was introduced to the medical community at the NPWH Conference. It generated the most
excitement and traffic during the two days in which 35 plus companies displayed their
products. Of the 300 nurse practitioners attending the conference, we estimate that 95%
visited our booth at least once, some multiple times. They actively asked questions about
Viacrème and were given medical responses to those
questions. The questions asked in order of frequency, and therefore importance;
Libido! Does Viacrème restore or increase a woman's libido? (Far and away the most
commonly asked question!)
2. How does Viacrème work? Is it different than Viagra®?
3. Would you expect some placebo effect from Viacrème?
4. Did you do clinical evaluations?
5. Does Viacrème work for every woman?
6. What can I do if Viacrème does not work?
7. How is Viacrème different from testosterone cream, to be applied to a woman's
clitoris, as recently seen on Oprah?
8. How is Viacrème different from Astroglide? Can patients use it as a
9. Does the menthol in Viacrème burn?
10. What can I do if the Viacrème burns my patients?
11. Does Viacrème affect the man?
12. Does Viacrème treat Female Sexual Dysfunction?
13. What do you think about the Viagra® study for women?
14. Is Viacrème safe? How do you know?
15. Does Viacrème require a prescription, or is it OTC?
16. How much does Viacrème cost?
17. Can I have Viacrème samples supplied to my office?
18. Can I have patient education brochures supplied to my office?
19. Is Viacrème safe if ingested?
20. Can condoms be used with Viacrème or will the condom break?
1. No, and yes! Libido is documented to be related to the circulatory level of
testosterone for all women. Clinically libido can be improved by estrogen or
estrogen/testosterone administration to women on oral contraceptives, birth control
injections, or implants. If a woman has a positive experience (orgasm) with intercourse,
she is more likely to welcome or encourage another sexual experience. This type of libido
is not hormone dependent, but experience related. Viacrème can help a woman achieve
orgasm, especially if her partner is intent upon her achieving orgasm. (See attachment -
2. Viacrème is to be applied to
the mucus membrane, beneath the clitoris, and thoroughly rubbed in to help absorption. The
clitoral hood is partially keratinized and absorbs medication less than the
non-keratinized underside of the clitoris. The penile shaft is keratinized epithelium and
poorly absorbs medications. Viacrème has two components, a very weak concentration
of menthol and a weak concentration of L-Arginine. The menthol helps with the absorption
of the L-Arginine. The menthol has also been reported to cause a reflex vaginal
lubrication, even though the Viacrème is placed on the clitoris, and not in the
vagina. The L-Arginine is intended to induce the Nitric Oxide synthase pathway to create
Nitric Oxide and dilate the corpus cavernosa to maximally fill with blood. Orgasm can only
occur with continuous stimulation of the maximally aroused clitoris! Viagra® is an oral
medication that blocks the breakdown of Nitric Oxide; therefore the Nitric Oxide builds up
in the penis and allows an erection. Both Viagra® and Viacrème need "sexual
stimulation" such as odors, thoughts, rubbing, kissing, genital touching, and
foreplay to initiate the impulses down the spinal cord, pudendal nerves, and
clitoral/penile nerves to establish an erection. Neither is automatic.
3. Yes! With the "Directions for Use" and Q&A, which is provided with the
product, the public can be taught where a woman's clitoris is located, and how important
it is to arouse the clitoris to maximal erection, to achieve an orgasm. In a direct
comparison of Viagra® to a placebo, 583 women with documented sexual dysfunction, 47%
were able to achieve orgasm with Viagra®, while 43% were able to achieve orgasm with
placebo. This is a profound placebo effect! For a copy of this study via the
4. Yes, initially the L-Arginine was compounded and applied to the underside of a woman's
clitoris, but this was not effective. (5 nurses, 3 uses each) Menthol was chosen as a
vehicle because of its duel action of immediate sensation of the clitoris and it's
lipophilic ability to help the L-Arginine be absorbed. Menthol was compounded and 0.5% was
found to burn younger women, but was stimulatory for several patients older than 50. (4
nurses). The menthol was reported by all subjects to create vaginal lubrication, as a
direct action of the menthol. The 0.25% menthol and 2% L-Arginine were tested in 22 nurses
and found to be related to estrogen states and age to help achieve orgasms.
representative findings were documented in 22 nurses. An interesting finding was made
after the introduction of Viacrème to the general public; women were applying the
Viacrème in the wrong place. Viacrème cannot be expected to help achieve a
clitoral erection and orgasm if it is not placed on the underside of the clitoris and
thoroughly rubbed in. Many women in the general public did not know where the clitoris
was! All nurses know because of the anatomy they studied in school. This caused us to
reissue the "Directions for Use" with a more precise anatomic drawing of where
the Viacrème should be applied.
