What Is BlueChew for Women? Effects and Alternatives

BlueChew is a telemedicine brand that sells chewable tablets of sildenafil and tadalafil, both PDE5 inhibitors approved by the FDA exclusively for erectile dysfunction in men. The company does not prescribe to women, and no PDE5 inhibitor pill carries FDA approval for female sexual dysfunction. That said, the underlying drugs do have real physiological effects on female genital tissue, and researchers have spent decades studying whether sildenafil and related compounds can help women with arousal difficulties. The picture that has emerged is more complicated than “it works” or “it doesn’t,” and the alternatives available to women look quite different from what men are typically offered.

How PDE5 Inhibitors Affect Female Tissue

The basic mechanism behind sildenafil and tadalafil is increasing blood flow by relaxing smooth muscle in blood vessels. In men, that effect targets the penis. In women, the same biochemical pathway exists in clitoral and vaginal tissue. Research has confirmed that the clitoral erection response relies on nitric oxide triggering a cascade that ultimately relaxes smooth muscle and increases engorgement, and that sildenafil enhances this process in a dose-dependent way.¹ So the drug is not biologically irrelevant to women. The question is whether increased genital blood flow translates into improvements that women actually notice and care about.

What Clinical Trials Found When Women Took Sildenafil

The results depend heavily on which women were studied and what kind of sexual difficulty they had. In a double-blind, placebo-controlled trial of women diagnosed with female sexual arousal disorder (FSAD), sildenafil showed improvement on arousal-related measures compared to placebo. But there was a critical catch: the benefit was concentrated among women whose only issue was arousal. Women who also had low desire saw no meaningful improvement.² This distinction matters because low desire and arousal difficulty frequently overlap in women, making it hard to find a population that benefits from a purely blood-flow-based treatment.

A separate trial with 68 women found that sildenafil improved arousal, orgasm, and sexual enjoyment compared to placebo, with side effects described as mild and transient.³ Cardiovascular monitoring in another study of women with spinal cord injuries showed only modest changes in heart rate and blood pressure, and the drug was well tolerated.⁴ So safety has not been a major concern in the research that exists.

The overall pattern across trials, though, was not strong enough for any pharmaceutical company to pursue FDA approval for an oral sildenafil tablet for women. The drug reliably increases blood flow to genital tissue, but female sexual response involves a tighter interplay between desire, psychological arousal, and physical sensation than simply improving circulation can address. Pfizer reportedly abandoned its own large-scale trials in women in the early 2000s after disappointing results in broader populations.

Where Sildenafil Clearly Helped Women

One subgroup stood out across multiple studies: women whose sexual dysfunction was caused by antidepressant medications, particularly SSRIs. In a randomized controlled trial, women taking sildenafil alongside their antidepressant showed significantly better sexual function scores than those on placebo, with improvements across desire, arousal, lubrication, orgasm, and satisfaction domains. Depression scores stayed the same between groups, meaning the sexual benefit did not come at the cost of worsened mood.⁵ A systematic review and meta-analysis confirmed these findings, noting that the sildenafil group showed significant improvement in all sexual function domains except pain.⁶

An earlier open study of nine women with antidepressant-induced anorgasmia or delayed orgasm reported that most experienced significant reversal of their dysfunction, often with the first 50 mg dose.⁷ If you are experiencing sexual side effects from an SSRI, this is one of the more evidence-supported off-label uses of sildenafil in women, and a conversation with your prescriber about it is reasonable.

Topical Sildenafil Cream, a Newer Approach

Rather than giving women an oral pill designed for men, researchers have been developing a sildenafil cream applied directly to genital tissue. The idea is to concentrate the blood-flow effect locally while minimizing the systemic side effects like headache and flushing that come with swallowing a pill. A phase 2b trial of 200 premenopausal women found that the cream improved arousal sensation scores and reduced sexual distress compared to placebo. Subgroup analyses showed particular benefit for non-white participants and unpartnered women, with improvements in satisfactory sexual events and orgasm scores.⁸

An earlier randomized controlled trial of the cream found that while the sildenafil group showed greater improvement in arousal sensation scores, the overall differences between sildenafil and placebo did not reach statistical significance across the full study population. However, in a subset of women whose primary diagnosis was arousal disorder (with or without co-occurring low desire), the cream did show a significant benefit.⁹ This cream is not yet FDA-approved, but it represents the most plausible path for a sildenafil-based product eventually reaching women through legitimate medical channels.

