During the discovery of heart medication, a curious side-effect became apparent: it gave guys boners. Image credit: Yuriy Maksymiv/Shutterstock.com

Viagra, the famous little blue pill, is a medication used to treat erectile dysfunction. However, what would hypothetically happen if someone without a penis were to take this medication? 

First thing’s first: Viagra is not indicated or approved for use in women by the US Food and Drug Administration (FDA). In the US, Viagra is only available through prescription and the FDA’s approval of the drug is restricted to use under the supervision of a licensed healthcare professional. In the UK, a form of Viagra is available over the counter without a prescription for men over 18, but the pharmacist should ask a few private questions before handing over the drug. In other words, don’t try this at home — never take Viagra unless you meet the recommended criteria and get the thumbs up from healthcare professionals. Seriously.   

With that in mind, let’s explore. 

How Does Viagra Work?

Sildenafil is the active ingredient found in medication commonly sold as Viagra. Sildenafil was initially discovered by Pfizer scientists while looking for a treatment for heart-related chest pain in the 1980s. The idea was that the drug would block the action of an enzyme called PDE5. By stopping PDE5 from working, sildenafil causes the blood vessels to relax, increasing blood flow and lowering blood pressure. 

However, a curious side-effect of the drug became apparent: it gave guys boners. There are numerous types of PDE, but PDE5 — the one that sildenafil acts on — is highly expressed in the corporal erectile tissue of the penis. This means that the drug is particularly effective in increasing blood flow to the penis, resulting in an erection. Since erectile dysfunction is so common among people of all ages, there was a clear market for an oral pill that safely resulted in erections, and the drug was approved for medical use to treat male impotence by the US and in the European Union in 1998. 

What Does Viagra Do To Women?

Although Viagra is not approved for general use in women by the FDA, a number of scientific studies have explored what effect its active ingredient, sildenafil, has on women. 

It’s known that PDE5 inhibitors, such as sildenafil, also cause an increased blood flow to the vagina and clitoris, which results in a clitoral erection. This is because PDE5 is also expressed in vaginal, clitoral, and labial smooth muscles, just like the corporal erectile tissue of the penis. One avenue of interest has looked at whether it could help women experiencing low sexual libidos. A small study in 2008 found that sildenafil may help women who struggle to feel sexually aroused due to taking anti-depressants.

Broader evidence that it can benefit women with low libidos is inconsistent and lacking. As one example, a larger randomized clinical trial in 2002 looked at whether sildenafil could help women with female sexual arousal disorder, but it had no significant impact.

As well as this lack of evidence, the drug can bring some unwanted side effects, such as headaches, hot flushes, dizziness, nausea, stuffy nose, and visual disturbances. Furthermore, there’s a lack of data on whether the drug is safe for women since the drug is overwhelmingly used by men. This means, in this scenario, to treat erectile dysfunction, the drug was likely only tested on men and the real impact the drug might have on women, particularly in the long term, is shrouded in uncertainty. 

However, there is a real need to better understand the effects sildenafil has on women given the potential benefits the drug might have for other conditions. A study from earlier this year found that Viagra can significantly reduce the risk of another heart attack and increase the life span in men already diagnosed with cardiovascular disease. Just recently, another promising study even hinted it might help to ward off Alzheimer’s disease.

Is there a "female Viagra" for women? 

You may have come across articles talking about a "female Viagra", but that's a bit misleading. Discussions around "female Viagra" generally refer to drugs called flibanserin, which comes in little pink pills sold under the brand name Addyi, or bremelanotide, sold under the brand name Vyleesi. The FDA has approved both these medications in recent years to treat "acquired, generalized hypoactive sexual desire disorder," essentially a lack of libido, in pre-menopausal women. 

However, there is a significant amount of controversy surrounding these drugs. Unlike Viagra, which sparks a purely physiological reaction, these two drugs act on brain chemistry that's associated with mood and thinking (flibanserin was initially developed as an antidepressant). How effective they are is unclear as results are mixed and they are associated with undesirable side effects. The lack of directly comparable drugs for women, with proven results and easy access, has fired up discussion about how female sexuality is treated in science, as well as the medicalization of low sex drives. 

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