Viagra: Women using this pill should be careful

Viagra (sildenafil citrate) was initially developed to treat heart-related conditions including angina pectoris and hypertension. However, during the clinical trials, it was noted to be highly effective in inducing erection.

This led to Pfizer applying for FDA approval for its use in a billion-dollar industry problem. It remains the most prescribed drug in the US.

In practice, direct advertising of prescription pharmaceutical products to potential patients is not permitted. However, special consideration was made for Viagra so as to raise awareness about erectile dysfunction, a condition that was generally a silent epidemic across the world, and encourage men to seek help with their doctors as there was finally a proven treatment option. 

Closer home, our poorly regulated pharmaceutical dispensing space means that the blue pill is readily available across the counter to anyone who can afford to pay. As our social space evolves into a more liberal one, the interaction between men and women has greatly evolved too.

More complex sexual function
The challenge arising out of this is that many taking the ‘blue pill’ without a prescription put themselves in harm’s way because they miss out on the very crucial evaluation determining their suitability to use it. Even worse, the lay notion that more is better has resulted in unnecessary drug overdose and sudden death.

The older middle-aged man is more likely to have underlying chronic illnesses that may or may not already be diagnosed, such as hypertension, diabetes, obesity, and heart disease.
Overdosing on the blue pill sets off a cascade of events that easily result in heart attacks or strokes. Aside from overdose, Viagra can also interact with other medicines a person may be taking, causing harmful effects.

Does this mean that women are safe? 
While there have been various attempts to establish whether Viagra improves sexual function in women, there has not been convincing evidence to support the same.
This is because female sexual function is a much more complex process than increased blood flow to the genital organs. This resulted in the advent of Flibanserin and Bremelanotide, drugs that aim to improve sexual function in premenopausal women. Unfortunately, it has minimal role in post-menopausal women.

In addition, other existing drugs have been modified to improve the sexual experience for women by relieving vaginal dryness. These drugs are oestrogen-based vaginal pessaries that are highly effective for older women. They remain prescription-only because of the great need to evaluate the woman for safety first.
What is now alarming is the number of women in the peri-menopausal period who have chosen to take matters into their own hands.

These are women struggling with heavy, painful and irregular periods that herald the onset of menopause. The disordered and uncomfortable nature of the periods greatly diminishes their quality of life and rains on their parade when it comes to sexual pleasure.

Career success
A number of these women have opted to start taking the combined oral contraceptive pill readily available over the counter to combat these symptoms. Overall, the pill will regularise the periods, reduce the bleeding volume and duration and it even comes with the bonus of reducing period pain. This is the reason the pill is considered a treatment option for adolescent girls and younger women struggling with period problems.

However, women entering the fifth floor of their lives do not get a carte blanche to use the pill indiscriminately. The pill is prescribed with great caution to women above the age of 35 while it is not recommended for those who are above 35 and are smokers. It increases the risk of hypertension, deep vein thrombosis and pulmonary thrombo-embolism.

Risk
Towards menopause, the risk for endometrial cancer is greatly increased, hence the need to avoid oestrogen, which is a known trigger.

In the current generation, women in their 50s are getting a new lease of life, fuelled by career success, financial stability, grown children flying the coop and increased self-affirmation. This has triggered a sexual awakening and concerted effort to seek satisfaction.

Nevertheless, in the process of finding fulfilment, the risk of finding themselves in harm’s way is real. They may not experience sudden death as their male counterparts seem to but they will not escape the cruel hand of death.

Caution
As we make fun and create memes about the negative outcomes of the inappropriate use of these drugs, let us not miss out on the lessons learnt. These pharmaceutical products may improve the quality of life but they must never be treated casually. They require proper administration and oversight by a doctor to rule out pre-treatment risk factors and also keep tabs as these arise to prevent unnecessary complications and death.

Nelly is a consultant specialist obstetrician/ gynaecologist

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