Sunday, January 3, 2010

Viagra and Women

Viagra doesn’t work as a treatment for women, most studies show. But new research suggests that among women who suffer sexual side effects as a result of antidepressants, the little blue pill may help.

Sexual side effects due to antidepressant treatment are common, affecting from 30 percent to 70 percent of men and women who use the drugs. In the first month of treatment, about two out of three patients will stop using antidepressants, often citing sexual side effects as a reason.

In a new study, researchers studied the effects of Viagra and a placebo in 98 women, average age of 37, who were using antidepressants for major depression. All the women also reported sexual side effects like lack of arousal or difficulty achieving orgasm. For eight weeks, the women took either Viagra or a placebo pill one to two hours before having sex.

The study, which was funded by Viagra-maker Pfizer, showed that 72 percent of women taking Viagra reported improvement, compared to 27 percent of those taking the placebo. The Viagra users reported significant improvements in their ability to achieve orgasm and enjoyment and showed greater improvement in overall sexual function based on an established rating scale.

The finding is believed to be the first time researchers have demonstrated an effective treatment for antidepressant-related sexual side effects in women. It’s also one of the few studies that has shown a benefit of Viagra for women with sexual problems. So far, studies of Viagra in women have been disappointing, showing that while the drug increased blood flow to a woman’s genital area, that change failed to enhance women’s enjoyment of sex.

Because the study involved only a small group of women, it’s not viewed as conclusive. In addition, because Viagra has obvious side effects, such as flushing and headache, it’s possible the Viagra users were aware they were getting the real drug and not the placebo, which could have influenced their perceptions of the benefit.

Dr. Glenn D. Braunstein, an endocrinologist and chairman of the department of medicine at Cedars-Sinai Medical Center in Los Angeles, told The Los Angeles Times that the findings need to be confirmed in a larger group of women. That said, he expects many women using antidepressants won’t wait for another study.

“If I had to predict, use of Viagra will go up,” he told the paper. “A woman might not even ask her gynecologist for it — she might just ask her significant other to give her some.”

Why Study the Relationship Between Women and Viagra?

At first glance, it makes little sense to examine the relationship between women and Viagra. After all, this drug was developed to treat impotence in men and nearly all prescriptions written for Viagra are for this purpose. However, Viagra has done much more than merely treat male sexual dysfunction--it has excited the media and captivated the attention of the American public as a whole. Not since Prozac has America become so fervent over a drug and the potential it has to change the way we live. This excitement extends far beyond the male segment of our society: Viagra has the potential to drastically change the sex lives of women as well.

For too long, sexual disorders in women have been ignored by the American medical establishment. Ironically, Viagra, a drug intended for use in men, has had the effect of bringing female sexual dysfunction to the forefront of discussion in the medical community. As doctors begin to explore the potential use of Viagra in women, investigators are re-examining what constitutes female sexual dysfunction. In so doing, myriad issues relating to gender bias in the way we perceive sex have begun to surface. Since there is virtually no academic literature which discusses the effects Viagra has and will have on women, this report is meant to bring together many of the ideas which have begun to surface in popular media circles. When examined as a collective, perceptions of this drug and its use in women speak volumes about larger social issues in America.

What Is Viagra and What Does It Do?

Viagra is the common name for the molecule sildenafil citrate, a powerful phosphodiesterase inhibitor. This molecule works by preventing a specific phosphodiesterase (PDE5) from breaking down cyclic GMP in a complex cascade of chemical reactions.1 The net effect of Viagra is to cause certain blood vessels to dilate and surrounding muscle to relax, which leads to increased blood flow in specific tissues (i.e. penile tissue). Although the effects of Viagra are mostly localized to the genitals, other parts of the body can be affected, leading to side effects such as blue-tinted vision and nausea.

Interestingly, sildenafil citrate was first developed as a potential treatment for patients suffering from cardiac ailments. However, while Pfizer, the company which developed the drug, was conducting clinical trials, many male patients noticed that their ability to achieve erection greatly increased.2 Subsequently, the course of Viagra research shifted drastically, and today Viagra has become one of the principal options available to physicians in the treatment of erectile dysfunction in men.

It is well documented that Viagra works well in most men unable to achieve erection, but no one really knows what effects, if any, Viagra might have in women. It is theorized that because the vasculature and tissues of the clitoris are similar to those of the penis, sildenafil citrate could increase blood flow to the female genitals in the same way it does in males.3 It is important to note that this is merely a hypothesis some investigators hold, to this point in time, no definitive research has been done to show that this is actually the case.

