Viagra for Women: What the Evidence Actually Shows

"Viagra for women" is one of the most commonly searched health topics online, but the reality is more nuanced than the search term suggests.

The short answer: Viagra (sildenafil) is not licensed for women in the UK or anywhere in Europe.

It is licensed exclusively for erectile dysfunction in men and for pulmonary arterial hypertension (in both sexes, under a different brand name and dosing regimen).

What this means in practice:

• No UK prescriber should routinely prescribe sildenafil for female sexual dysfunction
• It is not available to women over the counter (Viagra Connect is restricted to men)
• Any use in women would be considered "off-label" and would need to be justified on an individual basis by a specialist

The reason sildenafil is not licensed for women is straightforward: the clinical trial evidence does not demonstrate consistent, meaningful benefit for female sexual dysfunction.

Female sexual response involves a far more complex interplay of physiological, psychological and relational factors than can be addressed by a single vasodilator medicine.

Several clinical trials have investigated sildenafil in women, predominantly in post-menopausal women and women taking antidepressants (SSRI-induced sexual dysfunction). The results have been mixed.

Studies showing some benefit:

• A small number of studies found that sildenafil increased genital blood flow and subjective arousal in post-menopausal women
• In women with SSRI-induced sexual dysfunction, some trials reported modest improvements in arousal and orgasm

Studies showing no benefit:

• Pfizer conducted a large programme of clinical trials in women and ultimately abandoned the programme because the results did not demonstrate consistent efficacy
• The disconnect between physiological arousal (increased blood flow) and subjective arousal (feeling aroused) was a recurring finding. Women reported increased genital blood flow on measurement but did not consistently feel more aroused

Key takeaway:

The evidence does not support sildenafil as an effective treatment for female sexual dysfunction in general practice.

While individual women might experience some effect, the benefit is not reliable enough to warrant licensing or routine prescribing.

Female sexual dysfunction (FSD) encompasses a range of persistent problems that cause personal distress.

It is more common than many people realise, affecting an estimated 30 to 40% of women at some point in their lives.

Types of female sexual dysfunction:

• Hypoactive sexual desire disorder (HSDD): persistently low sexual desire that causes distress
• Female sexual arousal disorder: difficulty becoming or staying aroused despite adequate stimulation
• Orgasmic disorder: difficulty reaching orgasm or markedly reduced orgasm intensity
• Sexual pain disorders: including dyspareunia (pain during intercourse) and vaginismus (involuntary tightening of vaginal muscles)

Contributing factors:

• Hormonal changes (menopause, post-partum, hormonal contraception)
• Psychological factors (stress, anxiety, depression, relationship difficulties)
• Medical conditions (diabetes, cardiovascular disease, neurological conditions)
• Medications (SSRIs, antihypertensives, hormonal treatments)
• Pelvic floor dysfunction

Because FSD is so multifactorial, a single medicine like Viagra is unlikely to address the full picture. Effective management usually involves a combination of approaches.

The NHS and NICE recognise several evidence-based approaches to female sexual dysfunction. Your GP can refer you to appropriate services.

Psychological and behavioural therapies:

• Cognitive behavioural therapy (CBT) has good evidence for multiple types of FSD
• Psychosexual therapy, available through some NHS sexual health clinics
• Mindfulness-based approaches have shown benefit for arousal and desire difficulties
• Couples therapy when relational factors are involved

Hormonal treatments:

• Topical oestrogen (vaginal pessaries, creams or rings) for vaginal dryness and atrophy associated with menopause. Available on NHS prescription
• Hormone replacement therapy (HRT) may improve desire and arousal in menopausal women
• Testosterone is sometimes prescribed off-label by specialists for post-menopausal HSDD. The British Menopause Society supports this use in selected patients

Other medical treatments:

• Lubricants and moisturisers for vaginal dryness (available over the counter)
• Pelvic floor physiotherapy for pain-related sexual dysfunction and vaginismus
• SSRI dose adjustment or switching when medication is the suspected cause

Flibanserin (marketed as Addyi in the US for pre-menopausal HSDD) is not licensed or available in the UK.

Sexual health concerns are a legitimate and important reason to see your GP. Many women hesitate to raise the topic, but GPs are trained to discuss sexual function sensitively and can offer real help.

Consider seeing your GP if:

• You have persistent low desire, arousal difficulties or pain during sex that is causing you distress
• The problem has lasted more than a few months and is not improving
• You suspect a medication you are taking may be affecting your sexual function
• You are experiencing menopausal symptoms including vaginal dryness
• You have noticed changes in sexual function following surgery, illness or childbirth

What to expect:

• Your GP will take a careful history, including medical, psychological and relational factors
• Basic investigations (blood tests for hormones, thyroid function, blood glucose) may be arranged
• You may be referred to a sexual health clinic, psychosexual therapist, menopause clinic or gynaecologist depending on the likely cause
• Treatment is usually individualised and may combine several approaches

The NHS provides sexual health services free of charge. You can also self-refer to many sexual health clinics without needing a GP appointment.