One day, not long after her 43rd birthday, Meg woke up and her orgasm was gone. Her doctor prescribed hormone replacement therapy, but Meg says it didn’t do anything for the sex part. She couldn’t bring herself to make an appointment specifically to complain about that; instead, Meg went down more Internet rabbit holes, finding her way to Reddit and, eventually, a telehealth company that prescribed a topical cream she was told to rub into her vagina, particularly the clitoris, about a half-hour before sex.
It contained sildenafil, which increases blood flow—and is the key active ingredient in Viagra. It’s estimated that one in five women will experience female sexual arousal disorder (FSAD), defined as a distress-causing inability to attain or maintain sexual excitement, which often includes lack of lubrication and decreased genital swelling. And although sildenafil is, of course, approved by the Food and Drug Administration (FDA) to treat erectile dysfunction—it famously received “Priority Review” status in 1997 and then was given the green light six months later—the drug is not approved as a topical cream for women.
In fact, there are zero FDA-approved treatments for FSAD. That means women like Meg often have to DIY their sexual health care, including seeking out information about “scream creams,” the colloquial term for topical formulations applied to the clitoris and genital area. The creams are typically available from telehealth platforms such as Wisp, which debuted its sildenafil formulation—dubbed OMG!
According to the company, demand (including repeat sales) was so strong that in 2025, Wisp launched an extra-strength formulation with 3 percent sildenafil compared with 1 percent in the original. (Trying the 1 percent version is not a prerequisite for trying the extra-strength, says the company’s lead nurse practitioner, Andrea Sleeth. These people existed—for example, Anna Cabeca, DO, a triple-board-certified ob-gyn in Dallas, has been offering patients what she calls a “joy gel” for more than 20 years—but even in 2026, prescribers remain few and far between. Before you can even think about treating FSAD, you need a diagnosis—and many women slip through the cracks at this stage.
Few doctors feel comfortable diagnosing patients with the condition, says Maria Sophocles, MD, a gynecologist and the author of The Bedroom Gap. More than half of ob-gyn residents were not able to describe the disorders of sexual function or list common medications that affect sexual function, according to one study. That’s because most residencies have, at best, limited education around female sexual dysfunction, says Tami Rowen, MD, an ob-gyn in San Francisco and president-elect of the International Society for the Study of Women’s Sexual Health.
This is mainly due to a lack of investment from the medical establishment; the field of sexual medicine “does not reimburse particularly well,” says Dr. Doctors can “bring their own family, sociocultural, religious layering of their own sexual beliefs” into the exam room, says Dr. Others feel embarrassed—or the secondhand embarrassment of their providers (again, partly due to the lack of education)—to ask questions in the first place.
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