Last year we shared with our readers information about diabetes and sexual dysfunction. At that time Pfizer had brought out Viagra and jokes about this medication, Viagra web sites, and copy cat drugs were rampant. Now, however, we are receiving questions about women, sexual dysfunction and Viagra. We hope that this article will help you by once again fulfilling our promise to you of making you informed consumers when it comes to living the most complete lives you can.
First, allow me to share that Pfizer has updated its Viagra labeling with new warnings in response to postmarketing reports of serious adverse events. Revised in consultation with the FDA, the new labeling is intended to make sure that consumers and doctors are fully informed about the benefits and risks of using Viagra, know that consideration must be given to the cardiovascular status of patients prior to prescribing Viagra, and know how to safely use the drug. The label has always warned against taking the medication with nitrate medication because the combination can drop blood pressure to levels that can have fatal consequences. The revised label warns specifically those in whom the drug had not yet been studied, such as men who have had a heart attack, stroke or life-threatening arrhythmia in the past six months, those with significant hypotension or hypertension, those with unstable angina and those with retinitis pigmentosa.
You will note that the preponderance of research on Viagra has been done on men. An example of this is an article in Clinical Psychiatry News, Vol. 28, No.1,Jan.00 which states that Viagra helps depression and sexual dysfunction; however, the subjects were 136 men. It is also interesting that in the last 5 years thousands of papers have been written on sexual dysfunction in diabetic men, but only 13 have been written on the same subject in women. Only now is there ongoing research attempting to identify whether Viagra is a viable oral therapy for use in female sexual dysfunction. It is currently not approved for use for women by the FDA for sexual dysfunction. So, let us begin by discussing just what sexual dysfunction in women is all about, the percentages in diabetic women and then examine some of the studies on the use of Viagra in females.
Labeling the various female sexual dysfunctions has been an ongoing debate in the field of sexology. For the purpose of this paper we will refer to: female sexual arousal disorder, female orgasmic disorder and vaginismus. Inhibited sexual desire can be experienced by both men and women and will also be described.
Dysfunctions can be classified as:
Life Long-has always been present
Acquired-at some point the person was able to function without dysfunction
Situational-dysfunction occurs in some situations and not others, and
Generalized-dysfunction occurs regardless of the situation
Now let's look at how these dysfunctions are described. We are not including the psychiatric or physical components to these disorders. This is not the appropriate venue for that. If you feel you have symptoms described, now is the time to speak to your personal physician for a complete work up.
Female Sexual Arousal Disorder (FSAD) is the inhibition of the general arousal aspect of sexual response. The woman with FSAD does not lubricate, her vagina does not expand, and there is no formation of orgasmic platform. She typically does not feel erotic sensations and may even find physical contact repulsive, or find it enjoyable only to a point. This disorder may fit any of the classifications of dysfunctions.
Female Orgasmic Disorder is the impairment of the orgastic component of the female sexual response. It is important that this be separated from FSAD. With Female Orgasmic Disorder, the women may be very sexually aroused but never reach orgasm. It can be also fit any of the classifications of dysfunctions.
Vaginismus is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.
Inhibited Sexual Desire is strictly speaking not a sexual dysfunction; it is the persistent and pervasive inhibition of sexual desire. This can be caused by chronic physical disease, as well as hormone deficiencies, depression, stress, alcoholism, and kidney failure. It can also be caused by the psychological repercussions of life events.
Now we look at research on women with diabetes and sexual dysfunction and also on the use of Viagra in women. Our first article is from Johns Hopkins and looks at the basis for research of Viagra in women. The title, 'Viagra and Woman,' by Arthur L. Bennett, MD examines the rational for using Viagra (Sildenafil) in women. The author uses the term "female impotence" which he sees as having physical similarities to male impotence. He suggests that one-third of women report a lack of interest in sex and one in four women say that they are unable to achieve orgasm. He bases his theory on "nitric oxide" as a principal mediator of penile erections. This leads to the production of another chemical, cyclic GMP, which allows penile arteries to expand during sexual stimulation. Before a paper that the author wrote on the subject in 1992, this process was not known. At that time Viagra was designed to treat angina, not impotence. Pfizer was about to give up on the trial of the drug because results in this area weren't effective in increasing blood flow to the coronary arteries, but they found that men in trials who had been sexually dysfunctional were getting better erections. The new understanding of nitric oxide made the difference in how the medication was to be marketed.
