Viagra ( Sildenafil )

Can Women Use Sildenafil (Viagra)? Is There a Better Alternative for Low Sex Drive in Women?

Janan Sarwar, PharmDChristina Aungst, PharmD

Viagra is FDA-approved for sexual dysfunction in men, but some women use it off-label for the same reason.

Many factors can cause low sex drive in women — Viagra’s potential effects may not address all of them.

Medications, supplements, and lifestyle changes are often used to help with low sex drive in women.

Blister pack of pills

Viagra (sildenafil) — the infamous “little blue pill” — is an FDA-approved medication for people with erectile dysfunction that helps to improve blood flow to the penis. It’s not approved for sexual dysfunction in women — yet, though some may use it. In these cases, providers may choose to prescribe the medication off-label to help with arousal issues.

This article explores if using Viagra in women is safe and effective for low sex drive and what FDA-approved options are currently available as alternatives.

What is Viagra, and how does it work?

Viagra ( sildenafil ) is a prescription medication used to treat erectile dysfunction (ED). It helps to relax muscles and promote blood flow to the penis. When sexually aroused, the person taking it can achieve an erection. Similar medications in the same class include Cialis ( tadalafil ) and Levitra ( vardenafil ).

Viagra is available in three doses: 25 mg, 50 mg, and 100 mg. It can be taken 30 minutes to 4 hours before sex, and it will work for as long as 4 to 8 hours. But just because an erection is possible within this time frame doesn’t mean the erection itself should last that long.

In fact, an erection that lasts over 4 hours — called priapism — is dangerous and can cause permanent damage. In the event that happens, emergency medical attention is required.

What is low libido?

Sexual dysfunction in women can include several problems with the ability to enjoy sex, including impaired desire, impaired arousal, impaired climax, or painful sex. Of these, impaired desire or lowered interest in sex ━ also known as low libido ━ is a common sexual dysfunction, affecting 1 out of every 3 women in the U.S.

It has a number of complex causes, including:

Cultural and emotional views towards sex

Being in a bad relationship

Having a history of depression

Hormone changes during menopause and pregnancy

Periods of stress or extreme fatigue

Taking certain medications

It’s important to note that libido and arousal — which is when you’re sexually stimulated — are different. This means that you may have desire for sex but the inability to become aroused — and vice versa. For this reason, arousal disorder differs from low libido and may require different treatment.

Does Viagra work for low libido in women?

Not really. Viagra has physical effects on the body to help with erectile dysfunction. As mentioned above, low libido in women means that they’re less interested in sex — physical effects may not be an issue.

When used in women, Viagra is thought to raise blood flow to the genitals so that there’s more sensitivity and stimulation. Studies have shown that Viagra may provide a benefit for women having difficulty with sexual arousal — since it may help them respond better to sexual stimulation. However, it may not show a benefit if there’s low sexual desire.

In other words, treatments that target sexual desire are needed for people with low libido to see results.

However, Viagra may benefit people who are taking medications like selective serotonin reuptake inhibitors (SSRIs) for depression. This is because antidepressants like SSRIs can cause sexual dysfunction as a side effect. Studies suggest that women taking Viagra before sex may experience fewer unwanted sexual side effects from the antidepressant.

What happens if a woman takes Viagra?

Just as Viagra helps improve blood flow for an erection, it may improve blood flow in the female reproductive parts. When this happens, it may cause more sensitivity and stimulation, causing the person taking it to become more aroused.

What are the potential side effects?

A clinical trial studying Viagra in women for arousal disorder reported mild to moderate side effects overlapping with those seen when sildenafil is taken for erectile dysfunction.

Common side effects for women taking Viagra may include:

Severe side effects can include loss of hearing or vision, fainting, or shortness of breath.

What medications can a woman take for low sex drive?

Healthcare professionals may prescribe medications to boost libido in women. There are a few FDA-approved options, depending on the low sex drive causes.

