sildenafil-citrate and Sexual-and-Gender-Disorders

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

Sildenafil is a selective inhibitor of cyclic GMP-specific phosphodiesterase type 5 that has been associated with greater improvement of erectile function compared to placebo among men with erectile dysfunction. The goal of our study was to evaluate its efficacy in a small sample of outpatients with antidepressant-induced sexual dysfunction.. We studied the first 14 depressed outpatients (9 men and 5 women; mean age: 46.4 +/- 8.4) who were consecutively treated with oral sildenafil. Twelve of the 14 patients were treated with an SSRI and 2 with mirtazapine. All patients were prescribed oral sildenafil tablets at the initial dose of 50 mg q.d. p.r.n., with the possibility of increasing the dose to 100 mg q.d. p.r.n., if clinically indicated. We administered a sexual functioning questionnaire derived from the Guided Interview Questionnaire for females and males and from the Arizona Sexual Experience Scale to all patients before and after at least 4 weeks of treatment with oral sildenafil. The mean sildenafil dose in our 14 patients was 57 +/- 18 mg/day.. All 14 subjects completed the follow-up assessments and no subjects discontinued the drug prematurely. We observed statistically significant improvements in all domains of sexual functioning, including libido, arousal, orgasm, sexual satisfaction, and (in males only) erectile function, with a 69% rate of patients reporting themselves as much or very much improved. Oral sildenafil treatment appeared to be very well tolerated, with only 1 out of 14 (7%) patients reporting an adverse event (hot flashes).. Our findings of statistically significant improvements in all domains of sexual functioning in a sample of 14 men and women with antidepressant-induced sexual dysfunction suggest that this agent may represent an efficacious approach to this population.

Topics: Administration, Oral; Adult; Antidepressive Agents; Enzyme Inhibitors; Female; Humans; Male; Middle Aged; Piperazines; Purines; Sexual and Gender Disorders; Sildenafil Citrate; Sulfones; Treatment Outcome