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Female Sexual Dysfunction

Sildenafil: Less SSRI-Related Sexual Dysfunction in Women?
By Robert Finn
Mar 13, 2003, 10:18pm

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LOS ANGELES — Three open-label studies and preliminary data from a double-blind, placebo-controlled study support the use of sildenafil in women who have sexual dysfunction induced by selective serotonin reuptake inhibitors.

The studies, funded in part by Pfizer Inc., which markets sildenafil as Viagra, were reported by Dr. H. George Nurnberg at a psychopharmacology update sponsored by the University of California, Los Angeles. Dr. Nurnberg has conducted studies showing that sildenafil is an effective treatment for male sexual dysfunction induced by selective serotonin reuptake inhibitors (SSRIs).

Previous studies on sildenafil in women with sexual dysfunction have been equivocal, with some reporting negative results and some reporting positive results. Dr. Nurnberg, professor of psychiatry at the University of New Mexico, Albuquerque, restricted his studies to women taking SSRIs who had achieved complete remission of their depression. Even in these women, the drug did not work for everyone.

“If you take men with [erectile dysfunction] and treat it with sildenafil, they get better. With women, you had better know what their hormone status is. You had better know whether they're premenopausal or postmenopausal. You need to know whether they're on HRT,” he said. Previous studies on sildenafil in women did not control for those factors.

Sildenafil is known to work via the nitric oxide system. Postmenopausal women who lack estrogen have very low nitric oxide levels. Estrogen replacement brings nitric oxide levels back up, but the levels remain low in women who receive progesterone in addition to estrogen.

Dr. Nurnberg's double-blind, placebo-controlled study involves 150 women taking SSRIs in successful treatments for depression; all have had some degree of sexual dysfunction. The average age of the women is 40; control patients are age matched with those receiving sildenafil.

The study is about three-quarters complete, but a preliminary analysis indicates that sildenafil is effective, he said. Women who fail to respond have progesterone levels four times higher than those who do respond. This may indicate that clinicians can predict which women will respond to sildenafil and which will not.

Women with hypoactive sexual desire also failed to respond well.

“For those of you who want to go off label in using this drug ... it's in the literature, there are plenty of data, well over 3,000 women have been treated with this drug, and it has been reported to be safe,” Dr. Nurnberg said. Patients who are receiving nitrates should not be given sildenafil, he cautioned.

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