Osphena

Painful sex because of vaginal dryness can be a cause of low libido. If someone experiences vaginal dryness, Osphena (ospemifene) is an option. Osphena is a once-daily oral pill FDA-approved for painful intercourse and vaginal dryness due to menopause.

Estrogen helps thicken the vaginal walls and support vaginal cells that produce lubrication. A drop in estrogen levels is a cause of vaginal dryness.

Osphena works by binding to estrogen receptors in the body, activating them in some areas (like vaginal tissue) and blocking them in others. It’s well tolerated with common side effects that include hot flashes and vaginal discharge. It doesn’t directly fix low libido, but it can address painful sex as a potential contributor.

Addyi

Addyi (flibanserin) is an oral medication that’s FDA-approved for low libido in premenopausal people. However, it isn’t recommended if the low libido is resulting from medical problems, relationship issues, or medications. It’s dosed once daily at bedtime.

The exact way that Addyi works to treat low libido isn’t known. It’s called the “female Viagra” — as well as the “little pink pill” — and may slightly improve interest in sex.

However, Addyi comes with a number of undesirable side effects, including:

Addyi also carries a boxed warning — the FDA’s most serious warning — about the risk of a severe drop in blood pressure and passing out. Drinking alcohol within 2 hours of your dose (or having at least 3 drinks), taking medications that interact with Addyi, and liver problems can raise this risk.

Vyleesi

Vyleesi (bremelanotide) is an injectable medication FDA-approved for premenopausal women with low sexual drive. Like Addyi, the way it works for low libido is unknown. Additionally, it isn’t recommended if there are medical conditions, medications, or relationship issues causing low libido.

Vyleesi is injected at least 45 minutes before having sex. You can inject one dose within a 24-hour period — and no more than 8 doses a month.

The most common side effect is nausea. Flushing, reaction at the injection site, and headache are also common side effects.

Health experts weren’t impressed with how Vyleesi performed in its clinical trials and would like to see more research done before recommending it.

Other medications

Bupropion (Wellbutrin) has been studied off-label for difficulties with arousal, desire, lubrication, and sexual satisfaction. In one study, almost 72% of women taking bupropion for sexual desire were satisfied with treatment.

Topical testosterone (gels and patches) is sometimes used for low sexual desire and function in people who’ve gone through menopause. Your provider may prescribe testosterone off-label since it’s not FDA-approved for use in women.

Are there any natural alternatives to Viagra for women?

There are supplements that claim to be natural alternatives that help with female sexual dysfunction. However, there aren’t enough studies to confirm they are safe and effective. Just because supplements contain natural substances does not mean they are harmless.

A recent systematic review suggests that the supplement L-arginine in combination with ginkgo biloba and Korean red ginseng may help enhance desire for sex. Ginkgo and ginseng are both able to boost nitric oxide levels, which plays a role in sexual function.

Red clover — an herb that contains estrogen-like substances called phytoestrogens — may improve libido, sleep, and mood. It’s also been used for menopause symptoms like hot flashes.

Cannabidiol (CBD) has the potential to lower anxiety, which can contribute to low libido. When people are stressed, higher cortisol (stress hormone) levels can suppress sex hormones that impact sexual desire. Although CBD products can be found over-the-counter (OTC), they aren’t FDA-approved, and there have been quality and contamination concerns.

Tribulus terrestris is a popular plant used in Chinese and Ayurvedic medicine. In small studies, participants taking this herb reported enhanced sexual experiences. In studies with premenopausal people, it also raised participants’ testosterone levels.

Speak with your medical provider before taking any supplements for low libido. At best, these may help raise sexual desire or arousal. Keep in mind that they’re not FDA-approved, which means that we don’t know the safety, efficacy, or long-term effects. Plus, herbal products carry side effects and can interact with other medications you’re taking.

Other natural alternatives include:

Sex therapy or individual therapy with a licensed therapist

Regular exercise for well-being, especially for people with sexual problems from antidepressants