FDA-Approved Drugs for Female Sexual Dysfunction

Two medications currently carry FDA approval for a specific condition in women: hypoactive sexual desire disorder (HSDD), which is persistently low sexual desire that causes distress. Neither works like BlueChew. They target the brain rather than blood flow.

Flibanserin (brand name Addyi) is a daily pill that acts on serotonin and dopamine receptors. A meta-analysis found that premenopausal women taking flibanserin had about 0.7 more satisfying sexual events per month than those on placebo, along with improvements in desire scores and reductions in sexual distress. Postmenopausal women also saw benefits across similar measures.¹⁰ The practical effect size is modest. You cannot mix flibanserin with alcohol, which limits its appeal, and side effects like dizziness and low blood pressure are common enough to have earned it a boxed warning.

Bremelanotide (brand name Vyleesi) is a self-injected shot taken as needed before sexual activity. It works on melanocortin receptors in the brain. Across two large phase 3 trials, women using bremelanotide had significant increases in sexual desire and significant reductions in desire-related distress compared to placebo.¹¹ However, the overall clinical benefit has been described as modest, and nausea is a frequent side effect that leads many women to discontinue.¹² Both drugs are approved only for premenopausal women with HSDD, leaving postmenopausal women and women with arousal-specific issues without an FDA-approved pharmacological option.

Testosterone for Postmenopausal Women

For postmenopausal women with low desire, the best-studied pharmacological option is low-dose testosterone. Clinical practice guidelines identify it as the sole evidence-based hormonal therapy for HSDD in this group.¹³ In a major trial of postmenopausal women not taking estrogen, a 300-microgram daily testosterone patch more than tripled the increase in satisfying sexual episodes compared to placebo over 24 weeks, and both desire and distress improved significantly.¹⁴ Earlier trials in surgically postmenopausal women on estrogen therapy found similar results, with satisfying sexual activity increasing by roughly 50 to 75 percent over placebo.¹⁵

The catch is that no testosterone product is FDA-approved for women. Doctors who prescribe it do so off-label, typically using compounded formulations or a fraction of a male-dosed product. Unwanted hair growth is the most common androgenic side effect. Long-term safety data remain limited, and the breast cancer signal in one trial, though likely unrelated to the short treatment period, has not been fully resolved. Still, for postmenopausal women whose primary issue is desire, testosterone has a stronger evidence base than either of the two FDA-approved drugs, which were studied mainly in premenopausal women.

Vaginal Estrogen for Menopause-Related Changes

Many women after menopause experience vaginal dryness, irritation, and pain during intercourse, collectively known as genitourinary syndrome of menopause. These symptoms are caused by declining estrogen levels thinning the vaginal lining, and they can devastate sexual function even when desire is intact. Low-dose vaginal estrogen, available as creams, rings, or tablets, is considered a safe and effective first-line treatment. A systematic review found moderate-quality evidence that vaginal estrogen improves dryness, itching, burning, and pain during sex.¹⁶ Another review confirmed clinical effectiveness at doses as low as 4 micrograms, with few adverse effects.¹⁷

This is worth highlighting because a woman searching for “BlueChew for women” might be dealing with pain or discomfort that has nothing to do with arousal or desire in the psychological sense, and for which a blood-flow drug would miss the point entirely. If dryness or pain is the main barrier to enjoyable sex, vaginal estrogen or even over-the-counter lubricants and moisturizers are a more direct solution.

Over-the-Counter Topical Gels

Several non-prescription products marketed for women contain L-arginine and L-citrulline, amino acids that the body uses to produce nitric oxide, the same molecule that PDE5 inhibitors enhance. These gels are applied directly to the clitoris. In a small study, application of an L-arginine and L-citrulline gel produced significant increases in clitoral blood flow within five minutes, roughly doubling peak blood velocity.¹⁸ A separate study confirmed these blood flow increases at both 5 and 15 minutes after application.¹⁹

These findings are promising in terms of mechanism, but both studies measured blood flow using ultrasound rather than asking women whether they experienced better sexual encounters over time. Increased clitoral blood flow is a reasonable physiological proxy for arousal, but it is not the same as demonstrating that a gel improves satisfaction, orgasm, or overall sexual experience in daily life. These products are generally inexpensive and available without a prescription, making them low-risk to try, but expectations should be tempered.

