Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Research
  • Published:

Vardenafil enhances clitoral and vaginal blood flow responses to pelvic nerve stimulation in female dogs

Abstract

The relaxation of the smooth muscle in the vagina and clitoris and the increase of blood flow into these organs is thought to be essential in the female sexual response. Vardenafil is a type 5 phosphodiesterase (PDE5) inhibitor that potentiates the nitric oxide (NO)/cGMP pathway facilitating penile smooth muscle relaxation and improving penile erection in men. Although the potentiation of the NO/cGMP pathway through PDE5 inhibitors can clearly enhance blood flow into the penis and is used in the therapy of male sexual dysfunction, there is controversy about the efficacy of these agents in improving female sexual function. The aim of this work was to evaluate the effects of vardenafil on the increase of blood flow into the vagina and clitoris induced by pelvic nerve electrical stimulation (PNES) in a female dog model. Application of PNES produced consistent and frequency-related increased blood flow into the vagina and clitoris of anesthetized female dogs. The magnitude and duration of the blood flow responses to PNES were variable among the different animals but remained stable over time within the same animal. The intravenous administration of vardenafil (1 mg/kg) significantly potentiated the increases in blood flow produced by PNES into the vagina (381.4 and 206.2% of control response at 5 and 10 Hz, respectively, P<0.01, n=6) and clitoris (379.4 and 238.5% of control response at 5 and 10 Hz, respectively, P<0.01, n=6) 20 min after administration. The significant enhancement of PNES-induced responses was maintained 50 min (224.5 and 181.0%, P<0.01 in vagina; 294.8 and 258.9%, P<0.05 in clitoris) and 80 min after vardenafil administration (209.5 and 156.9%, P<0.05 in vagina; 268.9 and 194.9%, P<0.05 in clitoris). Here we present a feasible model for research into female sexual function. Our results show that vardenafil effectively potentiates the blood flow responses to PNES in the genitalia of female dogs. These results emphasize the role of the NO/cGMP pathway in the local vasodilatory response in female sexual organs and provide a rationale for testing PDE5 inhibitors, such as vardenafil, as a treatment for certain forms of female sexual dysfunction.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Laumann EO, Paik A, Rosen RC . Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–544.

    Article  CAS  Google Scholar 

  2. Park K et al. Vasculogenic female sexual dysfunction: the hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency. Int J Impot Res 1997; 9: 27–37.

    Article  CAS  Google Scholar 

  3. Vachon P, Simmerman N, Zahran AR, Carrier S . Increases in clitoral and vaginal blood flow following clitoral and pelvic plexus nerve stimulations in the female rat. Int J Impot Res 2000; 12: 53–57.

    Article  CAS  Google Scholar 

  4. Giuliano F et al. Vaginal physiological changes in a model of sexual arousal in anesthetized rats. Am J Physiol Regul Integr Comp Physiol 2001; 281: R140–R149.

    Article  CAS  Google Scholar 

  5. Cellek S, Moncada S . Nitrergic neurotransmission mediates the non-adrenergic responses in the clitoral corpus cavernosum of the rabbit. Br J Pharmacol 1998; 125: 1627–1629.

    Article  CAS  Google Scholar 

  6. Vemulapalli S, Kurowski S . Sildenafil relaxes rabbit clitoral corpus cavernosum. Life Sci 2000; 67: 23–29.

    Article  CAS  Google Scholar 

  7. Ziessen T, Moncada S, Cellek S . Characterization of the non-nitrergic NANC relaxation responses in the rabbit vaginal wall. Br J Pharmacol 2002; 135: 546–554.

    Article  CAS  Google Scholar 

  8. Sáenz De Tejada I et al. The phosphodiesterase inhibitory selectivity and the in vivo and in vitro potency of the new PDE5 inhibitor vardenafil. Int J Impot Res 2001; 13: 282–290.

    Article  Google Scholar 

  9. Porst H et al. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Int J Impot Res 2001; 13: 192–199.

    Article  CAS  Google Scholar 

  10. Berman JR, Adhikari SP, Goldstein I . Anatomy and physiology of female sexual function and dysfunction. Classification, evaluation and treatment options. Eur Urol 2000; 38: 20–29.

