The link led to a paper by Nascimento et al, entitled: Sexual dysfunction and cardiovascular diseases: a systematic review of prevalence.
The paper summarized a meta-analysis of the literature on the impact of cardiovascular disease (typically post-heart attack) on males and females. The impacts were assessed by a wide variety of survey instruments such as the FSFI (Female Sexual Function Index), the RSS (Relationship Sexuality Scale) and the WDWDIAMH (Why Don’t We Do It Any More Honey).
Happily, of the twenty-three best papers found, twelve included data on females.
The results were very consistent, indicating that cardiovascular disease takes the same significant toll on all aspects of the sex life of women as it does for men. The effects include diminishment of the frequency and intensity of the following: desire, frequency of sexual interactions, arousal, sensitivity of relevant tissues, satisfaction, and confidence. Depression is also an issue.
Heart disease is caused by clogged arteries and the root of the clogging is damage to the endothelium or lining of the arteries. The disease also shows up in the smaller blood vessels in the peripheral tissues. “Fingers, toes, penis, nose” is the old saying from Med School listing important peripheral tissues that need a good blood supply. There is no reason why the clitoris should not have been included in that saying. Erectile dysfunction is not restricted to males, in my book.
There are many aspects to sexual response/function and there’s no way I can address all of them so I’m going to take a very simplified approach and focus on the plumbing. (We never think about plumbing until the toilet is plugged.)
This brings me to Viagra. And beets. And arginine
How does Viagra work? Well, nitric oxide (NO) is a soluble gas molecule that is made in healthy vascular endothelium. (NO can also be made from dietary sources of nitrate NO32-.) NO is a vasodilator, i.e. it increases blood flow to tissues by triggering a cascade of biochemical signals that opens up the blood vessels.
Viagra doesn’t increase NO but it prolongs the downstream effects of NO by prolonging the signals generated by it. The result is that you get more bang for your NO buck to paraphrase the old saying.
Another way to get more NO signaling is to eat foods that contain nitrate. Beets happen to be one of those foods. In fact, beets have a reputation for enhancing sexual health dating back to antiquity, although they confer many other benefits. This article lists 18 health benefits of beets: https://www.stylecraze.com/articles/top-10-health-benefits-of-beetroot/
Leafy greens including Arugula, Spinach and Parsley also contain high levels of nitrate but nowhere near what is in beets!
A third way to boost NO is to take the amino acid arginine, which can be used by the liver to form NO. At least one reputable nutritional supplement company makes an arginine product specifically for this purpose.
The bottom line is that a good supply of NO and healthy endothelial linings are crucial for erectile tissue. Another reason to have lots of NO on hand is to promote lubrication (Diedrich). Lubrication is impaired if the lubricant-producing tissue don`t have an ample blood supply. For example, the saliva glands are an example of a tissue that needs tremendous blood flow to keep oral mucosal tissues well-lubricated. (Remember that blood is basically half water.)
Two steroid hormones: estradiol and testosterone are important for blood flow to tissues. Note that these can be applied directly to the vulvovaginal tissues!
Per the diagram below, estradiol is where it’s at when we talk about NO in both men and women. Estradiol promotes the synthesis of eNOS or endothelial nitric oxide synthase, an enzyme that makes NO. Repeat after me: “No NO, poor blood flow.”