Medication Choices

Estrogen. If you only have vaginal
dryness and irritation (and not other symptoms such as hot flashes), you can
use a limited amount of
estrogen in a cream, tablet, or ring in the vagina.
The daily estrogen makes your tissue less thin and sensitive and more moist.
Many women find that using a cream or tablet twice a week is enough. This may
increase vaginal tone and , which will decrease
vulvar dryness, irritation, and shrinkage (atrophy).

If you also have other
menopausal symptoms that affect physical and mental
well-being, talk to your health professional about taking daily (systemic)
estrogen therapy.
Estrogen can increase the blood flow in the
vagina, as well as reduce hot flashes and other
symptoms of
menopause.
Estrogen therapy or
estrogen-progestin therapy can be oral (pills),
vaginal, or (with a patch). In a small number of women, hormone
therapy causes heart disease, breast cancer, dangerous blood clots, stroke, and
dementia. Talk to your health professional about whether this therapy is right
for you.

Testosterone. This hormone may play a part
in a woman’s sex drive and satisfaction. The ovaries make
testosterone throughout a woman’s lifetime. Women have
the most testosterone in early adulthood; testosterone levels drop by half
between the early 20s and the early 40s.

In women who have their ovaries removed (oophorectomy),
testosterone drops by 50%.¹⁰ If you have had an
oophorectomy, your health professional may suggest trying
testosterone therapy. But the U.S. Food and Drug
Administration (FDA) has not approved any testosterone therapy for women.

What To Think About

The formula called Estratest is
not approved by the FDA. The company that makes it
markets it for moderate to severe
menopausal symptoms. It is also prescribed to some
menopausal women to improve sexual desire and
response. But Estratest is made with
, which the body uses differently than testosterone. It does
not directly raise the amount of testosterone in your body. And, taking a
testosterone by mouth does put you at risk for problems with your liver and
possibly your heart. Using a patch or cream does not.

At this time, there is no testosterone pill, patch, or cream
approved for women-those made for men have too high a dose for women. Side
effects of too much testosterone include acne, facial hair, and loss of hair
and a deepening of the voice, which may be permanent.

No studies have looked at the benefits and risks of taking
testosterone for longer than 6 months. The long-term effects of testosterone
therapy in women are not known.¹⁰

Sildenafil (Viagra) is used to treat
erectile dysfunction in men. The maker of this
medicine has decided not to market it for improving women’s sexual desire and
arousal. This was based on research showing that sildenafil was not effective
for most women. The maker has commented that women’s sexuality is a complex mix
of physical, emotional, and relationship factors, and it is not as simple to
treat with a medicine as male erectile dysfunction is.¹¹

Currently no medications are approved by the FDA to treat female
sexual problems, although several paths are being studied, including
stimulation of certain molecules (receptors) in the brain and increasing blood
flow to the genitals. It is still too early in the process to know whether any
of these medications will prove to be effective and safe treatment
options.¹²

Nov. 16, 2005 — A drug called Revatio may help treat an condition called pulmonary arterial .

Patients with pulmonary hypertension have elevated blood pressure in the pulmonary (lung) blood vessels. The condition often arises from lung problems, but some cases are without a known cause. It can result in heart failure and early death.

, most of the medications that are used to treat this serious condition are not easy to take and are given by IV, injection, or inhalation — with real risks of unwanted side effects.

Revatio has the same active ingredient — — as Viagra. Revatio and Viagra are made by Pfizer.

Pfizer funded the new study, which appears in The New England Journal of Medicine. Pfizer is a WebMD sponsor.

The researchers included Nazzarene Galie, MD, of the cardiology institute at Italy’s University of Bologna.

Walking Test

The study lasted for 12 weeks. It included 278 patients with pulmonary hypertension. The patients lived in the U.S., Mexico, South America, Europe, Asia, Australia, South Africa, and Israel.

Three times daily, the patients took Revatio (20, 40, or 80 milligrams) or an empty drug (placebo) orally. That was in addition to any other standard pulmonary hypertension medications.

The big question was how far patients could walk in six minutes. That’s an important exercise test for patients with pulmonary hypertension. The farther patients can walk, the better.

Walking Farther

All of the patients taking Revatio walked farther at the end of the study:

• 20-milligram group: Walked about 148 extra feet (a 13% increase).
• 40-milligram group: Walked about 151 extra feet (a 13% increase).
• 80-milligram group: Walked about 164 extra feet (nearly a 15% increase).

