Introducing the Scream Creams

One day, not long after her 43rd birthday, Meg woke up and her orgasm was gone. Poof. Disappeared.“The things that used to work suddenly didn’t work anymore,” she says. “It was hard to get excited, and even when I’d get turned on, it felt like the volume had been turned down so low it was on mute.”She Googled some of her other symptoms—which ranged from dryness to feeling almost as if she were being stabbed in the vagina whenever her boyfriend touched her—and self-diagnosed perimenopause. Her doctor prescribed hormone replacement therapy, but Meg says it didn’t do anything for the sex part. She couldn’t bring herself to make an appointment specifically to complain about that; instead, Meg went down more Internet rabbit holes, finding her way to Reddit and, eventually, a telehealth company that prescribed a topical cream she was told to rub into her vagina, particularly the clitoris, about a half-hour before sex. It contained sildenafil, which increases blood flow—and is the key active ingredient in Viagra.“It worked, thank god,” Meg says. “But why did I have to find out about this from Reddit?”Indeed. It’s estimated that one in five women will experience female sexual arousal disorder (FSAD), defined as a distress-causing inability to attain or maintain sexual excitement, which often includes lack of lubrication and decreased genital swelling. And although sildenafil is, of course, approved by the Food and Drug Administration (FDA) to treat erectile dysfunction­—it famously received “Priority Review” status in 1997 and then was given the green light six months later—the drug is not approved as a topical cream for women. In fact, there are zero FDA-approved treatments for FSAD.River ChadThat means women like Meg often have to DIY their sexual health care, including seeking out information about “scream creams,” the colloquial term for topical formulations applied to the clitoris and genital area. The creams are typically available from telehealth platforms such as Wisp, which debuted its sildenafil formulation—dubbed OMG! Cream—in 2022.According to the company, demand (including repeat sales) was so strong that in 2025, Wisp launched an extra-strength formulation with 3 percent sildenafil compared with 1 percent in the original. (Trying the 1 percent version is not a prerequisite for trying the extra-strength, says the company’s lead nurse practitioner, Andrea Sleeth. “Some people just want to start with 3 percent right off the bat.”)Before the telehealth boom, you had to be lucky enough to see a clinician who specialized in sexual health and also worked with a compounding pharmacy that could mix up a cream for you. These people existed—for example, Anna Cabeca, DO, a triple-board-certified ob-gyn in Dallas, has been offering patients what she calls a “joy gel” for more than 20 years—but even in 2026, prescribers remain few and far between.Misunderstanding ArousalBefore you can even think about treating FSAD, you need a diagnosis—and many women slip through the cracks at this stage. Few doctors feel comfortable diagnosing patients with the condition, says Maria Sophocles, MD, a gynecologist and the author of The Bedroom Gap. More than half of ob-gyn residents were not able to describe the disorders of sexual function or list common medications that affect sexual function, according to one study. That’s because most residencies have, at best, limited education around female sexual dysfunction, says Tami Rowen, MD, an ob-gyn in San Francisco and president-elect of the International Society for the Study of Women’s Sexual Health.This is mainly due to a lack of investment from the medical establishment; the field of sexual medicine “does not reimburse particularly well,” says Dr. Rowen. “So, to be a specialist within an academic center [and] to maintain the goals of the enterprise, you end up doing a lot of obstetrics and other types of gynecology outside the realm of sexual medicine.”“It worked, thank god. But why did I have to find out about this from Reddit?”There’s also the matter of bias. Doctors can “bring their own family, sociocultural, religious layering of their own sexual beliefs” into the exam room, says Dr. Sophocles. “That can make sexual questions or issues in their patients something they really either avoid asking about or are sort of demure in terms of talking about.” Some women feel dismissed by their doctors’ answers (“Of course, you’re not having good sex; you have three kids”). Others feel embarrassed—or the secondhand embarrassment of their providers (again, partly due to the lack of education)—to ask questions in the first place. “This happens very commonly, and it shuts women down,” says Dr. Sophocles. “They just blame themselves.”River ChadScreaming for MoreBeyond having sildenafil as the active ingredient, scream creams aren’t standardized, and because of that, results vary. Some women say the creams live up to their name, while others say the only thing they arouse is intense frustration that nothing seems to be happening. “It was so disappointing,” says one user, who tried a cream about six times—or until she got so annoyed, she threw it out. “I wasn’t expecting anything miraculous, but I got nothing but the faintest tingle.” (Women are apparently frustrated with the cream’s results often enough that the telehealth platform Strut published “Scream Cream Not Working?,” a long blog post with six application tips, which include trying the cream multiple times and not expecting it to “do 100 percent of the work.”)While the creams aren’t recommended if you’re pregnant, breastfeeding, or have a heart condition, they have no known side effects beyond irritation (relatively rare), making them low risk and potentially high reward.But just how high remains a matter of debate, even among sexual health specialists. These creams are typically prescribed to women for whom the struggle to climax is something new, often related to menopause. But they’re usually not the first line of defense for Lori Davis, a doctor of nursing practice and a sex counselor in Ithaca, New York. Although she’s been prescribing arousal creams (Davis’s preferred term) to patients for more than 10 years, she often prescribes testosterone cream first, which can take several months to take effect.In addition to the T cream, she’ll often prescribe an arousal cream to patients who come in saying their orgasm is meh, that it’s “really hard to get there, and when I get there, it’s sort of like, ‘what’s the point?’ ” Davis says. She’ll also offer the cream—as a kind of Hail Mary to patients who are really struggling—as another way to enhance the neurofeedback from their clitoris to their brain, and to work with that natural arousal process. “I think it’s worth a trial for any woman who has orgasm trouble,” Davis says. “The only thing you’re doing is wasting money if it doesn’t work.” (The pharmacy Davis uses to compound hers charges about $90 for a tube with 30 applications.)Dr. Rowen has also been prescribing compounded creams to her patients for 13 years, usually to those experiencing a loss of sensation, often because of age. “I would love for it to work better,” she says. It can also be “a little bit of a hard sell” to patients, Dr. Rowen adds, since you have to apply the cream about a half-hour before sex. (The same can be said for oral sildenafil—men are told to pop their little blue pill 30 minutes to an hour before sex for optimum results.)But that added time may actually help some women who struggle with sexual desire in addition to arousal. Sameena Rahman, MD, a gynecologist and menopause specialist in Chicago, says that every person she talks to about their lack of desire usually has some form of arousal dysfunction—and that women, especially in long-term relationships, tend to lose spontaneous desire. Instead, they have responsive desire, meaning they have to get aroused before they have the desire for sex. Scream creams can kick-start that arousal process by increasing blood flow to the vulva, and particularly the clitoris (why that little nub becomes engorged), creating the conditions for responsive desire to show up. “When you can fix an element of arousal, you’re actually fixing their whole sexual function experience,” she says.River ChadThe Secret SauceAs with many aspects of women’s health, the creams also suffer from a research problem—essentially, the lack of it. Unfortunately, this isn’t unusual. “In the field of sex medicine, we don’t have a lot of research on most of the things that we’re working with,” says Davis. Add to that the fact that orgasms are multisensory and multifactorial and include a strong psychological component. As a result, they are not easily replicable, even in the same woman.Studies involving sex are difficult to conduct and present novel problems, something you can glimpse even in the researchers’ neutral clinical language. In one Chinese study, women were “instructed to attempt vaginal intercourse five times between visits 2 and 3 [a four-week period]”—but what if they didn’t feel like it or, say, had had a fight with their partner? Another piece of research involving a sildenafil cream stopped far short of the desired sample size partly because it was so hard to sign up volunteers. Women didn’t want to tell their partners that they were using the cream, but the study required that partners answer questions about any adverse effects they may have had from contact with the cream within 72 hours of any sexual event.What little research there is tends to show a strong placebo effect (which isn’t unusual—in a meta-analysis of studies involving oral sildenafil and other PDE5 inhibitors for men, the authors concluded that participants receiving a placebo exhibited gains in erectile function). In the Chinese study, women using the strongest cream formulation achieved an “arousal success rate” of over 50 percent, but the rate was still 33 percent for patients who got the placebo cream. Another study showed no “statistically significant differences” in the mean number of “satisfactory sexual events” between women who used the cream and those who used the placebo. It doesn’t help that critics charge that it is the rubbing-in action, not the creams themselves, that gets results, and at least one study instructed participants “to engage in foreplay to facilitate the action of the medication”—but defenders are doubtful the rubbing is the secret sauce. “Massaging it in definitely helps with blood flow, but that’s where the controlled trials make a difference,” Dr. Cabeca says. “In those, we definitely see the benefit with the ingredient compared to the placebo.”