Female Viagra: what it is and what it is not

Why is the name misleading?

Worth addressing before anything else, because the wrong expectation guarantees disappointment.

In men, erectile difficulty is frequently a plumbing problem — the desire is there, the blood flow is not. A drug that improves blood flow solves it.

Female sexual difficulties are structured differently. Blood flow matters, but it is rarely the limiting factor.

The common problems are low desire, difficulty becoming aroused, difficulty reaching orgasm, and pain. Of those, only the second is substantially a blood flow question.

So this product addresses one component of a system where that component is usually not the bottleneck. That is the honest position.

What it actually does

It contains sildenafil, the same compound used in men.

Genital tissue in women also contains erectile tissue, and it also engorges with arousal through the same signalling pathway. Nitric oxide release, a messenger that relaxes smooth muscle, increased blood flow.

PDE5 breaks that messenger down. Sildenafil blocks PDE5, so the messenger lasts longer and blood flow increases.

That can mean more engorgement, more sensitivity and better natural lubrication.

What it does not do: produce desire. Desire originates in the brain, in hormonal and psychological systems this drug does not touch.

Where it may genuinely help

• Reduced genital blood flow after the menopause
• Arousal difficulty where desire is present but the physical response lags
• Sexual side effects from some antidepressants, where this has been studied
• Vaginal dryness alongside, not instead of, other measures

The pattern where it is most plausible: you want to, but your body is not keeping up. That is an arousal problem rather than a desire problem.

Where the real causes usually lie

Being thorough about this is more useful than a longer sales pitch.

• Hormonal. Menopause, after childbirth, breastfeeding, thyroid problems, some contraception
• Medication. Antidepressants above all, but also some blood pressure medicines and hormonal contraception
• Pain. Dryness, endometriosis, pelvic floor tension, vaginismus. Pain destroys desire reliably and the pain needs addressing, not overridden
• Exhaustion. Consistently underestimated. Chronic tiredness suppresses desire more than almost anything else
• The relationship. Resentment, distance, routine
• Mental health. Depression and anxiety both reduce desire substantially
• Body image and past experience

Any one of those will defeat a blood flow drug entirely, because the drug is not addressing the problem.

Taking it

• Around thirty minutes to an hour beforehand.
• Not after a heavy fatty meal, which delays absorption.
• Once in twenty-four hours at most.
• Limited alcohol.
• No grapefruit juice.

Arousal is still required — it amplifies a response rather than producing one.

Nitrates: absolute

Anything taken for angina — glyceryl trinitrate, isosorbide mononitrate or dinitrate, nicorandil, including an emergency spray. Also amyl nitrite sold as poppers.

Together the blood pressure drop can be life-threatening. If you take any of these, this is out.

Who should not take it

• Recent heart attack or stroke
• Unstable angina
• Severe heart failure
• Uncontrolled or very low blood pressure
• Severe liver disease
• Retinitis pigmentosa
• Pregnancy or breastfeeding

Possible side effects

• Headache, the most common
• Flushing
• Blocked nose
• Dizziness
• Indigestion
• Visual tinting

What tends to help more

• A good lubricant, which solves more than people expect
• Vaginal moisturisers or local oestrogen after the menopause
• Reviewing medication, especially antidepressants
• Treating pain as a medical problem rather than enduring it
• Pelvic floor physiotherapy where there is tension or pain
• Sleep and reduced load, dull as that sounds
• Sex therapy, particulary where the change was sudden
• Taking the pressure off, which changes more than any tablet

The first item on that list resolves more complaints than anything further down it, and costs the least.

Ordering without prescription: how it works

Keeping some at home is the usual reason for ordering online rather than asking at a counter.

Pick the strength and the pack size, put in a delivery address, confirm. Couple of minutes, any time of day, no queue and no conversation across a counter.

It goes out in plain packaging. No pharmacy name on the outside, nothing that hints at what is inside. How long delivery takes depends on where the parcel is headed.

On price it comes down to strength and pack size. Larger packs generaly work out better per unit.

A parcel locker or a work address works as well as home for UK delivery, provided the details are complete and the name is on the door. The plain packaging is unchanged either way.

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