Viagra appears to be effective for women diagnosed with sexual arousal disorder. (Root Cause Must Be Physiologic).

MONTREAL - Among women with sexual dysfunction, those with sexual arousal disorder appear to be the most likely candidates for treatment with sildenafil, results of a study of 200 women suggest.

Still, not all women with sexual arousal disorder will get results with the drug, Laura Berman, Ph.D., the study's principal author, said at the 10th World Congress of the International Society for Sexual and Impotence Research.

"The tricky part for the physician is not necessarily going to be identifying the diagnosis but identifying the causal factors and then delineating whether the causes for her sexual arousal disorder are emotional, relational, medical, or some combination, because that will be the difference as to whether Viagra [sildenafil] may or may not resolve it," said Dr. Berman of the University of California, Los Angeles.

Female sexual arousal disorder (FSAD) is defined as a persistent and pervasive lack of lubrication and genital sensation, which causes the patient distress. These women complain of dryness and numbness, a lack of sensation in their genital area, and a general sense of lack of arousal or feeling engorged, swollen, and aroused," she said in an interview

But sildenafil is likely to solve these problems only if their root cause is physiologic and not psychosexual, Dr. Berman explained.

"If the patient's symptoms have been lifelong, if they're situational, meaning she does not have them when she's on vacation ... or if they don't exist with self-stimulation, if she has a history of abuse or sexual trauma, if she has a psychiatric history if she's experiencing depression or stress, if her partner has sexual dysfunction, or if she has relationship issues, those are all signs that she should have further psychosexual evaluation, and that Viagra may not resolve it," she explained.

In a study funded by Pfizer Inc., which markets Viagra, 202 postmenopausal or posthysterectomy patients with FSAD were randomized to either a flexible dose of sildenafil (25-100 mg/day) or placebo. Those on sildenafil experienced significantly better genital sensation during intercourse or stimulation and sexual satisfaction with intercourse and/or foreplay compared with those on placebo. In a subgroup analysis, women with concomitant hypoactive sexual desire disorder reported less improvement with sildenafil than those without the disorder.

Dr. Irwin Goldstein, professor of urology at Boston University, said that he is not surprised by the findings of the study.

"My sense is that we will find that sildenafil will help a subset of, but not all, women with sexual dysfunction-just as it has helped only a subset and not all men with sexual dysfunction. It helps men with erectile dysfunction, but it doesn't help other forms of male sexual dysfunction, such as premature ejaculation, for example," said Dr. Goldstein, who has received research funding from Pfizer but does nor have a financial interest in the company.

A larger Canadian study published earlier this year reported no difference in sexual dysfunction among 781 women randomized to either sildenafil or placebo (J. Womens Health Gend. Based Med. 11[4]:367-77, 2002). The women in the study had been diagnosed with a broad spectrum of sexual dysfunction disorders, including FSAD.