Higher doses didn’t bring a notable increase in distance walked, the researchers report.

Patients were then allowed to take Revatio for up to a year; 230 did so. The researchers looked at the walking tests of 222 of those who were only taking Revatio as treatment. After a year, they walked about 167 extra feet, on average, compared with the beginning of the study.

How Patients Fared

Most of the patients included in the study had milder stages of pulmonary hypertension. Few cases worsened, regardless of treatment type, the study shows.

Patients taking Revatio weren’t any more or less likely to have their symptoms worsen during the trial.

The study wasn’t designed to see if Revatio helped patients live longer. Four died during the study. No deaths were judged to be linked to the , write the researchers.

Side effects seen with Revatio were mild or moderate and included headache, flushing, muscle pain, and diarrhea, report Galie and colleagues.

July 24, 2006 — Like Viagra before it, a drug once studied to treat heart problems may help treat sexual . But this time it’s being tested exclusively for women.

A new study shows that a modified version of the experimental heart drug Candoxatril was effective at increasing blood flow to the vagina in animal tests.

If further research confirms these results in humans, the drug may be used to treat female sexual arousal disorder (FSAD).

Researchers say an estimated 40% of women suffer from FSAD or other forms of sexual dysfuction, such as low libido or pain during intercourse.

Candoxatril went into clinical trials in the 1990s as a heart failureheart failure medication but has since become the focus of efforts to develop a medication to treat female sexual arousal disorder.

How the Drug Works

Candoxatril is one of several compounds that targets levels of vasoactive peptide (VIP), which controls blood flow to the vagina. Researchers say decreased blood flow to the vagina is thought to be a key factor in female sexual arousal disorder.

An enzyme called NEP degrades VIP in the body, and Candoxatril works by blocking NEP.

In a new study, published in the Journal of Medicinal Chemistry, researchers altered the molecular structure of Candoxatril in order to focus the drug to treat female sexual arousal dysfunction.

In animal tests, researchers at Pfizer Global Research and in the U.K., found the new compound effectively blocked NEP, took effect quickly, and the effect lasted for a relatively short time.

They say the results suggest that the drug might have similar effects in humans, but further research is needed.

Nov. 7, 2005 - The drug made famous for its treatment of erectile appears to have another therapeutic use.

A study in the journal Circulation suggests Viagra could help treat a circulatory disorder called Raynaud’s phenomenon, which affects about 5% of the population. Raynaud’s phenomenon can be associated with other diseases such as lupus.

Raynaud’s phenomenon causes episodes of numbness, tingling, and pain in the fingers and toes, as well as skin sores or gangrene in severe cases. The attacks are spawned by spasms in small blood vessels in response to cold temperatures or emotional stress.

These spasms cause blood vessels to constrict and compromise blood flow to distal areas such as toes and fingers. The disorder is sometimes treated with medications to relax the blood vessels, but this is not always successful.

The Viagra study involved 18 patients (mostly women) whose Raynaud’s symptoms were not responsive to therapies. While taking Viagra twice a day for four weeks, the patients experienced improved blood flow in the and fewer Raynaud’s attacks. Symptoms improved and the duration of attacks was also shorter. In those who had skin sores, the ulcers began to heal visibly.

These effects did not occur while patients were taking a placebo. At the end of the study, 16 of the participants asked to continue taking Viagra off-label (that is, for a purpose other than its FDA-approved use).

Viagra causes blood vessels to dilate in a different way from other vasodilating drugs, which may explain why it helped Raynaud’s patients who didn’t respond to standard treatments. The researchers conclude that drugs like Viagra could offer “a promising new approach in patients with microcirculatory disorders.”

Although Viagra has risk for serious side effects such as heart attack, stroke, and vision loss, none of the study participants reported any such adverse effect. The side effects reported by study participants included headache, muscle pain, flushing, mild nausea, dizziness, and nasal congestion.

One of the researchers has served as a consultant and speaker for Viagra’s , Pfizer. Pfizer is a WebMD sponsor.

Oct. 25, 2006 — Viagra may ease blood pressure in the lungs of people with chronic obstructive pulmonary disease (COPD).

That’s according to a small Dutch study in Salt Lake City at Chest 2006, held by the American College of Chest Physicians.

COPD is the No. 4 cause of death in the U.S. and worldwide, according to the National Heart, Lung, and Blood Institute (NHLBI).

