The Role of Drugs in Treating Female Sexual Dysfunction

Abstract

Female sexual dysfunction is a bio-psycho-social healthcare problem in which treatment options engage multiple disciplines. A consensed management paradigm engages after the diagnosis a step-care plan which first starts with modification of reversible causes. This includes sex therapy, medication changes, physical therapy, diet and exercise, relaxation, addressing partner issues. Should the sexual health concern continue, the next step in the process of care engages non-hormonal and hormonal pharmacologic intervention. After a full discussion of the risks and benefits of each pharmacologic agent, a clinical trial is pursued and where appropriate, follow up includes validated psychometric outcome scale measurement, psychologic interview, and appropriate lab tests as needed. Hormonal drug intervention involves androgens such as systemic DHEA and testosterone, local, intravaginal, vestibular and systemic estradiol and systemic progesterone. In addition SERMS and SARMS may be considered. Non-hormonal pharmacotherapy involves vasoactive agents, dopaminergic agonist agents, alpha 2 receptor antagonist, and local and central medications for pain management. The management of women with female sexual dysfunction can be directed in a step-care process with the rational use of multi-disciplinary therapeutic interventions.