In women, Dr. Bennet sees "female impotence" as the inability to achieve clitoral swelling and vaginal lubrication, both of which rely on blood to come to the vaginal area. He hypothesizes that when women have poor orgasms, can't achieve orgasm, or suffer from vaginal dryness, it may also be due to poor blood flow. He conceded that these symptoms may be due to heart disease, diabetes, or high cholesterol, poor diet, smoking, or lack of exercise, plus about 500 medications from high blood pressure drugs to ulcer remedies which can contribute to this disorder. He concludes that he and his staff at Hopkins are in the process of examining how effective Viagra is in treating "female impotence" in women. He does not recommend that Viagra be prescribed for women, but thinks it will offer some benefits to women as it does in men.
An article titled, 'Prevalence of sexual disorders in a selection-free diabetic population,' May 1999 done in Germany indicates the incidence of sexual dysfunction was 18/42% in IDDM and NIDDM women. The conclusion of these researchers was that there is a general underestimation of the prevalence of sexual disorders in diabetic women and that physicians should work to better understand the needs of their female patients. Sex hormones and diabetes, in Diabetes Review, 1998 indicates that hormonal changes in both men and women with diabetes may lead to a decline in libido and a loss of the quality of the erection in men, and vaginal dryness that may be associated with dyspareunia in women.
An article titled 'Double blind placebo controlled study with crossover to assess effect of Sildenfil on physiological parameters of female sexual response,' by Berman, J. et al discusses sexual arousal disorders in women. The goal of this study were to utilize contemporary technologies to evaluate this response in the clinical setting and to assess the effect of sildenafil on these responses. 17 post-menopausal or hysterectomized women (mean age 45+/-9.8: range 28-70) were evaluated. Duplex Doppler ultrasonagraphy of genital blood flow velocity, vaginal pH, and vaginal compliance were measured pre and post sexual stimulation using a 15-minute erotic video and vibrator. The same protocol was implemented following placebo and 100 mg. sildenafil. The results of the study showed that sildenafil appears to enhance the female sexual response to visual and vibratory stimulation. Pre and post stimulation vaginal pH levels were significantly increased with sildenafil compared to placebo. Genital blood flow, primarily clitoral, increased as well. In this population vasoactive agents such as sildenafil may improve complaints associated with diminished genital blood flow.
In another article titled 'Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction,' by Kaplan, BA et al, the researcher notes that this medication is safe when used in men with erectile dysfunction, but that the role of sildenafil in treating women with sexual dysfunction is not known. The research looked at the response of posrmenopausal women with self-described sexual dysfunction treated with sildenafil for 3 months. 33 consecutive postmenopausal women with sexual dysfunction based on history were entered in this open-label, non-randomized study. All patients received 50 mg of sildenafil. Efficacy was assessed at weeks 4,8, and 12 using a newly developed 9-iem, self-administered Index of Female Sexual Function (IFSF) and a global efficacy question. "Did treatment improve your sexual function?" The IFSF quantifies the domains of desire, quality of sexual intercourse, overall satisfaction with sexual function, orgasm, lubrication, and clitoral sensation.
Of the group, 91% (30 women) completed the study and were available for follow-up at 3 months. Mean baseline IFSF score before therapy was 24.8+/-9.8. Mean useage of sildenafil was 3.1+/-1.4 times per week for the duration of the study. The IFSF score to 29.5+/-7.6, 30.3+/-8.5, and 31.4+/-10.4 at 4, 8, and 12 weeks respectively. Mean scores for questions 2 (lubrication), 8 (orgasm), and 9 (clitoral sensation) improved by 23.2%, 7.4%, and 31.3%, respectively at 12 weeks. Seven women (21%) noted improvement on the global efficacy question.. Overall, only 6 (18.1%) of 33 patients had a significant (more than 60% improvement in IFSF score) therapeutic response. The researchers concluded that overall sexual function did not improve significantly, although there were changes in vaginal lubrication and clitoral sensitivity. The role of sildenalfil in treating sexual dysfunction in various cohorts of women is still to be determined.
In closing, for many of you who have shared your feelings and questions about sexual dysfunction and diabetes, and your feelings about this sometimes embarrassing, let us share that sex has many meanings to different people. Just remember last year and the White House. For many people, just being held is a sexual act as it makes them feel protected. There are many professionals available to you to help you desensitize any anxieties you have and to introduce you to ways of feeling better about yourself and your partner. The first step is yours: You need to share your problem with a trusted physician to get a referral, a work-up, and some help.
We hope that this article is a good beginning for you. It has rudimental information, but hopefully it will provide you with the knowledge you need to speak to professionals with less anxiety.
