Female arousal cream is a compounded prescription cream that a woman applies to the clitoris and vulva shortly before sexual activity. It is often called scream cream. Bayview Pharmacy compounds it to a provider's prescription, most often as a blend of sildenafil, L-arginine, and theophylline in a cream base made for vulvar and vaginal tissue. Your provider decides whether it fits your situation, and a valid prescription is required.
What is female sexual arousal disorder?
Female sexual arousal disorder describes a persistent or recurrent inability to reach or keep enough genital arousal during sexual activity (Daré Bioscience). It is one of several kinds of sexual concerns. Low sexual desire and pain with sex are different problems with different treatments, and they often overlap with arousal problems, so a provider usually looks at the whole picture first, including medications, hormones, relationship factors, and other health conditions.
Two medications are FDA-approved for low sexual desire, not arousal: flibanserin tablets (Addyi label) and bremelanotide injection (Vyleesi label). Both are approved only for premenopausal women with acquired, generalized hypoactive sexual desire disorder, and both labels state they are not meant to enhance sexual performance.
What is in an arousal cream?
Arousal creams are compounded to the prescriber's ingredient list. The blends Bayview prepares most often use three active ingredients:
- Sildenafil, a PDE5 inhibitor and the active ingredient in Viagra tablets (prescribing information).
- L-arginine, an amino acid.
- Theophylline, a medicine better known as a tablet or liquid for asthma and other lung diseases (MedlinePlus).
The amount of each medicine in a single application is smaller than a typical dose taken by mouth. Some prescriptions use only L-arginine and theophylline, without sildenafil.
What the evidence shows
Research on these treatments in women is limited and mixed:
- Sildenafil by mouth. In a randomized trial of 202 postmenopausal women, those whose main problem was arousal reported better arousal, lubrication, and orgasm with sildenafil than with placebo, while women whose arousal problem came with low desire or pain did not. An earlier randomized study found no significant change (Lo Monte et al., 2014).
- Sildenafil cream. A 3.6% sildenafil cream developed for women did not reach statistical significance on its main arousal measure in a phase 2b trial completed in 2023, although other measures and later analyses suggested benefit in some women (Contemporary OB/GYN). A phase 3 trial has not started (Daré Bioscience).
- Compounded blends. Bayview could not find published controlled trials of compounded sildenafil, L-arginine, and theophylline creams.
Results vary from person to person. Your provider decides whether an arousal cream is worth trying and which formula to use.
How is it used?
Use the cream exactly as prescribed. Prescriptions filled at Bayview usually direct a pea-sized amount, or one 0.5 mL pump, applied to the clitoris and the surrounding vulva about 15 to 30 minutes before sexual activity, and gently massaged in. Do not use more, or more often, than your prescription says. Wash your hands after applying it. Ask the pharmacist whether your cream's base can be used with latex condoms.
Side effects & safety
The cream is applied to sensitive skin, so irritation, burning, or itching where it is applied can happen. Stop using it and call your provider if they do. Some of the medicine may be absorbed into the body. Taken by mouth, sildenafil most often causes headache, flushing, upset stomach, and stuffy nose, and it can lower blood pressure (prescribing information).
Who should not use it?
Do not use an arousal cream if you are allergic to any ingredient in your prescription. Do not use a sildenafil version if you take nitrates or riociguat. Do not apply it to broken skin, sores, or an area with an infection, and see your provider about any new vulvar symptoms first. Tell your provider if you are pregnant, trying to become pregnant, or breastfeeding, and about any heart or blood pressure condition.
How do I get started?
An arousal cream is a prescription medication, so a licensed provider decides whether it is appropriate and chooses the formula and strength. Bayview Pharmacy does not provide consultations or determine appropriateness. Already have a prescription at another pharmacy? You can transfer it to Bayview. Once you have a prescription, your provider can order through Bayview, and a pharmacist is available if you have questions. Bayview compounds arousal creams as part of our compounded medications catalog, alongside vulvodynia vaginal creams and oxytocin.
Clinical details for prescribers
Regulatory. No FDA-approved therapy for female sexual arousal disorder (FSAD) (Daré Bioscience). Sildenafil citrate (Viagra) is approved for erectile dysfunction and is not indicated in females; contraindicated with organic nitrates or nitrites in any form, guanylate cyclase stimulators such as riociguat, and known hypersensitivity (labeling). Flibanserin and bremelanotide are approved for acquired, generalized HSDD in premenopausal women only, not for postmenopausal women and not to enhance sexual performance (Addyi; Vyleesi). Compounded arousal creams are not FDA-approved and are noncontrolled.
Evidence:
- Oral sildenafil 50 mg vs placebo, 12 weeks, 202 postmenopausal women (Berman 2003): improvement in arousal, lubrication, and orgasm in women with primary FSAD; no significant gains in women with concomitant HSDD or dyspareunia. Basson 2002 (pre- and postmenopausal women): no significant change in sexual response (Lo Monte et al. 2014).
- Sildenafil Cream 3.6% (investigational, Daré): phase 2b RESPOND, double-blind, placebo-controlled, premenopausal women with FSAD, completed 2023; the SFQ28 arousal-sensation co-primary endpoint was not met, the distress-about-arousal endpoint was reported as met, and post-hoc subgroup benefit was reported; phase 3 design under discussion with FDA (Contemporary OB/GYN; Daré Bioscience).
- Compounded sildenafil / L-arginine / theophylline creams: no published controlled trials identified.
What Bayview compounds (2026 fills):
- Sildenafil 2% / theophylline 2.5% / L-arginine 6% cream (the most often filled) and sildenafil 1% / theophylline 2.5% / L-arginine 6%, in Ellage or VersaBase, 30 or 60 g tube or 0.5 mL metered pump.
- L-arginine 6% / theophylline 2.5% cream (no sildenafil); sildenafil 0.2% / L-arginine 1% cream; other strengths and blends on prescription.
- Usual directions: a pea-sized amount or one 0.5 mL pump to the clitoris and surrounding vulva 15 to 30 minutes before sexual activity.
Licensed to dispense in RI, MA, CT, NJ, NH, FL, ME, and PA. Ordering and account setup are covered on our for providers page.
This information is about a prescription medication and is not medical advice. Compounded medications are prescription-only and are not FDA-approved. Your provider determines whether treatment is appropriate and sets the formula, strength, and directions.
References
- Daré Bioscience: Sildenafil Cream 3.6%, investigational, for female sexual arousal disorder
- Lo Monte et al. 2014: women taking sildenafil, a review of the trials (Drug Des Devel Ther)
- Viagra (sildenafil citrate) prescribing information, FDA label
- Addyi (flibanserin) prescribing information, FDA label
- Vyleesi (bremelanotide) prescribing information, FDA label
- MedlinePlus: theophylline
- Contemporary OB/GYN: sildenafil cream phase 2b results for female sexual arousal disorder (2023)