“It was hard to get excited, and even when I’d get turned on, it felt like the volume had been turned down so low it was on mute.”Kelly Casperson, MD, a urologist who specializes in female sexual health, points to the placebo effect seen in both Viagra and selective serotonin reuptake inhibitors (SSRI) studies. (In the latter, the placebo response is estimated to account for up to approximately 75 percent of the overall clinical improvement.) She says, “We don’t get rid of all SSRIs because there’s a significant placebo effect. Picking on women’s sexual health because of the placebo effect is gender bias.”And doctors trained in treating sexual dysfunction know sildenafil—actual sildenafil, not the placebo—makes a real difference for some women. Daré Bioscience, a company focused on women’s health, did some initial testing on a sildenafil cream to see if, and how quickly, it increased blood flow. The company stopped the study after six women because it was clear it was having the intended effect. (If you need further proof of the difficulty of testing sex-related products, and of lining up volunteers, this particular test used a heat-sensing camera, while the study volunteers, feet in stirrups [and hands to themselves], watched curated porn for women. The women had to agree to be tested three times, randomized between the product, no cream, and a placebo cream.) And Dr. Cabeca, who uses a compounding pharmacy to make her “joy gels,” says some patients can get a similar effect from a cheaper version that uses a mix of non-sildenafil vasodilators, including L-arginine. If that doesn’t work, she gives them one with the sildenafil added, which does the trick for about half her patients who try it.River ChadFuture of an FDA-Approved OMany doctors who focus on women’s sexual health say they began working with compounding pharmacies in part because of the long history of general dismissiveness toward their specialty. Dr. Cabeca, for example, says she got into it in the early 2000s because other doctors were telling her breast cancer patients “just be thankful you’re alive—come back next year to see if the cancer comes back.” (Breast cancer treatments can drastically lower estrogen levels, leading to vaginal dryness, which can make sex painful.)This was back when hormone replacement therapy was villainized—a result of research revealed to be seriously flawed—so Dr. Cabeca got into bioidentical hormones and sexual health issues. “My approach was to restore the vulva, the vaginal tissue, the vaginal health, because that is key to the quality of life of a woman, especially as we age,” she says. “We didn’t have options, so I had to compound.”Scream creams aren’t a perfect solution, but they are a relatively easy one to try. FDA approval would bring much wider access (and, potentially, insurance coverage); however, the approval is slow in coming (no pun intended). Daré Bioscience has been working on a sildenafil cream—one with a novel absorption technology—since 2018. In 2023, it completed its phase 2 trial, which is one of the biggest hurdles for a new drug application because that is where companies have to show the drug can actually work. This one showed improvement in sexual satisfaction, arousal sensation, lubrication, and achievement and pleasure of orgasm—though it fell short of being statistically significant. (One of the biggest takeaways from this trial was that there “were no statistically significant differences in the mean number of satisfactory sexual events between sildenafil cream and placebo cream users.” This standard has been criticized, however, by women’s sexual health advocates because it’s a very male-centered metric.)But—far from the Viagra fast-track—three years later the company is still in discussions with the FDA about what would be an appropriate phase 3 study design. The argument isn’t about the validity of the questionnaires around arousal sensations (these are similar to the kinds of questions men in the Viagra study answered about their erections). According to Sabrina Martucci Johnson, Daré’s founder, the FDA wants a component to the assessment that shows whether the drug improves the interpersonal distress that is a criterion for the diagnosis of female sexual arousal disorder—a completely subjective measure. But the FDA required no such thing of Viagra, even though causing such distress is a criterion for the diagnosis of erectile dysfunction too.Johnson says she doesn’t see this as a function of the FDA’s reluctance to move on women’s health issues. (The organization’s history of sluggishly approving other sexual health medications designed for women suggests otherwise.) Instead, she speaks with the diplomacy of someone who has to keep working with the FDA: “I think it’s really challenging for any company in any disease area when you’re trying to innovate where there’s no already FDA-approved product you can point to as a road map.” Dr. Casperson is more forthright: “It’s embarrassing,” she says of the FDA’s slowness. (The FDA said its policy was not to comment on new drug applications.)Some doctors say if Daré can clear the FDA hurdles and the cream is approved, it will make a huge difference in awareness and use of the product. “It’ll make it massively easier and less complicated for doctors to prescribe it,” Dr. Rowen says.Dr. Rahman, who describes herself as a “true believer” in the cream, takes it one step further. “I think this is probably going to be a game changer for a lot of people,” she says.She isn’t the only one who thinks so. Daré says that when it published the results of its phase 2 trial in 2024, doctors reached out asking for the formula, wondering if they could give it to a compounding pharmacy. The enthusiastic response pushed Daré to find a compounding pharmacy itself. Since February, doctors have been able to write prescriptions for the cream, called Dare to Play, though it won’t be dispensed until later this year.Patients “are waiting,” says Dr. Sophocles. “In a clinic like mine, they all want it. They’re all excited about the possibility of it.”And that’s the thing: the possibility. Doctors don’t agree about how effective sildenafil cream is—how effective any arousal cream is—or even how significant it would be if the FDA approved one. But many agree on one thing: Women deserve a chance to try it.Makeup: J. Patrick for see ManagementProp stylist: Nicole Louie for Walter Schupfer