    Article  CAS  Google Scholar 

  11. Laan E, Everaerd W, Evers A . Assessment of female sexual arousal: response specificity and construct validity. Psychophysiology 1995; 32: 476–485.

    Article  CAS  Google Scholar 

  12. Berman JR et al. Clinical evaluation of female sexual function: effects of age and estrogen status on subjective and physiologic sexual responses. Int J Impot Res 1999; 11 (Suppl 1): S31–S38.

    Article  Google Scholar 

  13. Wagner G, Levin RJ . Oxygen tension of the vaginal surface during sexual stimulation in the human. Fertil Steril 1978; 30: 50–53.

    Article  CAS  Google Scholar 

  14. Giraldi A et al. Effects of diabetes on neurotransmission in rat vaginal smooth muscle. Int J Impot Res 2001; 13: 58–66.

    Article  CAS  Google Scholar 

  15. Ottesen B et al. Vasoactive intestinal polypeptide provokes vaginal lubrication in normal women. Peptides 1987; 8: 797–800.

    Article  CAS  Google Scholar 

  16. Levin RJ . VIP, vagina, clitoral and periurethral glans: an update on female genital arousal. Exp Clin Endocrinol 1991; 98: 61–69.

    Article  CAS  Google Scholar 

  17. Hoyle CH et al. Innervation of vasculature and microvasculature of the human vagina by NOS and neuropeptide-containing nerves. J Anat 1996; 188: 633–664.

    PubMed  PubMed Central  Google Scholar 

  18. Burnett AL et al. Immunohistochemical description of nitric oxide synthase isoforms in human clitoris. J Urol 1997; 158: 75–78.

    Article  CAS  Google Scholar 

  19. Park K et al. Sildenafil inhibits phosphodiesterase type 5 in human clitoral corpus cavernosum smooth muscle. Biochem Biophys Res Commun 1998; 249: 612–617.

    Article  CAS  Google Scholar 

  20. Min K et al. Sildenafil augments pelvic nerve-mediated female genital arousal in the anesthetized rabbit. Int J Impot Res 2000; 12 (Suppl 3): S32–S39.

    Article  Google Scholar 

  21. Rajfer J et al. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med 1992; 326: 90–94.

    Article  CAS  Google Scholar 

  22. Goldstein I et al. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group. N Engl J Med 1998; 338:1397–1404.

    Article  CAS  Google Scholar 

  23. Padma-Nathan H et al. On-demand IC351 (Cialis) enhances erectile function in patients with erectile dysfunction. Int J Impot Res 2001; 13: 2–9.

    Article  CAS  Google Scholar 

  24. Kaplan SA et al. Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction. Urology 1999; 53: 481–486.

    Article  CAS  Google Scholar 

  25. Nurnberg HG et al. Sildenafil for women patients with antidepressant-induced sexual dysfunction. Psychiatr Serv 1999; 50: 1076–1078.

    Article  CAS  Google Scholar 

  26. Sipski ML, Rosen RC, Alexander CJ, Hamer RM . Sildenafil effects on sexual and cardiovascular responses in women with spinal cord injury. Urology 2000; 55: 812–815.

    Article  CAS  Google Scholar 

  27. Berman JR et al. Effect of sildenafil on subjective and physiologic parameters of the female sexual response in women with sexual arousal disorder. J Sex Marital Ther 2001; 27: 411–420.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Carlos Correa and Ana Isabel Ortiz for veterinary animal care and preparation. This work was partially supported by a grant from Bayer AG.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to I Sáenz de Tejada.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Angulo, J., Cuevas, P., Cuevas, B. et al. Vardenafil enhances clitoral and vaginal blood flow responses to pelvic nerve stimulation in female dogs. Int J Impot Res 15, 137–141 (2003). https://doi.org/10.1038/sj.ijir.3900985

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijir.3900985

Keywords

This article is cited by

Search

Quick links