COPD is a lung disease in which breathing is difficult. It’s usually caused by smoking , but it can also be caused by other lung irritants.

The disease develops slowly and may take years to show symptoms, which include:

• Cough
• Sputum (mucus) production
• Shortness of breath (especially with exercise)
• WheezingWheezing
• Chest tightness

Those symptoms may or may not indicate COPD, states the NHLBI’s web site.

Viagra Study

The Viagra study included 12 COPD patients, half of whom had high blood pressurehigh blood pressure in the pulmonary artery, which brings blood to the lungs. The development of pulmonary hypertensionpulmonary hypertension is a complication of COPD, but not everyone with COPD will develop it.

The researchers included Sebastiaan Holverda, MSc, of Amsterdam’s Medical Center.

They tracked the patients’ pulmonary artery blood pressure before and after taking Viagra.

Why Viagra? It relaxes (dilates) blood vessels, lowering blood pressure and helping blood to flow.

First, the patients rested. Then they pedaled a stationary bike for three minutes at a mild pace.

As expected, pulmonary artery blood pressure was higher during exercise, since the lungs were working harder.

Next, the patients took a Viagra pill, waited 45 minutes, and repeated the rest and exercise tests.

Their pulmonary artery blood pressure during exercise was lower after taking Viagra.

“These data suggest that during daily some COPD patients may benefit” from drugs that dilate blood vessels, the researchers write.

There are only three oral drugs approved by the FDA to treat erectile
dysfunction: Cialis, Levitra, and Viagra. All work by increasing the flow of
blood into the penis so that when a man is sexually stimulated, he can get an
erection.

What Are the Differences Between Cialis, Levitra, and Viagra?

Cialis, Levitra, and Viagra work by a similar mechanism to cause erections.
There are subtle differences in how long the drug works and how quickly it
works. Levitra works a little longer than Viagra. They both take effect in
about 30 minutes. With Levitra, the effects last for about 5 hours. With
Viagra, the effects last 4 hours.

Cialis works a bit faster (within about 15 minutes), and the effects last
much longer — up to 36 hours in some cases.

If One of These Drugs Isn’t Effective for Erectile Dysfunction, Can I Try Another?

Yes, but because these drugs work the same way, it’s unlikely that you’ll
have success with one if you’ve failed to achieve an adequate erection with
another.

What Should I Take Before Taking One of These Drugs?

There are certain situations in which these drugs may not be safe to take.
Before taking them, tell your doctor:

• If you are allergic to any drugs, including Viagra or other ED
  medications.
• About any prescription or nonprescription medications you are currently
  taking, including herbal and dietary supplements.
• If you are scheduled for surgery, including dental surgery.
• If you take nitroglycerin or a long-acting nitrate to treat chest pain. The
  combination of Cialis, Levitra or Viagra with these drugs can cause dangerously
  low blood pressure.
• If you take for blood pressure or prostate problems. The
  combination of Cialis or Levitra with these drugs can also cause dangerously
  low blood pressure.

In addition, always follow the directions on your prescription label
carefully and ask your doctor or pharmacist to explain any part that you do not
understand. Take these drugs exactly as directed. Do not take more or less or
take it more often than prescribed by your doctor. Do not take these drugs more
than once a day.

Who Should Not Take Cialis, Levitra or Viagra?

If you have suffered from a heart attack, stroke or life threatening
arrhythmia (irregular heart rate) within the last 6 months you should discuss
other options with your doctor. It is also advised to avoid these drugs if you
have high or low blood pressure or if you experience chest pain
with sex.

What Are the Side Effects of Cialis, Levitra and Viagra?

Side effects are not common but they can occur. Side effects can
include:

• Headache
• Upset stomach or heartburn
• Flushing (feeling warm)
• Nasal congestion
• Changes in vision (color, glare)
• Back pain (with Cialis)

Call your doctor if you experience severe forms of these symptoms or if they
do not go away after 4-8 hours.

Warning

Call your doctor or seek emergency treatment immediately if you experience
any of the following symptoms:

• Rash
• Painful erection
• Prolonged erection (longer than 4 hours)
• Fainting
• Chest pain
• Itching or burning during urination

Stop taking these medications and call a doctor or health care provider
right away if you experience sudden or decreased vision loss in one or both
eyes. A rare vision problem called NAION has been reported by a few men using
these drugs. NAION ( anterior ischemic optic neuropathy) causes a
sudden loss of eyesight because blood flow is blocked to the optic nerve.
People who have a higher chance for NAION include those who:

• Are over 50 years old
• Smoke
• Have heart disease
• Have diabetes
• Have high blood pressure
• Have high cholesterol
• Have certain eye problems

How Should These Drugs Be Stored?