Regardless of whether or not Viagra increases blood flow to the clitoris, the idea that it could be used in this manner opens a pandora's box of social issues regarding sex. First and foremost is the question of whether sex is primarily for pleasure or reproduction. A woman does not need to have an orgasm for fertilization to occur (although it is possible that the involuntary contractions of the uterus during orgasm may assist the movement of sperm into the oviduct).4 Still, American culture perceives sex first as a pleasurable experience and then as a means of procreation. People often want to have sex but don't want to have a child--as evidenced by the widespread use of contraception. Under this paradigm of sexual enjoyment, there is no reason why women should not have the same opportunity to experience the pleasures associated with sex as men.

Women and The New Pill

There are several reasons why more and more researchers are contemplating the use of Viagra in women. First of all, there is societal pressure from both men and women who hope that Viagra might be just the thing to improve their sex lives. Physicians are members of the population as well--they see the magazine articles, television news reports, and newspaper columns which are all part of America's Viagra craze. Thus, our societal obsession with Viagra has undoubtedly affected the thinking of these researchers and caused them to wonder what might happen if women could were to be treated with this drug.

Another principal reason why investigators are curious about the use of Viagra in women stems from a fundamental shift in perceptions of female sexual dysfunction. It used to be that if a woman could not achieve orgasm, her dysfunction was blamed on psychological problems. Recently, however, there has been movement away from psychology towards physiology in the perception of female sexual dysfunction.5 Accompanying this shift is a change in treatment strategy--from psychological therapy to drug treatment. However, there are no drugs specifically designed to treat sexual dysfunction in women, and thus, many researchers see Viagra as the best option for treatment.

There are also certain economic factors which have spurred interest in the use of Viagra in women. Currently, Viagra is the hottest selling prescription drug on the market--and the vast majority of these prescriptions are written for men. Thus, if the market for Viagra were to expand to encompass women, then Pfizer (and other pharmaceutical companies which are working on drugs similar to Viagra) would stand to nearly double their profits.6

Testing Viagra in Women

Although Viagra has been tested thoroughly in men, no one really knows what this drug will do in women. Thus, most physicians agree that similar studies to those previously conducted in men must be performed on women to determine the efficacy and safety of the drug. One of the main problems with such a study is determining how the effects of Viagra in women can be gauged. In men, the ability to achieve erection was a relatively straightforward method of determining Viagra's efficacy, however, such a measure is not so readily available in women. Researchers argue that there may be several effects of this drug in women which must somehow be measured (amount of lubrication, blood flow, overall sexual sensation, etc.) which complicates these studies.

In Europe, Pfizer is currently conducting clinical trials of Viagra in women.7 The methods Pfizer has adopted to measure the effects of this drug in women are similar to those the company used in men--patients are given detailed questionnaires concerning several aspects of sexual arousal/performance, and the results of these surveys used to determine efficacy. The results of this study, however, are not yet available, causing some U.S. doctors to take matters into their own hands.

Although Viagra only has the approval of the Food and Drug Administration (FDA) for use in men, doctors are legally allowed to write prescriptions for Viagra for any person, regardless of sex. Thus, many physicians, not willing to wait for the results of clinical studies, have begun performing "proof-of-concept" studies on female patients. These studies, although often well-intended, have several problems associated with them. First, the sample size of these trials are often too small to accurately determine whether there are any significant effects caused by Viagra in women. Furthermore, these studies use different methods (doses of Viagra, method of measuring response, etc.) from one another making it impossible to examine the results of these studies as a whole. Also, because these studies tend to be conducted out of a physician's desire to help his or her patient, they tend to be performed without proper control groups--a necessary treatment in any scientific study.

The dangers associated with administering a drug that might have unknown deleterious side-effects to patients have led many in the medical community to disapprove of these "proof-of-concept" studies. Some argue that the women who participate in these studies are little more than human guinea pigs--a means to satisfy the curiosity of rogue investigators. However, these women participate in these studies, no matter how unethical they may be, because they want to--they have the right to wait for the results of more accepted clinical trials.

Some women have gone a step further and begun testing Viagra in themselves without the supervision of a physician. The results of such anecdotal studies can be found on the pages of popular magazines such as Cosmopolitan and Harper's Bazaar, as well throughout the world-wide-web. Many women who take Viagra illegally may be doing so for a number of reasons. Journalists may be cashing in on the wide-spread cultural interest in Viagra to increase their readership; others may be simply be interested in trying Viagra as a recreational drug--much like marijuana or cocaine. Regardless of motive, these anecdotal studies are dangerous. The specific effects of Viagra in women are unknown, and there is the definite possibility that Viagra can be dangerous in women who have certain heart conditions, just as in men.

Arousing Each Others Sexual Desires

Men and women are different. In bed, they act differently to achieve a single goal – ecstasy. Your desires and your partner’s sexual needs are not the same. And your role to each other is to answer one another’s whims and fetishes in bed. Total intimacy is achieved by most couples because they understand this fact. The give and take relationship works best with them.

