Women Taking Viagra? Addyi?

Men have clamored for Sildenafil, usually known as Viagra or Cialis, since it flooded the market in 1998. Despite professional cautions that a pill cannot provide a “quite fix” for every sexual dysfunction, upwards of 25 million prescriptions have been written for the drug. It was only a matter of time, of course, until women began knocking on laboratory doors: What about us?

Sexual problems (arousal disorders, low desire, lack of orgasm) may be more prevalent in women than men cross-culturally.[1] The source of the problem, however, is quite different. Sildenafil works to increase blood flow to the genital area, making it ideal for treating erectile dysfunction in men. Only 20% of women are reported to have difficulties with lubrication, which can be eased with such an increase in blood flow.[2] Researchers caution that women’s lack of sexual interest is often a relational issue rather than a medical one; because women’s sexual issues are so complex, they stress that it is highly unlikely that a wonder drug can ever produce results across the female population as Viagra has for men. A study in the July 2008 issue of the Journal of the American Medical Association found that women taking Sildenafil reported improvements in lubrication, ability to reach orgasm, and controlling pain, but that there was no significant increase in libido. Even when women’s lower sex drives are related to the physical changes accompanying pre-menopause or menopause, experts believe it may not always make sense to “treat” the situation medically. (The lukewarm reception that the drug touted as the “female Viagra,” Addyi, has received is worth its own blog post).

But just like many men without medical reasons to do so have experimented recreationally with Viagra, women have also experimented with it off-label—stealing the little blue pill off their boyfriend’s nightstand or purchasing it illegally online. What happens when women take an erectile drug meant for men?

Women that I spoke to informally, along with those who have written about their experiences,[3] report the same occasional side effects men do: headaches, flushing, bluish vision, nasal congestion, and an occasional upset stomach. Some women also reported swelling in the genital area and increased sensitivity that ranged from pleasurable to an almost painful hypersensitivity; a few women experienced no change in response, either positive or negative. One woman I spoke with used 100 mg of Viagra to control pain during sex due to internal scar tissue; the increased blow flow, she believed, allowed for a more “normal” sexual response and more “comfortable” intercourse. As doctors hadn’t been able to help, using Viagra off-label seemed like the best option. Another woman I spoke with had been prescribed Viagra after being treated for cancer and entering early menopause; while doing so enabled her to “be aroused and have intercourse,” she also found the experience to be “nothing special.”

In the narratives I collected, women pondered about the fact that while taking Viagra made them wetter and more “receptive,” they did not necessarily feel “hornier”—just as researchers suggested would happen.  One woman reported that after taking 100 mg of Viagra, she noticed the congestion first, followed by a visible swelling in her genital area— she “found this surprising” because she had assumed that such visible physical changes would only happen if she “was already aroused.”  Walking home from a friend’s house, she told me with a laugh, she “became extremely aware” of her pants because of the engorgement.  But the experience didn’t make her “feel any hornier.”  

The key to understanding sex differences here may be something that is already being investigated by researchers who study female sexual desire—women can experience physiological responses, such as the vasocongestive changes induced by Viagra, without an increase in subjective excitement.  One possible reason, sex researcher Meredith Chivers suggests, is rooted in anatomy—the penis is external, and thus men may more readily perceive physiological responses and interpret these responses as signaling the presence of desire; women may experience a disconnect from bodily states for cultural reasons as well.  This doesn’t mean that women are harder to arouse, however, as they respond bodily to a much wider range of stimuli than men do.  But it does suggest that women’s physiological arousal—and the bodily changes that accompany it—may have little to do with women’s subjective feelings of desire.       

Though it is often too simplistic to categorize sexual issues as physical/medical versus psychological/emotional, there is some evidence that at least attempting to do so can help individual women decide whether experimenting with Viagra might be beneficial.  Women taking antidepressants, for example, often experience side effects such as a difficulty reaching orgasm that makes them good candidates for Sildenafil.  Some research suggests that Sildenafil might also be useful for menstrual cramps due to its ability to increase blood flow.  

For women whose primary complaint is low sexual desire, however—which some experts suggest impacts almost 50% of the female population—better possibilities might be testosterone patches, combination drugs (oral estrogen and testosterone), herbal remedies, or even Wellbutrin, though none of these may work if there are more underlying psychological or emotional aspects to the problem than physical ones.  

What about Addyi? 

Flibanserin, otherwise known as Addyi, was promoted as the “female Viagra”—but so far has fallen short.  Addyi works on serotonin and dopamine receptors in the brain rather than through increasing blood flow, and has shown some success in raising women’s libidos.  

But not by much.  In fact, one study found that women taking Addyi experience “one-half of an additional sexually satisfying encounter per month” more than those who did not.[5]   Addyi can also have unfortunate side effects like dizziness or fainting.  When taking Addyi, women are told to stay away from alcohol completely.  It makes one wonder if forgoing a glass or two of wine on “date night” could have an impact on the missing “one-half of an additional sexually satisfying encounter per month.”  

If nothing else, the intensity of the media conversation sparked by the search for a miracle “cure” should assure women that they are not alone if they experience flagging desire in a long-term relationship or over their life course—perhaps even being able to talk more openly about the complexities of desire, and of women’s relationships to their bodies and partners, can lead to positive outcomes.


[1] Chivers, M. & Rosen, Raymond.  (2009).  Phosphodiesterase Type 5 Inhibitors and Female Sexual Response:  Faulty Protocols or Paradigms?  Journal of Sexual Medicine.  7(2):  858-872. 
[2] http://health.discovery.com/centers/womens/viagra/viagra.html
[3] Kuczynski, Alex.  “Curious women are seeing if Viagra works wonders for them.”  The New York Times, May 17, 1998. 
[4] Bergner, D.  “What do women want?”  The New York Times, January 22, 2009. 
[5] https://www.nytimes.com/2016/03/01/health/female-viagra-addyi-flibanserin-sex-drive-women.html

Katherine Frank