Personal Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Behavior; Sexual Dysfunctions, Psychological; Sexual Partners; Sildenafil Citrate; Sulfones

Topics: Adult; Depressive Disorder; Erectile Dysfunction; Female; Humans; Male; Phosphodiesterase Inhibitors; Physician's Role; Piperazines; Psychiatry; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

Topics: Adult; Depressive Disorder, Major; Dose-Response Relationship, Drug; Female; Humans; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Adult; Evidence-Based Medicine; Female; Humans; Middle Aged; Nitric Oxide; Patient Selection; Phosphodiesterase Inhibitors; Piperazines; Premenopause; Purines; Research Design; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

Topics: Adult; Female; Humans; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Adult; Depressive Disorder; Enzyme Inhibitors; Erectile Dysfunction; Humans; Male; Orgasm; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sertraline; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Adult; Dysthymic Disorder; Enzyme Inhibitors; Erectile Dysfunction; Female; Humans; Male; Middle Aged; Orgasm; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Adult; Depressive Disorder; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

Topics: Anxiety Disorders; Female; Humans; Orgasm; Paroxetine; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sex Factors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

This report describes the presence of sexual dysfunction associated with selective serotonin reuptake inhibitors (SSRIs) in two male patients treated successfully with sildenafil (Viagra). The sexual dysfunction was assessed using the Arizona Sexual Experiences Scale for males (ASEX-Males; McGahuey et al. [1997: Presented at the 150th Annual Meeting of the American Psychiatric Association, May 19, 1997, San Diego, CA]).

Topics: Adult; Depressive Disorder; Dose-Response Relationship, Drug; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Antidepressive Agents; Antidepressive Agents, Second-Generation; Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme Inhibitors; Cytochrome P-450 Enzyme System; Drug Interactions; Drug Therapy, Combination; Half-Life; Humans; Mixed Function Oxygenases; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Triazoles

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Antidepressive Agents; Humans; Phosphodiesterase Inhibitors; Piperazines; Publishing; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Time Factors

With the introduction of the erection-supporting oral drug sildenafil (Viagra) the development of somatic treatments of male sexual dysfunction has reached a temporary peak. The availability of a medicament that is easy to take will result in an increase of the incidence and possibly also the prevalence of erectile disorder. It may even lead to the myth that only a perfect erection is normal. The question is where to draw the line between a normal inconvenience of life and a serious disease. The erection pill will probably be preferred to all other treatments. Therefore, most patients will consult their family physician, who will refer only difficult cases to urologists or sexologists. Physicians should take 'the man behind the penis' into consideration before writing a prescription, otherwise a distressed man without an erection might become a distressed man with an erection. In the long run, psychosexual therapy is less expensive than taking sildenafil for many years.

Topics: Adult; Aged; Enzyme Inhibitors; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Psychotherapy; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Somatoform Disorders; Sulfones