These drugs should be kept in its original container and out of reach of
children. Store them away from excess heat and moisture (not in the bathroom).
Discard any medication that has expired or is no longer needed.

Reviewed by the doctors at the Glickman Urological
Institute at The Cleveland Clinic.

By Sheryl Ubelacker Health Reporter, The Canadian Press

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TORONTO - They’re embedded in everything from mattresses to insoles for shoes to wrist bands - but there is no definitive scientific evidence that static magnets actually relieve chronic pain, researchers say.

Products that incorporate static magnets are a multibillion-dollar business worldwide and many chronic pain sufferers are drawn to the promise they hold for alleviating such nagging conditions as arthritis, and low back discomfort.

The theory from proponents is that the device’s magnetic field increases blood flow, causing increased oxygen, nutrients, hormones and painkilling endorphins to be distributed to tissues in the affected area.

So researchers at the Complementary Medicine, Peninsula Medical School, at the Universities of Exeter and Plymouth decided to search the medical literature to determine whether there is any proof magnets can actually reduce pain.

In their analysis of nine randomized trials comparing products containing magnets with those containing either no magnet or very weak ones, the researchers found that the data did not support the use of the alternative therapy for pain control.

“There is no definite grounds of being absolutely sure that a magnet works or not,” lead author Dr. Max Pittler, a complementary medicine specialist, said Monday from Exeter, England.

“The evidence does not support the use of static magnets for pain relief and therefore magnets cannot be recommended as an effective treatment,” he said. The analysis is published in Tuesday’s Canadian Medical Association Journal.

However, Pittler acknowledged that the findings also mean that magnets could work - but the clinical trials weren’t able to prove that either. In part, that’s because pain measurements are subjective - subjects self-report pain levels - and individual studies in the analysis may have been too small to provide statistically relevant results.

Still, Pittler said the biggest concern is that people seeking to ease their pain may be buying into - and paying big bucks - for a therapy that may not be effective.

“It is important to realize that this is a situation where there is a huge market out there,” he said. “In a situation where you don’t have rigorous data . . . patients are putting their hopes into a magnet and spending a lot of money on it.”

He suggests many pain sufferers would be better off taking an painkiller such as ASA or acetaminophen.

“Or if patients are keen on trying complementary medicine for certain pain conditions, there is some data available that acupuncture might alleviate some of the pain they feel,” Pittler said. “Acupuncture might be one complementary therapy in certain pain conditions,” such as .

Health Canada considers claims for specific therapeutic benefits of static magnets to be unfounded, a spokeswoman for the federal department said by e-mail Monday. “These claims include, but are not limited to: pain relief, increased blood circulation, increased oxygenation, reduction of high blood pressure, stimulation of the immune system and the treatment of sleep disorders, infections, depression, erectile dysfunction, rheumatoid disease and cancer.”

A static magnet promoted for any of these purposes is considered a violation of the Food and Drugs Act or Medical Devices Regulations.

Commenting on the analysis, naturopath Kieran Cooley agreed that magnets wouldn’t be high on the list of possible therapies to treat chronic pain.

“I don’t think naturopaths overall would be strong advocates of magnetic therapy if (patients) hadn’t already tried other modalities like acupuncture or other pain-specific treatments for what they’re going through, whether it’s fibromyalgia, chronic fatigue syndrome or even acute back pain,” said Cooley, a researcher and assistant professor at the Canadian College of Medicine in Toronto.

“Acupuncture is probably the biggest one. Mild to moderate exercise has actually been shown to have the best effect on pain overall of any sort of therapy you can use, even conventional drugs or over-the-counter pain medications like Advil or Aspirin.”

Yet magnets can’t be written off completely until more definitive evidence on their or lack of effectiveness is obtained, Cooley conceded. “There are clearly some people (in the British analysis) who are benefiting from the therapy. There are other people who are not benefiting very much and a few people who seem to be getting worse.”

“So in that respect, magnet therapy is definitely a buyer-beware or consumer-beware kind of industry.”