Viagra for Women: What You Need to Know

What Is Viagra & How Does it Work?

Viagra is the brand name for the generic medication sildenafil. Viagra is used to prevent the breakdown of cGMP in the body, increasing smooth muscle relaxation and blood flow in the penis. It is recommended to take Viagra 30 minutes before sexual activity to experience its full effects. This means that the FDA has determined that Viagra is safe and effective to treat ED in men. Viagra is not FDA-approved to treat sexual dysfunction in women.¹

What Is Low Libido?

Low libido is a decrease in the psychological drive to have sex. Low libido can feel as if one is uninterested or not in the mood for sexual stimulation. Women may also experience various physiological sexual dysfunction issues, such as pain with penetration, vaginal dryness, and vaginal spasms.

Physiological and psychological sexual dysfunction issues in females may be caused by female sexual arousal disorder (FSAD). FSAD is a broad diagnosis, including many types of arousal issues. For your prescriber to make this diagnosis, symptoms should be occurring for a minimum of 6 months, 75-100% of the time a woman seeks sexual arousal.^{3, 4}

Causes of Low Libido in Women

Low libido causes are divided into three categories: biomedical, psychosocial, and sexual. Biomedical causes of low libido come from physical and mental health conditions. This may include reproductive issues, cardiovascular and endocrine diseases, neurological and psychiatric disorders, and chronic illness.

Psychosocial causes come from individual thoughts and social factors. This may include low self-esteem, grief from loss, stress, or even cultural and religious beliefs. Sexual causes may come from past sexual trauma, including acquiring sexually transmitted infections or lack of sexual experience.⁴

Some common physical causes of low libido in women include:

• Hormonal changes during pregnancy or menopause
• Fatigue
• Menstrual abnormalities
• Endocrine disorders (e.g. thyroid issues or diabetes)
• Current heart disease treated by medications

Some common psychological causes of low libido in women include:

• Depression
• Anxiety
• Sexual performance anxiety
• Conflict in relationship
• Psychological effects from past sexual trauma
• Use of neurological or psychiatric medications

Can Women Take Viagra for Low Libido?

There is not much evidence supporting Viagra in women to treat low libido. Viagra is only FDA-approved to treat erectile dysfunction in men, but it has been used off-label to treat sexual dysfunction in women. Off-label means that it is not FDA-approved for use but a provider may prescribe it in patients if they believe it will have possible benefit. There have been a few research studies proving the effectiveness of Viagra in women, however not enough for FDA approval.²

Viagra enhances and prolongs erections and induces lubrication. This medication may cause an increase in blood flow to the clitoris in women, but studies have shown inconsistent results, and this physiological effect does not affect libido.

What Happens When a Woman Takes Viagra?

In men, Viagra enhances sexual performance through sexual arousal. This works by increasing blood flow in the penis, causing an erection. In women, blood flow within the clitoris and labia would be enhanced by Viagra. Increased blood flow to these areas has the potential to increase lubrication and sensation for women. This may enhance arousal and libido for women, but it depends on the individual.²

Potential Side Effects for Women Taking Viagra

Viagra side effects in men may include headache, hearing loss, and vision changes. These side effects may also apply to women who take Viagra.^{1, 2}

Common side effects of Viagra include:*^{1, 2}

• Headache
• Flushing (redness or warmth in the face, neck or chest)
• Hearing loss
• Visual disturbances
• Nasal congestion

*All medications, including Viagra, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor and pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Medications Women Can Take for Low Libido

Some commonly prescribed medications to treat low libido in women are Addyi, Vyleesi, and Osphena. Addyi and Vyleesi are FDA-approved to treat hypoactive sexual desire disorder in pre-menopausal women. Osphena is FDA-approved to treat pain and dryness caused by vulvar and vaginal atrophy from menopause.

