Sildenafil Use in Women with Antidepressant-Induced Sexual Dysfunction

After detailed counseling, the couple opted for Sildenafil citrate 25 mg vaginally twice a day.

• Remember that sildenafil is not designed specifically for women; evidence is ongoing.
• Consult your healthcare provider for personalized advice concerning usage.
• Be aware that psychological and physical factors both influence female libido.
• The medication can help improve vaginal blood flow during arousal.
• Regular use without medical supervision is not recommended.
• Some women may experience improved sexual confidence with sildenafil.
• Manage expectations by understanding that results vary widely.
• Do not suddenly stop other medications without doctor approval.
• Educate yourself about symptoms of potential adverse reactions.
• Maintaining overall health can enhance the effectiveness of sildenafil.
• Use caution if combining sildenafil with herbal supplements.
• Ensure comprehensive sexual health assessment before commencing treatment.

Repeat ultrasound at 28 weeks showed an improvement in blood flow and an increase in AFI to 6.5 with a fetal weight of 680 g after starting sildenafil citrate as shown in Figure 4. The umbilical artery diastolic flow improved after 2 weeks of therapy, with no brain-sparing effect in MCA; however, the S/D ratio was >3.

Furthermore, ultrasound at 30 weeks showed an AFI of 7.5 and a fetal weight of 1,000 g. The patient also experienced a subjective increase in perception of fetal movements.

• Female-specific studies on sildenafil show mixed results.
• Sildenafil is sometimes used off-label for female libido enhancement.
• Always check for allergies before taking sildenafil citrate tablets.
• Sildenafil may cause vision disturbances in some women.
• Proper hydration can reduce side effects when using sildenafil.
• Combining sildenafil with alcohol can increase risks.
• Be aware of potential interactions with hormonal contraceptives.
• Do not share sildenafil tablets to prevent misuse or overdose.
• Women should report any adverse reactions to their healthcare provider.
• Sildenafil may help with certain conditions like Female Sexual Arousal Disorder.
• Cost of sildenafil for women varies, and insurance may not cover it.
• Follow prescribed instructions precisely to avoid overdose.

All medications were continued with weekly monitoring of fetal weight and AFI. Gradually at 31 weeks, there was further decrease in pulsatility index, and S/D ratio was <3, in both umbilical and MCAs as shown in Figures 5 and 6.

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Ask your pharmacist any questions you have about refilling your prescription. Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies. Back to Journals » International Journal of Women's Health » Volume 8 Authors Choudhary R , Desai K, Parekh H, Ganla K Published 9 August 2016 Volume 2016:8 Pages 367—372 Editor who approved publication: Professor Elie Al-Chaer Rana Choudhary,1 Kavita Desai,2 Hetal Parekh,3 Kedar Ganla1 1Department of Reproductive Medicine, Ankoor Fertility Clinic, 2Department of Radiology, Dadar Imaging and Diagnostic Centre, 3IVF Department, Hiranandani Hospital, Mumbai, India Abstract: Fetal growth restriction (FGR) and preeclampsia are the major causes of neonatal morbidity and mortality, which affect up to 8% of all pregnancies.

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The pathogenesis in FGR is an abnormal trophoblastic invasion leading to compromised uteroplacental circulation. However, in spite of this understanding and identification of high-risk patients, the management options are limited. There are some new studies which have demonstrated the role of sildenafil citrate in improving vasodilatation of small myometrial vessels and therefore improvement in amniotic fluid index, fetal weight, and even uterine and umbilical artery Doppler patterns. We report here the case of a 31-year-old female with infertility and preconceptional thin endometrium responding well to sildenafil citrate, followed by conception. However, she presented with an early-onset FGR at 26 weeks of gestation, and again after treatment with sildenafil citrate, showed improvement in amniotic fluid index and fetal weight, finally resulting in delivery of a full-term healthy baby with uneventful neonatal course. The fetal well-being was continuously monitored using biophysical profile every 2 weeks.

Sildenafil citrate therapy was stopped at 36 weeks. An elective cesarean section was done at 37th week for breech presentation, and a healthy female child of 2.3 kg was delivered. Baby cried immediately after birth, and Apgar score was 7/10 and 9/10 at 1 and 5 minutes, respectively.

Side Effects and Risks

Patient was called for follow-up visits every 3 weeks. Ultrasound for congenital malformation at 20 weeks did not reveal any abnormality. Fetal weight at that time was 440 g, and amniotic fluid index (AFI) was 10. Repeat ultrasound at 24 weeks was suggestive of oligohydramnios (AFI 6) with a fetal weight of 490 g (less than fifth percentile). Color Doppler in umbilical arteries showed normal systolic/diastolic (S/D) ratio, pulsatility index, and resistive index.

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

However, there was notching seen in the uterine artery Doppler study. Investigations such as complete blood count, blood sugars, liver function test, renal function test, urine routine, and microscopy were within normal limits. Her blood pressure was normal; there was no peripheral pitting edema or proteinuria and hence no evidence of preeclampsia. The couple was informed regarding the guarded prognosis of pregnancy, and written informed consent was obtained voluntarily. The patient was kept on bed rest and sildenafil 45 mg chewable tablets given vitamin supplements, intravenous amino acid infusions, and nitric oxide donor (L-arginine sachets). Placenta was examined after delivery; on gross examination, it was smaller in size (400 g) with areas of calcifications and increased thickness of membranes. On histopathological examination, there were areas of infarction.

