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On the vulva, an internal portion of the clitoris behind and beneath the clitoral glans. Fifty percent of the women reported improvement in their sexuality after surgery and 21 reported deterioration32 29 of women reported no change. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking anti hypertensive medications. There are no controlled clinical data on the safety or efficacy of sildenafil in the following groups if prescribed, this should be done with caution.