Recently Viacrème™ 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;

1. 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 lubricant?
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 - LIBIDO)
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 www.viacreme.com site.
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.

These 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 Responsiveness".
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, not unpleasant.
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 Viacrème™is 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 Sexual Responsiveness".
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 bhassman@aol.com 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.

BACKORDERED 12 pack $95.00