What to avoid

Keywords: sildenafil citrate, fetal growth restriction, oligohydramnios, thin endometrium Early-onset fetal growth restriction (FGR) accompanied by severe oligohydramnios is often associated with high perinatal morbidity and mortality.1 Only a proportion of pregnancies with FGR show altered maternal peripheral vascular resistance, while some women may have elevated maternal peripheral vascular resistance in uterine arteries and hence poor perinatal outcome. In such pregnancies, if resistance values are normalized in later trimesters, there may be a significantly better outcome.2 Some recent studies have shown that sildenafil citrate increases uterine blood flow and potentiates estrogen-induced vasodilation.3 In this case of early-onset FGR, sildenafil citrate therapy was successful in managing FGR and accompanied severe oligohydramnios with a favorable neonatal and maternal outcome. A 31-year-old female with a history of secondary infertility of 1 year and 6 months was referred to our clinic. She had two spontaneous miscarriages at tenth week of gestation, the last being 2 years and 6 months back, both followed by dilatation and curettage. After her last abortion, she did not conceive for 2 years.

Side effects

Multiple cycles of ovulation induction with oral agents as well as injectable gonadotropins were done. All follicular studies showed consistently thin endometrium of 6–8 mm around the time of ovulation. On hysteroscopy done 1 year back, uterine cavity was normal. At our clinic, we started with follicular growth and endometrial thickness monitoring in natural cycle. Doppler for endometrial blood flow around the time of ovulation was suggestive of absent flow in zones 2, 3, and 4 of endometrium (Applebaum criteria).4,5 An attempt to improve the blood flow was made by starting Aspirin 75 mg, vitamin E, and Pentoxyfylline.6 However, repeat Doppler around the time of implantation did not show any improvement.

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In the next cycle, successful ovulation induction with gonodatropins was done, and sildenafil tablets lp 100 mg trigger was given when the follicle was 18 mm, followed by intrauterine insemination. Luteal support was given with oral estrogen, progesterone, and vaginal Sildenafil citrate 25 mg (Alivher®; Akumentis Healthcare Ltd., Mumbai, India) twice a day in view of decreased endometrial blood flow in the previous cycle, which may be one of the causes of repeated abortions.7 Doppler for endometrial blood flow around the time of implantation (7–8 days after ovulation) showed good flow in all the zones. Serum β-human chorionic gonadotropin test done 14 days later confirmed the pregnancy. Sildenafil citrate was stopped on confirmation of pregnancy. Ultrasound at 12 weeks for nuchal translucency, nasal bone, and dual marker test were normal. The maternal and neonatal courses were uneventful. We have followed up the child up to 14 months with normal mental and physical development. Adequate placental blood flow is essential for the optimal delivery of nutrients from mother to fetus and for growth of conceptus.

• Sildenafil may improve blood flow to the clitoris, aiding arousal.
• Use caution with grapefruit or grapefruit juice, which can affect drug levels.
• Document any pre-existing medical conditions before starting sildenafil.
• Sildenafil may cause dizziness; avoid activities requiring alertness.
• Women with liver or kidney impairment should consult a physician first.
• The drug is not a hormone; it works on blood vessels.
• Patients should report any sustained erections or discomfort.
• Combining sildenafil with certain antidepressants may alter effectiveness.
• Keep track of any changes in sexual satisfaction or function.
• Sildenafil should be used as part of a comprehensive treatment plan.
• Avoid using sildenafil with recreational drugs that affect the cardiovascular system.
• Always follow up with your healthcare provider for ongoing assessment.

Restricted fetal growth results from pathophysiological and environmental factors, which alters uteroplacental blood flow, placental function, and therefore, nutrient availability to the fetus.8,9 There are still limited data on the efficacy of sildenafil citrate for treatment of FGR. In our case, we found sildenafil citrate useful in pregnancy complicated by severe oligohydramnios with FGR probably as it improves the placental perfusion. Sildenafil citrate, a specific phosphodiesterase-5 inhibitor, has been proposed as a potential therapeutic strategy to maintain placental function and emerging as a potential candidate for the treatment of intrauterine growth restriction.10 In this case of previous pregnancy losses and thin endometrium, vaginal sildenafil citrate improved the uterine artery blood flow and endometrial thickness and hence reduced the chances of miscarriages.7 Further, when there was problem with the placental perfusion in second trimester, we restarted vaginal sildenafil citrate.

• Sildenafil citrate can be prescribed off-label for female sexual dysfunction.
• Consult a doctor before using sildenafil citrate tablets for women.
• Side effects in women may include headache, flushing, or nasal congestion.
• Sildenafil works by increasing blood flow to enhance female arousal.
• Dosage for women varies; always follow medical advice.
• Sildenafil tablets may interact with other medications, like nitrates.
• Not approved by FDA specifically for female sexual dysfunction.
• Use with caution in women with heart conditions or high blood pressure.
• Possible benefits include improved libido and vaginal blood flow.
• Sildenafil should be taken on an empty stomach for best results.
• Long-term safety of sildenafil in women is not well established.
• Store sildenafil citrate tablets in a cool, dry place out of children’s reach.

Studies have shown that it helps in improvement of uteroplacental blood flow and in turn improves the fetal weight3,11,12 by causing vasodilatation of the intra-myometrial and intra-placental blood vessels. Increased uteroplacental blood improves the delivery of oxygen and other nutrients to fetus, which results in improved growth and development.

Statistical Analysis

Ultrasound at 26 weeks showed an estimated fetal weight of 550 g and an AFI of 4.5. Color Doppler showed an increased S/D ratio in the umbilical arteries with brain-sparing effect in the middle cerebral artery (MCA) as shown in Figures 1 and 2. A repeat ultrasonography at 27 weeks showed reduction in diastolic flow in the umbilical arteries. Figure 3 shows the ultrasonography Doppler image with reduced blood flow at the myometrial placental junction at diagnosis of intrauterine growth restriction. In view of grave prognosis of the pregnancy and unavailability of any other established definitive treatment, the couple was counseled regarding the limited role and experimental nature of Sildenafil citrate in oligohydramnios and FGR.