Hormonal and Pharmaceutical Treatment Approaches

An integral part of a treatment plan for managing sexual dysfunction in women is the use of hormonal and pharmaceutical agents. For women who opt to incorporate these agents in their treatment plan, a variety of agents are available.

Hormonal Agents. Hormonal agents used to treat sexual dysfunction in women include estrogen and androgens (testosterone).^1,2,3 Because these hormone levels decline as a woman ages, particularly in postmenopausal women, it is thought that replacing these hormones in the body may improve sexual functioning in women.

However, data on use of hormones to improve sexual functioning in women is mixed. The Women’s Health Initiative found that estrogen when used systemically (taken orally) with progestin therapy did not improve sexual satisfaction in women.¹ Data do show, however, that estrogen therapy can be effective in improving symptoms of menopause that can interfere with a women’s otherwise healthy sex life. As such, reasonable approaches are available to using estrogen therapy for women with sexual dysfunction (Table 1).

(Ref #1)

Less data are available on the effectiveness of testosterone to treat sexual dysfunction in women. There is some evidence suggesting that testosterone may have a positive impact on desire, arousal, and orgasmic response in postmenopausal women, but results are mixed and little long-term follow-up data are available.^1,2,3 Currently, testosterone is not approved by the Food and Drug Administration (FDA) in the United States to treat female sexual dysfunction. However, testosterone is sometimes used “off-label” by clinicians to treat sexual problems in women, and current data suggest that specific testosterone preparations are most likely to achieve therapeutic levels in women (Table 2). However, it is important to inform patients of the potential side effects of testosterone therapy, particularly given that many of the testosterone formulations are too high for women and increase the likelihood that side effects will develop.^1,2,3

(Refs #1,3)

Pharmaceutical Agents. Along with hormonal agents, other pharmacological agents that have been considered to treat sexual dysfunction in women include the phosphodiesterase (PDE-5) inhibitors commonly used for men with erectile problems (i.e., sildenafil, tadalafil, vardenafil). However, none of these agents are usually recommended based on the lack of data showing their ability to improve sexual function in women.^1,2,3 The one exception is that sildenafil may have a positive effect on sexual arousal and orgasm in premenopausal women taking antidepressant medications that adversely affect their sexual functioning.^1,2,3

To date, there is only one FDA approved drug to treat sexual problems in select women. Approved in 2015, flibanserin is approved for treating low desire for sex in premenopausal women in whom such a lack of desire causes distress.² However, clinicians need to let patients know that this medication can cause side effects, including low blood pressure or fainting. Other side effects may include nausea, dizziness, and headache.²

Finally, an inexpensive and effective treatment for women with vaginismus and vulvodynia is an injection of botulin into the bulbospongiosus muscles.¹

REFERENCES

1.    Finding Solutions for Female Sexual Dysfunction. American College of Obstetricians and Gynecologists. July, 2010. http://mail.ny.acog.org/website/FSDResourceGuide.pdf

2.    Shifren JL. Patient Education: Sexual Problems in Women (Beyond the Basics). UpToDate. 2017. http://www.uptodate.com/contents/sexual-problems-in-women-beyond-the-basics?view=print

3.    Female sexual dysfunction. Practice Bulletin No. 119. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:996-1007. http://journals.lww.com/greenjournal/Citation/2011/04000/Practice_Bulletin_No__119__Female_Sexual.38.aspx