When arousal goes missing, apparently Reddit gets the call. With no FDA-approved treatment for female sexual arousal disorder, some women are turning to “scream creams” containing sildenafil, the active ingredient in Viagra. It’s approved for erectile dysfunction, but a cream for women? Still waiting.
Meg would have appreciated a few more options. She told Women's Health that not long after her 43rd birthday, she woke up and her orgasm was gone. "It was hard to get excited, and even when I'd get turned on, it felt like the volume had been turned down so low it was on mute," she told the magazine. Her doctor prescribed hormone replacement therapy, but Meg says it didn't help with sex. She found her way to Reddit and then a telehealth company that prescribed a cream containing sildenafil, to be rubbed into the vagina, particularly the clitoris, about a half-hour before sex.
"It worked, thank god," Meg said. "But why did I have to find out about this from Reddit?"
It's estimated that one in five women will experience female sexual arousal disorder (FSAD), defined by Women's Health as a distress-causing inability to attain or maintain sexual excitement, which often includes lack of lubrication and decreased genital swelling. Sildenafil received FDA "Priority Review" status in 1997 and was approved six months later for erectile dysfunction. For FSAD, there are no FDA-approved treatments at all.
Enter "scream creams," the colloquial term for topical formulations applied to the clitoris and genital area. Telehealth platform Wisp debuted its sildenafil formulation, OMG! Cream, in 2022. After strong demand, the company launched an extra-strength version in 2025 with 3 percent sildenafil, up from 1 percent in the original.
Getting to a cream starts with a diagnosis, and that's where many women slip through the cracks. According to Women's Health, more than half of ob-gyn residents in one study could not describe the disorders of sexual function or list common medications that affect it. Gynecologist Maria Sophocles, MD, author of The Bedroom Gap, said some doctors bring their own beliefs into the exam room and avoid asking about sex. "This happens very commonly, and it shuts women down," she said. "They just blame themselves."
Then there's the evidence, which is mixed. The creams aren't standardized beyond the sildenafil, so results vary. Some users say they live up to the name. Another told Women's Health she tried one about six times and got "nothing but the faintest tingle." The creams aren't recommended for people who are pregnant, breastfeeding or have a heart condition, and Women's Health reports no known side effects beyond irritation, which is relatively rare.
Research is thin, and it shows a strong placebo effect. In one Chinese study described by the magazine, women using the strongest formulation had an "arousal success rate" of over 50 percent, while the rate was still 33 percent for those who got the placebo cream. Another study found no "statistically significant differences" in satisfactory sexual events between cream and placebo users. Critics say the rubbing-in, not the cream, gets results. Anna Cabeca, DO, an ob-gyn in Dallas, disagrees: in controlled trials, she said, "we definitely see the benefit with the ingredient compared to the placebo."
Urologist Kelly Casperson, MD, pointed to the placebo effect in Viagra and SSRI studies too. "We don't get rid of all SSRIs because there's a significant placebo effect," she said. "Picking on women's sexual health because of the placebo effect is gender bias."
Clinicians who prescribe compounded versions are cautiously positive. Lori Davis, a doctor of nursing practice in Ithaca, New York, calls it "worth a trial for any woman who has orgasm trouble." "The only thing you're doing is wasting money if it doesn't work," she said. Her compounding pharmacy charges about $90 for a tube with 30 applications. Gynecologist Sameena Rahman, MD, said the creams can kick-start arousal by increasing blood flow to the vulva, creating the conditions for responsive desire, the kind that shows up after arousal rather than before it.
A real FDA-approved option is still a long way off. Daré Bioscience has been working on a sildenafil cream since 2018. Its phase 2 trial, completed in 2023, showed improvement in sexual satisfaction, arousal sensation, lubrication and orgasm, but fell short of statistical significance. Three years later, the company is still discussing a phase 3 design with the FDA, which Daré founder Sabrina Martucci Johnson said wants a measure of interpersonal distress. The FDA did not require that for Viagra, even though distress is a diagnostic criterion for erectile dysfunction too. The FDA told Women's Health its policy is not to comment on new drug applications.
Since February, doctors have been able to write prescriptions for a compounded Daré version called Dare to Play, though it won't be dispensed until later this year, per Women's Health.
"Patients are waiting," Sophocles said. "In a clinic like mine, they all want it."