vardenafil-dihydrochloride and Sexual-Dysfunctions--Psychological

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

We investigated safety and efficacy of vardenafil and sertraline in premature ejaculation (PE). Seventy-two men graded their primary PE on a scale of 0-8 (0 = almost never, 8 = almost always). Intravaginal ejaculatory latency time (IELT) was measured. Patients were included if they scored their PE as 4 or greater and their IELTs were less than 1.30 min. After 6 weeks of behavioural psychosexual therapy, 49 patients still had a PE of 4 or greater and an IELT less than 1.30 min and they were randomised: 6 weeks vardenafil (10 mg) or sertraline (50 mg). After a wash-out phase for 1 week, medication was changed in a cross-over design. Initially, all 72 men with PE received behavioural therapy. Twenty-three men were satisfied with treatment and excluded. The remaining 49 men graded their PE as 5.94 +/- 1.6 and IELT was 0.59 min and patients were randomised. Four men discontinued the study. Vardenafil improved PE grading: 2.7 +/- 2.1 (P < 0.01) and IELT increased to 5.01 +/- 3.69 (P < 0.001). PE grading improved 1.92 +/- 1.32, (P < 0.01) and IELT 3.12 +/- 1.89 (P < 0.001) with sertraline. It is concluded that vardenafil and sertraline are useful agents in the pharmacological treatment of PE.

Topics: Adult; Behavior Therapy; Cross-Over Studies; Ejaculation; Erectile Dysfunction; Humans; Imidazoles; Male; Middle Aged; Piperazines; Safety; Sertraline; Sexual Dysfunctions, Psychological; Sulfones; Treatment Outcome; Triazines; Vardenafil Dihydrochloride

There are limited data concerning the sexual function of women whose male partners receive pharmacological treatment for erectile dysfunction (ED).. One objective of this research was to prospectively compare the efficacy of vardenafil vs. placebo administered to men with ED in improving men's and women partners' sexual function and satisfaction. Another goal was to assess the relationship of erectile function changes in men with ED receiving treatment with sexual function changes in women partners not directly receiving treatment.. A randomized, double-blind, placebo-controlled, multi-institutional comparison of vardenafil vs. placebo was performed in 229 couples (treated man with ED>6 months and untreated woman partner). Co-primary outcomes for which this research was statistically powered were Sexual Encounter Profile (SEP3) (treated man with ED) and Sexual Life Quality Questionnaire (mSLQQ-QOL) (untreated woman partner).. Erectile function changes in men with ED receiving vardenafil vs. placebo were compared at last observation carried forward (LOCF) in SEP3, International Index of Erectile Function (IIEF-EF) and Erection Quality Scale (EQS). Sexual function at LOCF in women partners was determined by mSLQQ-QOL and Female Sexual Function Index (FSFI).. Compared with placebo at LOCF, vardenafil significantly increased least square (LS) mean scores in: (i) overall per-treated male SEP3 success rate, IIEF-EF, and EQS; and (ii) mSLQQ-QOL, total FSFI and sexual desire, subjective arousal, lubrication, orgasm and satisfaction FSFI domains in untreated women partners. Treatment-related improvement in erectile function as assessed by IIEF-EF and EQS was correlated reliably with improvement in women partners' FSFI total and individual domain scores.. Vardenafil is an effective ED treatment in men that also significantly improves sexual function/satisfaction in untreated women partners. Women partners' sexual function improvements relate significantly and consistently to treatment-related improvements in men's erectile function. ED management should emphasize both members of the couple.

