For far too long, women’s sexual health has been ignored, but that’s starting to change—and it’s about time. Women’s pleasure is taking center stage with libido-boosting “pink pills” and scream cream—a topical that, as the name suggests, can help make you scream in the bedroom.
Scream cream is “the latest addition to the arsenal of medications designed to help women achieve orgasm more easily,” says menopause specialist Sherry Ross, M.D. It can be a godsend for women dealing with common perimenopause and menopause challenges like low libido, vaginal dryness, and difficulty reaching orgasm (1).
The good news: These bedroom problems are very treatable. “Products [like scream cream] are thought to increase blood flow to the genitals and erectile tissue of the vulva, which ultimately can increase arousal, pleasure, sensitivity, and orgasm potential,” Ross says.
About The Experts
Joy Berkheimer, Ph.D., LMFT, is a psychotherapist and licensed sexologist. She is the chief sexologist at SXWA, a sexual wellness award platform.
Sherry A. Ross, M.D., FACOG, is a board-certified obstetrics-gynecologist at Providence Saint John’s Health Center in Santa Monica, California. She’s a menopause specialist and the author of She-ology and The She-quel.
Nicole Snow, Pharm.D., is a board-certified pharmacist based in Florida and the Clinical Pharmacy Liaison with Olympia Pharmaceuticals.
Rachel Wright, LMFT, is a sex-positive, New York-based licensed psychotherapist. She hosts the podcast “The Wright Conversations” and teaches online workshops.
What Is Scream Cream?
Scream cream is the colloquial term for an off-label prescription of vulva-friendly cream containing sildenafil—the same active ingredient in Viagra. Indeed, it’s often called ‘libido cream’’ because it helps women orgasm more easily.
Scream cream isn’t a trademarked name or brand. Various pharmaceutical providers and brands have their own versions of the pleasure-inducing product. While formulations differ slightly, they all have the same active ingredient: sildenafil.
How sildenafil boosts orgasms
Sildenafil can enhance blood to various parts of the body, including your genitals (2). Blood flow is crucial for the sexual response cycle, says board-certified pharmacist Nicole Snow, Pharm.D. Increasing blood flow to the vulva promotes natural lubrication, enhances clitoral sensitivity, and intensifies orgasms (3).
Female Sexual Arousal Disorder and Scream Cream
Libido, generally speaking, describes your interest in sex. If your libido is low, it can affect your mental well-being. It can feel distressing when your desire to have sex unexpectedly vanishes, explains licensed psychotherapist Rachel Wright, LMFT.
If your libido has been MIA for months on end, an OB-GYN may diagnose you with female sexual interest/arousal disorder (FSIAD), says psychotherapist and sexologist Joy Berkheimer, Ph.D. (4). FSIAD is marked by a lack of desire for sexual activity and physical arousal, she says (5). While FSIAD can impact people at any age, it’s more common in midlife and beyond.
“Sexual arousal disorder is seen more frequently in peri- and post-menopause,” Berkheimer says. One 2022 study suggests women ages 51 to 59 are most likely to be affected (6). Why? This age group experiences a rapid decline in estrogen levels, which can negatively affect vaginal lubrication and sexual desire, Berkheimer notes.
But there’s a silver lining for those navigating FSIAD: Scream creams and similar products, especially those with testosterone, may help restore your libido.
Can topical sildenafil improve sex?
Although only a handful of studies have explored whether sildenafil creams increase pleasure, they all show promise.
One of the first studies on the topic, published in 2020, looked at the effects of topical sildenafil on women ages 25 to 55 who didn’t have sexual dysfunction (7). After watching a 30-minute, sexually explicit film, those who used the cream experienced a significant increase in arousal compared to those who didn’t. That suggests sildenafil may help treat FSIAD, according to the study authors.
New studies show scream cream isn’t just about increasing arousal and lubrication. One large 2024 study found it can strengthen orgasms after just eight weeks; another from the same year suggests it can reduce anxiety or frustration around sex, too (8, 9).
Here’s the catch: So far, studies have only looked at how scream scream can help women before and during perimenopause. Postmenopausal women haven’t been represented. This doesn’t mean it won’t help this group, but we need more research to confirm, says Ross.
The risks of using scream cream are likely low. Old research suggests oral sildenafil is safe and effective for women in postmenopause (10). The researchers behind a 2024 study also report that sildenafil cream, in general, is safe and well-tolerated by users and their sexual partners (11).