Addyi and Vyleesi do not have a known mechanism of action, meaning there isn’t currently an exact explanation as to how they work to improve hypoactive sexual desire disorder. Osphena is an estrogen receptor agonist and antagonist. Osphena also balances estrogen levels in the body that can be affected by menopause. Estrogen is a sex hormone that promotes and supports secondary sex characteristics in women.^{5, 6, 7}

Medication	FDA-Approved Use	Mechanism of Action	Warnings
Addyi	To treat hypoactive sexual desire disorder (HSDD)	Unknown	Low blood pressure or fainting possible just from Addyi alone Low blood pressure or fainting possible from Addyi and alcohol use Possible central nervous system (CNS) depression; may affect alertness
Vyleesi	To treat HSDD	Melanocortin receptor agonist, but unknown how this affects HSDD	High blood pressure and low heart rate possible for up to 12 hours after each dose Dark spots on the face, gums, and breasts are possible (higher risk in patients with darker skin) Nausea requiring treatment may be possible
Osphena	To treat pain and dryness caused by menopause	Estrogen receptor agonist/antagonist	Possibility for deep vein thrombosis (DVT) or a pulmonary embolism (PE) in patients with venous thromboembolism Possible increased risk for endometrial cancer with prolonged use Should not be used in women that have liver impairment

Medications commonly prescribed for low libido on women include:

Addyi (Flibanserin)

Addyi, which contains the active ingredient flibanserin, is a medication used to treat hypoactive sexual desire disorder (HSDD) that presents specifically as low libido in premenopausal women. There is not an approved generic for Addyi. For Addyi to be effective, low libido must be from personal distress or difficulty and not from external factors of medical/psychiatric conditions, relationship issues, or other medication side effects. Addyi is dosed as a 100 mg tablet, taken once every day at bedtime. The cost of Addyi averages $560 per 30-count bottle without insurance.^{5, 8}

Addyi should be avoided in women taking CYP3A4 inhibiting medications, experiencing liver issues, or who have sensitivity to the drug or other inactive components of Addyi. Examples of CYP3A4 inhibitors include ketoconazole, ciprofloxacin, erythromycin, and grapefruit juice.

Low blood pressure and fainting are possible when using Addyi. Combining Addyi with alcohol use increases this risk. Central nervous system (CNS) depression is possible as well. CNS depression may present as fatigue, loss of alertness, drowsiness, or lower heart rate.^{5, 8}

Common Addyi side effects include:*⁵

• Dizziness
• Drowsiness
• Nausea
• Fatigue
• Insomnia

*All medications, including Addyi, have a risk of side effects, including serious side effects. You should talk with your doctor or pharmacist about the benefits and risks of any medication before starting treatment.

Vyleesi (Bremelanotide)

Vyleesi, which contains the active ingredient bremelanotide, is prescribed for premenopausal women with HSDD. It is a melanocortin receptor agonist drug, which means that Vyleesi binds to melanocortin receptors, controlling neurons in the central nervous system. It is unknown how this mechanism treats HSDD, caused by low libido, in women. For Vyleesi to be effective, low libido must come from personal distress or difficulty and not from external factors of medical/psychiatric conditions, relationship issues, or other medication side effects.

There is not an approved generic for Vyleesi. Vyleesi is a subcutaneous injection (injected under the skin) of 1.75 mg/0.3 ml, and it is injected into the abdomen or thigh. Vyleesi is used on an as-needed basis 45 minutes before sexual activity. Current guidelines do not recommend more than one dose in 24 hours and no more than 8 doses per month. The cost of Vyleesi is about $956 per pack of 4 injections without insurance.

Vyleesi is not recommended for patients who have uncontrolled blood pressure or cardiovascular disease. Using Vyleesi can increase blood pressure and decrease heart rate, which can be harmful to those with heart issues. Vyleesi should not be used with medications that you want to work quickly, such as pain medications. It slows down the digestive tract, reducing the absorption rate of medications. Additionally, Vyleesi should not be used if a patient is taking naltrexone for opioid use disorder or alcohol use disorder.^{3, 6, 9}

Common side effects of Vyleesi include:*⁶

• Nausea
• Flushing
• Injection site reaction
• Headache
• Vomiting

*All medications, including Vyleesi, have a risk of side effects, including serious side effects. You should talk with your doctor and pharmacist about the benefits and risks of any medication before starting treatment.