Herbal Supplements and the Evidence Behind Them

Two supplements that show up frequently in discussions about women’s sexual health are maca root and ashwagandha. A double-blind, placebo-controlled trial in women with antidepressant-induced sexual dysfunction found that maca root produced modestly higher remission rates than placebo across multiple sexual function scales, with the strongest signal in postmenopausal women. The differences were small and did not reach conventional significance thresholds for the primary outcome.²⁰

Ashwagandha fared better in a pilot study of healthy women, which found significant improvements in arousal, lubrication, orgasm, satisfaction, and number of successful sexual encounters compared to placebo.²¹ “Pilot study” is the key phrase here: the sample was small, and these results need replication in larger trials before drawing strong conclusions. Supplements are not regulated for efficacy the way prescription drugs are, and quality varies widely between brands.

Mindfulness-Based Therapy

One of the more surprising findings in the female sexual dysfunction literature is how well psychological interventions perform. A meta-analysis of mindfulness-based cognitive therapies found significant improvements in sexual function and significant reductions in sexual distress in women.²² Another study specifically focused on desire found that group mindfulness therapy significantly improved sexual desire, arousal, lubrication, and satisfaction, while also reducing sex-related distress. Increases in mindfulness and reductions in depressive symptoms predicted the desire improvements.²³

Clinical guidelines consider psychological interventions, including cognitive behavioral therapy and mindfulness-based approaches, to be first-line treatments for low desire, especially when psychological or relationship factors are contributing.²⁴ This can feel unsatisfying if you are looking for a pill, but the evidence behind mindfulness for female sexual concerns is genuinely strong and often underappreciated.

Physical Therapy and Devices

For women whose sexual difficulty involves pain during intercourse, pelvic floor physical therapy has a solid evidence base. A systematic review found that manual therapy treatments resulted in reduced pelvic pain associated with intercourse and improved overall sexual function scores across multiple studies.²⁵ This is not a fringe treatment; it is a specialized area of physical therapy, and many practitioners specifically treat sexual pain conditions.

On the device side, the EROS Clitoral Therapy Device was the first FDA-cleared treatment for female sexual dysfunction. It is a small, battery-powered vacuum device designed to increase blood flow to the clitoris by gently creating suction.²⁶ It has been studied in specific populations, including cervical cancer survivors who experienced sexual dysfunction after radiation treatment.²⁷ The device works on the same general principle as a PDE5 inhibitor, increasing genital engorgement, but achieves it mechanically rather than chemically.

The Placebo Problem in Female Sexual Dysfunction Research

One reason it has been so difficult to develop effective drugs for women is that the placebo response in female sexual dysfunction trials is enormous. A meta-analysis of the best-quality trials found that roughly two-thirds of the treatment effect seen in female sexual dysfunction studies is accounted for by placebo.²⁸ That does not mean the drugs do nothing, but it does mean the gap between drug and placebo is often narrow. It also suggests that context, attention, expectation, and the simple act of focusing on one’s sexual life as part of a study all contribute powerfully to improvement. This is part of why psychological interventions perform as well as they do, and why a pill-first approach to female sexual concerns often disappoints.

For women who stumble on BlueChew ads and wonder whether there is an equivalent quick fix, the honest answer is that female sexual function does not map cleanly onto the male hydraulic model. A drug that reliably improves erections in men can reliably improve genital blood flow in women too, but blood flow is a smaller piece of a more complex puzzle. The treatments that work best for women tend to address the specific problem: topical estrogen for dryness and pain, testosterone for desire after menopause, sildenafil for antidepressant-related dysfunction, mindfulness for desire and distress, and physical therapy for pain. Matching the treatment to the actual barrier is more effective than looking for a single pill that does it all.