Topics: Adult; Aged; Double-Blind Method; Erectile Dysfunction; Female; Humans; Imidazoles; Male; Middle Aged; Personal Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sexual Partners; Sexuality; Sulfones; Surveys and Questionnaires; Triazines; Vardenafil Dihydrochloride

Hypoactive sexual desire disorder (HSDD) is a common problem in women and may have a negative impact on quality of life. A recent clinical study shows an increase in sexual drive of HSDD women after cotreatment of testosterone and vardenafil (phosphodiesterase type 5 inhibitor).. In this study, we investigated the effect of testosterone and vardenafil on sexual activity in female rats..   Proceptive (darts and hops), receptive (lordosis), and paced-mating (percentages after exits and contact-return latencies) behaviors were quantified.. Ovariectomized female rats, sub-primed with only estradiol and fully primed with estradiol and progesterone, were tested in a paced-mating sex test and sexual behaviors were quantified. The sub-primed rats are thought to model HSDD. The effect of testosterone (100 and 300 µg, subcutaneous [SC]) and vardenafil (10 mg/kg, per os [PO]) alone and testosterone (300 µg, SC) in combination with vardenafil (3 and 10 mg/kg, PO) were tested. We also studied the effects of testosterone (300 µg, SC) + intracerebroventricular (ICV) injections of vardenafil (25 and 50 µg) on sexual activity.. No effect of testosterone and vardenafil alone was found, but cotreatment of testosterone and vardenafil (PO) caused a significant increase in proceptive and receptive behavior in the sub-primed female rats. Testosterone and vardenafil did not affect fully primed females. ICV administration of vardenafil combined with systemic testosterone, on the other hand, had no effect on sexual activity in both sub-primed and fully primed female rats.. We conclude that cotreatment of subcutaneous testosterone and oral vardenafil increase sexual activity in sub-primed female rats. Our data supports the human finding that combination treatment of testosterone and vardenafil could be used as a new treatment for women with HSDD.

Topics: Administration, Oral; Analysis of Variance; Androgens; Animals; Drug Combinations; Female; Imidazoles; Ovariectomy; Phosphodiesterase 5 Inhibitors; Piperazines; Posture; Rats; Sexual Behavior, Animal; Sexual Dysfunctions, Psychological; Sulfones; Testosterone; Triazines; Vardenafil Dihydrochloride; Vasodilator Agents

Female sexual dysfunction (FSD) may be associated with reduced central sensitivity for sexual cues. A single dose of testosterone might induce an increase in sensitivity for sexual stimuli, which in turn allows a PDE5 inhibitor to be effective in boosting the physiological sexual response. Negative sexual experience-like childhood sexual abuse (CSA)-might be an important intervening factor in these drugs-induced alterations.. To investigate if the combination of testosterone and vardenafil causes an increase in sensitivity for sexual cues and an increase in physiological sexual responding in women suffering from hypoactive sexual desire disorder (HSDD).. Thirteen women with HSDD underwent four different drug treatments: (i) placebo; (ii) vardenafil; (iii) testosterone; and (iv) combination of testosterone and vardenafil. During each treatment, they performed an emotional Stroop task and watched neutral and erotic film clips.. A masked version of the emotional Stroop task, and the vaginal pulse amplitude (VPA).. We found different effects in women who had reported CSA (N = 5) compared with those who had not (N = 8). In women without CSA, testosterone induced an increase in their originally low levels of preconscious attention for sexual cues, while women with CSA showed a decrease in their originally high levels of attention. In these groups, we also found different effects of the combination of testosterone and vardenafil on the VPA: women without CSA revealed a statistically significant increase in their VPA during treatment with the combination of testosterone and vardenafil as compared with placebo. Women with CSA, however, showed no alterations in their physiological sexual responding during this combined drug treatment.. In women without CSA, testosterone appears to activate central sexual mechanisms resulting in higher VPA under the combination of testosterone and vardenafil. This effect did not occur in women with CSA.

Topics: Adult; Attention; Child; Child Abuse, Sexual; Cues; Erotica; Female; Humans; Imidazoles; Phosphodiesterase Inhibitors; Photic Stimulation; Pilot Projects; Piperazines; Plethysmography; Sexual Behavior; Sexual Dysfunctions, Psychological; Sulfones; Testosterone; Triazines; Vagina; Vardenafil Dihydrochloride

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: Adult; Anxiety Disorders; Female; Humans; Imidazoles; Phosphodiesterase Inhibitors; Piperazines; Selective Serotonin Reuptake Inhibitors; Sertraline; Sexual Dysfunctions, Psychological; Sulfones; Treatment Outcome; Triazines; Vardenafil Dihydrochloride