5. No! A host of medical problems, medications, and interpersonal relationship problems
can affect both the libido and a woman's sexual responsiveness. This is quite a complex
problem and every woman is uniquely different. Please refer to the brochure "A
Woman's Sexual Responsiveness" for a list of causes of "Decreased Sexual
6. If the Viacrème does not work,
it could be because of a lack of estrogen mediated "youthfulness" of the vulva
tissue. This can be replaced with oral or transdurmal estrogen, or vaginal estrogen creams
or inserts (ESTRing ). It will probably take 2-3 months of therapy before an adequate
genital response can re-estrogenize the vulvar tissues. Estrotest is combined
estrogen/testosterone tablet. This used once or twice/day can help with both
re-extrogenizations of vulvar tissues and to help improve libido. Please refer to
"Causes of Decreased Sexual Responsiveness".
7. Testosterone cream has two effects; the immediate effect is as an irritant to cause a
reflex vaginal lubrication, the prolonged effect is to increase a woman's testosterone
blood level to help improve libido.
8. Astroglide use is intended as a vulvar lubricant. Viacrème use is not
intended to be on the vulvar tissues, other than the underside of the clitoris, and use is
not intended to be in the vagina as a lubricant.
9. Usually the 0.25% menthol will cause a
tingle and warmth when applied, If a patient reports burning, either she has a decreased
estrogen effect in the vulvar tissues (common with birth control medications and
menopause), a sub-clinical vulvar irritation due to yeast or some other infection,
detergents used to wash underwear, or fragrances used in toilet tissue. The precaution for
Viacrème is to discontinue use if irritation develops. Viacrème can again be
tried after the underlying problem is identified and corrected.
10. See answer to Question #9.
11. Men whose partner is using Viacrème sometimes report a menthol effect on the
gland and corona of the penis. This has been reported as "cooling" and pleasant,
12. No! Viacrème is intended to help enhance and increase a woman's sexual
responsiveness; it is not a treatment for sexual dysfunction.
13. I think the Viagra® study for women was poorly designed and therefore yielded poor
results. Viagra® is indicated for treatment of male erectile dysfunction. In an attempt
to expand the use of Viagra® in women, Pfizer designed a study as though women were men.
A man must have an erection to have intercourse. A woman does not require clitoral
erection for intercourse, but she does require maximal clitoral arousal for orgasm. Men
are simple, women are complex; The study referenced above was presented at the ACOG
Meeting, May 2000. It is questionable if Viagra® will get FDA approval for women.
14. Viacrème is produced under strict GMP (good manufacturing practices) in an FDA
approved pharmaceutical facility. Menthol in Viacrème is less than in a cough drop
that is orally absorbed. L-Arginine determined a single use of Viacrèmeis 40
micrograms; 30 grams were given IV to pregnant patients (29) to treat preclamsia (high
blood pressure) without adverse effect. See the back of the brochure "A Woman's
15. Neither, Viacrème is a consumer product to help a woman with sexual
responsiveness. To require a prescription or to be an OTC drug, the FDA approval process
is required. The FDA approval process consists of 2 tests: 1) Where your product is
manufactured. 2) Proof of any claims you make. The first test is satisfied.
Viacrème is made like prescription and OTC drugs, under GMP in an FDA approved
pharmaceutical facility. The second test is absolutely unattainable. The FDA currently
does not recognize an objective test to measure clitoral erection. Multiple modalities
have been evaluated, but none can satisfactorily measure the effect of drugs on clitoral
erection. Any subjective test, as Pfizer attempted with Viagra® by asking patients about
their responses to a medication are doomed to failure because a woman's sexual
responsiveness is so complex, individualistic, and dependant on the knowledge and caring
of her partner, to help her achieve orgasm.
16. Viacrème costs less per dose than a drink in most restaurants or bars, and is
sold in boxes of 12 doses, single dose packs and double dose packs.
17. Currently if you are a nurse practitioner you can get free samples of Viacrème.
This is a limited time only.
18. You may contact firstname.lastname@example.org for the brochures. This is a limited time offer.
19. Yes, the two components menthol and L-Arginine are safe. Menthol in cough preparations
contains ten times the amount of menthol as Viacrème. L-Arginine has 40 micrograms
per application. 100mg L-Arginine are ingested in preparations from Health Food Stores. We
are currently helping to develop a lipstick containing menthol and L-Arginine to increase
the size of lips when applied, instead of cosmetic surgical collagen injections.
20. Viacrème is compounded in a water base not a petroleum base. Condom breakage is
reported as a problem with petroleum but not with water based products.