Still, it’s not a cure-all. “Topical sildenafil products can assist in treating sexual arousal disorder in some women postmenopause,” Ross says. But, “sexual arousal disorder in women is complicated and can have many contributing factors.” Translation: If you’re struggling with low desire, it could be due to stress, relationship dynamics, or body image issues—not just biology.
Also, for truly satisfying sex, it’s essential to look at the whole picture. “Relationship counseling, stress reduction, sex therapy, more foreplay, or a weekend away with your partner may all help you get back on track to having good sex—no matter your life stage,” Ross says.
If you’re going through menopause, hormone replacement therapy (HRT) can address symptoms like vaginal dryness or painful sex that can sabotage your sex life, Ross adds. Products like scream cream also won’t remedy issues like vaginal atrophy, genitourinary syndrome symptoms, and dyspareunia (pain during sex). Only HRT—including vaginal estrogen can help with those, Ross says. In most cases, scream cream can be used in tandem with HRT.
Sildenafil is the star ingredient in most scream creams, but many also contain other ingredients that support sexual function. Some formulas, including Hone’s arousal cream, pack libido-boosting powerhouses like l-arginine and testosterone.
L-arginine
L-arginine is an amino acid often found in pre-workout supplements. Like sildenafil, L-arginine promotes better blood flow. It relaxes the smooth muscle in blood vessels, allowing more circulation to areas that matter—like your clitoris (12). One 2023 study found that blood flow to the clitoris increased within just 5 minutes of using a gel containing L-arginine (13). That means more sensitivity and enhanced arousal—fast.
Testosterone
Testosterone is known as the “male” hormone, but it’s critical for women’s sexual health, too, Berkheimer says. Doctors often prescribe it off-label to women to revive a diminished sex drive, Berkheimer explains.
Topical testosterone may be especially helpful for women in menopause, Berkheimer adds. One small study on 37 post-menopausal women found that intravaginal testosterone cream significantly improved sexual satisfaction and reduced pain during sex in as little as two weeks. (14).
How to Use Scream Cream
Patience is essential for having a pleasurable experience with topical sildenafil. As the saying goes, everything comes (ahem) to she who waits. It can take up to 30 minutes for scream cream to absorb into your genital tissues.
To get the most out of it, thoroughly massage the cream into your clitoris, labia, and surrounding tissues for 30 to 60 seconds. While you wait for the cream to do its magic, try other activities that support arousal, such as reading or listening to erotica, or snuggling with your partner.
And remember, there will be nights when you aren’t in the mood for sex—even after applying the cream—and that’s OK. While scream cream can be a powerful tool in your sexual toolbox, it’s not a wand-waving fairy godmother that makes all of your libido-blocking stressors disappear.
Who Shouldn’t Use Scream Cream?
If you have a pre-existing health condition, mention it to your doctor when you discuss scream cream, Snow says.
Research shows the drug can increase the risk of severe arrhythmia (abnormal heartbeat) in people with cardiovascular disease (15). You should steer clear of sildenafil if you have a heart condition or recently had a stroke or heart attack, Snow adds. Ditto if you have sickle cell anemia, hypotension, or liver issues (16).
If you have a history of genital herpes, talk to your gynecologist before using scream cream. Research suggests taking high doses of L-arginine can increase the risk of a herpes breakout (17).
Potential side effects
Any time you start a new prescription drug or skincare product, be on the lookout for adverse effects, especially during your first couple of uses. “If you experience side effects such as skin irritation, rash, discomfort, headache, or discoloration after use, discontinue use,” Snow says.
If you use a scream cream containing testosterone, keep an eye out for acne, increased body hair, and changes in mood or personality, Berkheimer says.
Can men use scream cream?
Scream cream and similar products are designed specifically for vulva owners. But these products are likely safe for non-op trans men, non-binary folks, and anyone else with a vulva.
But scream cream isn’t made for cisgender men or other penis owners. If you have a penis, are navigating sexual dysfunction, and prefer topical products, talk to your doctor about other options like Eroxon (MED3000)—a recently FDA-approved, over-the-counter gel for erectile dysfunction (18).
The Bottom Line
Scream cream is a catch-all term for creams that boost sexual arousal. Sildenafil is usually the main active ingredient in scream cream, but it can also include testosterone or l-arginine. Topical sildenafil shows promise as a treatment for low desire, specifically those with female sexual arousal disorder. Since low libido is common during and after menopause, it could be a game changer for pleasure-seekers in peri- and post-menopause. You need a prescription for scream cream, so if you’re curious about trying it, talk to a sex-positive healthcare provider who specializes in menopause.
