FEMALE SEXUAL AROUSAL DISORDER

Female Sexual Arousal Disorder (FSAD) = "Persistent or recurring inability to attain or maintain sufficient sexual excitement that causes personal distress" (American Foundation of Urological Diseases)

• Includes both objective manifestations (e.g. genital lubrication) and subjective excitement
• Distinct from hypoactive sexual desire disorder (HSDD) and female orgasmic disorder.

Sildenafil for FSAD

• 53 women 22-38y with subjectively normal sexual desire but FSAD x > 6mos randomized different sequences of sildenafil 25mg, sildenafil 50mg, or placebo (each x 4wks, in varying order, with 1wk washout in between treatments) PRN 1h before intercourse. Both sildenafil doses were associated with sig. higher sexual satisfaction scores (compared with baseline); placebo was not. (Br J Obstet. Gynaecol. 108:623, 2001)
• 202 postmenopausal women with FSAD > 6mos and "normal" (premenopausal) levels of testosterone and estradiol randomized to 50mg (titratable to 100mg or 25mg) x 12wks. Main outcomes were increased genital sensation w/stimulation and improved satisfaction w/intercourse and/or foreplay. Sildenafil group had sig. greater likelihood of improvement over baseline in these two measures than placebo group. This difference was ONLY seen in the subgroup of pts with no concomittant HSDD (44% of the study cohort). Among pts w/o HSDD given sildenafil, vs. pts given placebo, 69% (vs. 41%) reported increased genital sensation with stimulation, and 50% (vs. 20%) reported improved satisfaction w/intercourse and/or foreplay. (J. Urol. 170:2333, 2003)