Osphena (Ospemifene)

Osphena, which contains the active ingredient ospemifene, is an estrogen agonist/antagonist medication. This means that it regulates different levels of estrogen, a hormone controlling sex characteristics in women. Osphena is used to treat vaginal pain and dryness in women caused by menopause. There is not an approved generic of this medication yet. Osphena is a 60 mg tablet that is taken once a day with food. The price of Osphena is $266 per 30-count bottle without insurance.

Osphena should not be used in women with abnormal estrogen-dependent growths, undiagnosed abnormal genital bleeding, previous blood clots in the veins, or who are pregnant or actively trying to become pregnant. Osphena can increase the risk of stroke or clots, so it must be used cautiously in women who have or are at risk for heart issues.

Osphena can also increase the risk for endometrial cancer, so it should be avoided in patients with endometrial or breast cancer risk if possible. Lastly, women with liver issues should not be taking Osphena. Osphena can interact with estrogen medications, CYP3A inhibitors/inducers (e.g. Xanax, cyclosporine), warfarin, and highly protein-bound drugs (e.g. amiodarone, amitriptyline).^{7, 10}

Common side effects of Osphena include:*⁷

• Hot flush
• Vaginal discharge
• Muscle spasms
• Excessive sweating or night sweats
• Vaginal hemorrhage

*All medications, including Osphena, have a risk of side effects, including serious side effects. You should talk with your doctor and pharmacist about the benefits and risks of any medication before starting treatment.

Additional Medications for Low Libido in Women

Additional medications with off-label use for treating low libido and low sexual desire in women include Depo-testosterone, Wellbutrin, and Desyrel. These may be considered if other medications are ineffective or not a viable option.

Testosterone

Depo-testosterone is an injected medication that can be used off-label to treat low libido in women. Men and women share similar sex hormones, sometimes making testosterone effective at improving sex drive in women. The generic of this medication is testosterone cypionate.

Depo-testosterone works as replacement therapy for low testosterone levels in the body, which can be responsible for low sex drive. This medication comes in 100 mg/ml and 200 mg/ml vials, and it is injected intramuscularly every 2 to 4 weeks. It is not recommended that nursing mothers use this medication.

Depo-testosterone can interact with some medications. It may increase sensitivity to anticoagulant medications (e.g. blood thinners), and doses may need to be adjusted based on the patient’s reaction. Depo-testosterone may decrease blood sugar levels in the body, which could affect diabetic patients and require altering of insulin doses.

Common side effects of this medication are hirsutism (thick dark hair on various parts of the body, including the face), headache, inflammation at the injection site, and anxiety. There is potential for masculine feature development in women who use Depo-testosterone.¹¹

Wellbutrin

Wellbutrin is an antidepressant medication that can be used off-label to treat low libido in women. The generic of this medication is bupropion hydrochloride. It is unknown how Wellbutrin fully treats depression, but it has some relation to norepinephrine and dopamine neurotransmitters in the brain.

Increasing the action of these neurotransmitters promotes feelings of well-being and improves psychological state. Due to this, Wellbutrin may be effective in increasing libido in women with psychologically limited sex drive. This medication comes in a tablet form, and patients usually start with a 150 mg dose.

Wellbutrin should not be taken by women who have a seizure disorder or eating disorders, have abruptly stopped drinking alcohol or taking benzodiazepine medication (e.g. Xanax), or those taking monoamine oxidase inhibiting medications (e.g. phenelzine).

Additionally, there is an increase in the risk of suicidal thoughts and behaviors when beginning this medication. If a patient currently struggles with suicidal thoughts, it is not recommended that they take this medication. Common side effects of this medication are headache, dry mouth, nausea, and insomnia.¹²

Desyrel

Desyrel is a selective serotonin reuptake inhibitor (SSRI) that is sometimes used off-label to treat low libido in women. The generic of this medication is trazodone hydrochloride. Desyrel enhances serotonin levels in the central nervous system, improving depression and psychological state.

