Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: a randomised controlled trial

Objective Some postmenopausal women lose genital sexual responsivity despite preserved subjective sexual arousal from non-genital stimuli. When oestrogen replacement is without benefit, both the underlying pathophysiology and management of this acquired genital female sexual arousal disorder are unclear. We aimed to study the effect of sildenafil on sexual arousal and orgasmic functioning of such women. Secondly, we aimed to explore the concordance between a detailed historical assessment of genital response in real life, with laboratory vaginal photoplethysmographic assessment of genital vasocongestion. Design Session one consisted of a semi-structured clinical interview to assess real life sexual arousal. Session two employed vaginal pulse amplitude and self-report questionnaire assessment of erotica-induced sexual arousal. Sessions three and four were a randomised, double-blind, placebo-controlled crossover administration of sildenafil on orgasm latency, intensity, perception of genital congestion and subjective arousal to erotica plus clitoral vibrostimulation. Setting University associated Sexual Medicine Clinic and Psychophysiology Laboratory. Sample Volunteer sample of 34 oestrogenised postmenopausal women with acquired genital female sexual arousal disorder and impaired orgasm. Methods Sildenafil (50 mg) or placebo administered over two laboratory sessions. Main outcome measures Orgasm latency and intensity during drug sessions; subjective and psychophysiological sexual arousal during photoplethysmography session. Results The erotic video significantly increased subjective sexual arousal in all women. Vaginal pulse amplitude responses varied from robust to absent. Although across all women, sildenafil improved neither arousal nor orgasm, subsequent analyses comparing high versus low vaginal pulse amplitude responders revealed significantly reduced latency to orgasm, and increased subjective sexual arousal and perception of genital arousal in the latter group of women. Conclusion The data suggest that oestrogenised postmenopausal women with genital female sexual arousal disorder and orgasmic impairment based only on clinical assessment do not benefit from sildenafil. However, the photoplethysmograph had predictive value-those women showing low vaginal pulse amplitude response benefited from sildenafil compared with women with a higher response. Thus, oestrogenised women diagnosed with acquired genital female sexual arousal disorder may be a heterogeneous group and the photoplethysmograph might be useful in their further characterisation.