To arouse your desires and satisfy your partner, the first step is to understand your partner’s sexuality. Know more about your partner’s sexual behavior in bed. Does he prefer the more conventional ways of making love? Or is he more on the adventurous side that is very willing to try even the most absurd sex toy? Once you know more about your partner, you can easily adjust. And you will surely be able to answer his desires and yours, and make your partner love you more in the process.

There’s two ways to get this done. You can discuss sex with your partner directly or you can simply be a silent observer. Whenever you make love, you can talk dirty or passionately to your partner and see where he responds better. You can also try to play as the one with the upper hand in bed at one time and see whether he enjoys that or not.

You can know more about your partner through his actions. And at which point, you can decide for yourself if that’s the sex life you want or not. You can choose to introduce changes to your sexual relationship or you can just go along with it. The more important thing is that you know where you stand. The decision is yours if you want to give in or give up.

The difference between a man’s and woman’s view about sex has a lot to do with this. Men have sex to feel better and be gratified. Women, on the other hand, do it out of love and deep emotions. A woman’s desire is usually rooted in her heart. For a man, it is purely physical most of the time.

With the right mindset, a man and a woman can complement each other perfectly in bed. Just be what the other wants exactly. Know about the mood and the fantasies of your partner right there and bring them all to life. The way you approach your partner can put him or her in or out of the sex mood. It is important to know the spots you should touch your partner to solicit the right response. Once you have mastered the art of making love, arousing each other’s desires become a simple task.

Why There Will Never Be Viagra for Women

Psychologist Meredith Chivers conducted research that involved showing a variety of sexual videos to men and women, both straight and gay. The subjects’ genital blood flow (an indication of arousal) was monitored while they watched. Chivers found that the men were pretty predictable. The straight ones responded to anything involving naked women, but were left cold when only men were on display. Gay men were similarly consistent, though at 180 degrees.

The female subjects, on the other hand, were the very picture of inscrutability. Regardless of sexual orientation, most of them experienced increased genital blood flow whether they were watching men with men, women with women, a naked guy on the beach, a sweaty woman in the gym, or bonobo chimps in the zoo. But unlike the men, many of the women weren’t consciously aware of being turned on. Their bodies said “Yes,” but their minds said, “What?”

The disconnect between what these women experienced on a physical level and what they consciously registered suggests that women’s greater erotic flexibility may make it harder to know—and, depending on what cultural restrictions may be involved, to accept—what they’re feeling.

Psychologist Richard Lippa teamed up with the BBC to survey over 200,000 people of all ages from all over the world concerning the strength of their sex drive and how it affects their desires. He found a similar inversion of male and female sexuality: for men, both gay and straight, higher sex drive increased the specificity of their sexual desire. Straight guys with higher sex drives tended to be more focused on women, while higher octane gay guys were more intent on men. But with women—at least nominally straight women— Lippa found the opposite effect: the higher her sex drive, the more likely a woman was to report being attracted to both men and women. Self-identified lesbians showed the same pattern as men: a higher sex drive meant more women-only focus. Perhaps this explains why nearly twice as many women as men consider themselves bisexual, while only half as many consider themselves to be exclusively gay.

Those who claim this just means men are more likely to be repressing some universal human bisexuality should consider sexologist Michael Bailey’s fMRI scans of gay and straight men’s brains while they viewed pornographic photos. They reacted as men (and dogs, with all due respect to both) tend to do: simply and directly. The gay subjects liked the photos showing men with men, while straight subjects were into the photos featuring women. Bailey was looking for activation of the brain regions associated with inhibition, to see whether his subjects were denying a bisexual tendency. No dice. The men showed no unusual activation of these regions while viewing the photos.

Sexologist Lisa Diamond spent over a decade studying the ebb and flow of female desire, finding that many women experience sexual attraction to specific people, rather than to a particular gender. She writes, “The hypothesis that female sexuality is fundamentally fluid provides the most robust, comprehensive, and scientifically supported explanation for the research data.”

This fundamental fluidity finds support in studies of heterosexual couples who engage in group sex or mate-swapping. They agree that it is common for “heterosexual” women to have sex with other women in these situations but that men almost never engage with other men. While we’d be the last to cite popular culture as a reliable indicator of innate human sexuality, it’s probably worth noting that women kissing each other has quickly become accepted as innocent titillation in the U.S., while depictions of men kissing each other on television or films remains unusual and controversial. Most women presumably wake up the morning after their first same-sex erotic experience more interested in finding some coffee than in conducting a panicked reassessment of their sexual identity. The essence of sexuality for most women seems to include the freedom to constantly adapt to the changes life presents.

Faced with the mysteries of woman, Sigmund Freud, who seemed to have an answer for everything else, famously came up empty. “Despite my thirty years of research into the feminine soul,” he wrote, “I have not yet been able to answer . . . the great question that has never been answered: what does a woman want?” There is, perhaps, a liberating simplicity in women’s feline complexity, which both contemporary pharmacological researchers and Sigmund Freud seem to have overlooked. What does woman want? It depends.