Desyrel may be effective in increasing libido in women with psychologically limited sex drive. Though similar to Wellbutrin, Desyrel is a different class of antidepressant medication, so Desyrel may have a different effect than Wellbutrin. Desyrel comes in tablet form, and patients usually start with a 150 mg dose.

Desyrel should not be taken in women who are taking monoamine oxidase-inhibiting medications (MAOIs), such as  phenelzine. Additionally, there is an increase in risk of suicidal thoughts and behaviors when beginning this medication. If a patient currently struggles with suicidal thoughts, it is not recommended that they take Desyrel. Common side effects of this medication include edema, blurred vision, fainting, and drowsiness.¹³

*All medications, including medications for low libido, have a risk of side effects, including serious side effects. You should talk with your doctor and pharmacist about the benefits and risks of any medication before starting treatment.

Alternatives to Low Libido Medications

For some women, current FDA-approved and off-label low libido medications may not be a good fit. Price, medication delivery route, drug interactions, contraindications, and side effects may prevent women from taking these medications to improve their libido.

Here are some alternatives to medication for low libido in women:

• CBD: CBD use may reduce anxiety and also act as a muscle relaxant. This may help improve low libido if sex drive is inhibited by stress.¹⁴
• Sex therapy: Sex therapy can improve low libido in women by helping them connect with themselves or their partner. This feedback-based method guided by a therapist can be effective in exploring sexuality.¹⁵
• Couples therapy: Couples therapy can help partners learn to better communicate sexual wants and needs through the guidance of a professional, so that they can learn to communicate effectively on their own, improving their sex life.¹⁵
• Additional treatments/therapy: Additional sexual exploration exercises can help to improve low libido in women. Experimentation of various methods, whether that be physical or mental, may change their sexual perspective and increase their sex drive.⁹

How To Choose the Low Libido Medication for You

It can be challenging to choose a medication that may improve low libido. There are many contributing factors. Before choosing a medication, it is important to evaluate one’s self in order to find the best fit. Looking at physical and psychological health is the first step.

Health conditions, being on medications, or previous treatments are factors that may keep a person from choosing a medication. Additionally, certain qualities of the medication may not appeal to a person. Price, delivery route (painful or high maintenance), or side effects are all factors that go into the decision to choose a medication for low libido.

How to Get a Prescription for Low Libido Medication

Medications for low libido are prescription-only, so it is not possible to purchase any of the treatments discussed in this article over the counter.

To get a prescription for a low-libido medication, a patient will need to be seen by a prescriber. This could be a doctor, nurse practitioner, physician’s assistant, etc. It is possible that the provider would need to be specialized in reproductive health, so a patient may be referred to a gynecologist if they are seen by a general practice provider.

A prescriber may perform a physical evaluation or a psychological evaluation to determine the cause of low libido. Additionally, one may have to answer questions about their sex life and drive to give the provider an idea of what is causing their low libido.

Questions to Ask Your Healthcare Provider About Medication for Low Libido in Women

It is important to have open communication with one’s doctor, psychiatrist, pharmacist, or therapist when evaluating possible medication options to treat low libido. Asking questions can help the patient decide which medication is best for them. A patient may ask about medication side effects, how this will conflict with their current medications, if the healthcare provider normally sees good results with this medication, and what, if any, follow-ups or tests are needed with this medication.

If a patient needs to find a new prescriber that will help them find treatment for low libido, they may want to look into online psychiatry services. These services can be easy and convenient for patients, helping them find treatment efficiently.

Questions to ask your care team about postpartum medications include:

• How long will it take for me to adjust to taking medications for low libido?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• Is there anything I should tell my therapist about this new medication?
• What dangerous side effects should I be on the lookout for with this medication?
• What options are there for me if this medication doesn’t work?
• Do you see a lot of success with this medication?
• What routes of administration are available for this medication?
• Is this medication affordable?
• Will I have to come back for follow-up appointments or tests after starting this medication?
• What is your biggest concern with me taking this medication?
• How will I know if this medication is working or is not working?
• When will I start to see results with this medication?