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1. Vaginally-administered sildenafil citrate (Viagra) was associated with better pain relief in women with primary dysmenorrhea.
2. Sildenafil citrate was also associated with decreased uterine artery pulsatility.
Evidence Rating Level: 2 (Good)
Study Rundown: This double-blind randomized controlled trial found that vaginal administration of 100mg of sildenafil citrate was associated with decreased pain from primary dysmenorrhea. Previous studies have identified benefit to oral therapy of nitric oxide donor drugs in patients with dysmenorrhea but oral administration has been associated with significant side effects. This is the first study to assess the use of vaginal sildenafil for dysmenorrhea.
Strengths of this study include RCT study design and the use of both subjective (patient-reported pain scores) and objective (uterine artery pulsatility index on Doppler ultrasound) outcome measures to assess the impact of placebo vs. intervention on dysmenorrhea. Limitations include a small sample size and lack of long-term follow-up. Studies in a larger sample population with longer follow-up to assess long-term side effects and symptom improvement are merited. Specifically, duration of pain relief with a single administration should be evaluated to provide further insight into appropriate dosing.
Click to read the study in Human Reproduction
Relevant Reading: UpToDate: Treatment of primary dysmenorrhea in adult women
In-Depth [double-blind randomized controlled trial]: This study evaluated the effectiveness of a single vaginal administration of 100mg sildenafil citrate in providing pain relief to adult women with primary dysmenorrhea. 25 women were included in the study, with 13 randomized to sildenafil and 12 to placebo. Outcomes evaluated include total pain relief over four hours, pain as assessed by the visual analog scale and uterine artery pulsatility index as measured by color Doppler ultrasound.
Average total pain relief over four hours was 5.3 points higher in women receiving sildenafil (CI 2.9-7.6). Pain assessed by visual analog scale scores were lower in the treatment group at one, two, three and four hours, with a mean score difference of -42.6 (CI -58.3 to -26.8) at four hours. Uterine artery pulsatility index was also reduced in the sildenafil group, with a -0.7 difference in means (CI -1.2, -0.1).
By Denise Pong, MPH and Leah Hawkins, MD, MPH
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