Desire Disorder In Postmenopausal Women Research Articles

Placebo-controlled effect of topical Qust (Costus) oil on postmenopausal women's sexual desire disorder: a double-blind, randomized clinical trial.

Decreased libido and anorgasmia are common problems for women after menopause that reduce the quality of life of couples. This study examined the effect of topical Qust oil on sexual desire disorder in postmenopausal women. In this double-blind, randomized, clinical trial, 110 postmenopausal women with decreased sexual desire visiting a Traditional Medicine Center and Hazrat Rasool Akram Hospital (affiliated to Iran University of Medical Sciences) were selected by convenience consecutive sampling and randomly assigned to experimental and control groups. The experimental group received qust oil, while the control group was given a placebo (liquid paraffin); they were instructed to massage the product topically on their pubic area and perineum daily. The sexual function of both groups was assessed and compared before the intervention and four weeks after the intervention using the Female Sexual Function Index. The mean and standard deviation of the improvement of sexual function post-intervention were 37.66±32.52% and 11.96±11.18% in the experimental and control groups, respectively (p<0.001). In terms of the improvement of components of sexual function, a significant difference was observed between the two groups in the sub-scales of sexual desire [57.05±42.99% vs. 21.25±27.85%, p<0.001], arousal, orgasm, and satisfaction (p<0.001 for all); however, no significant difference was observed in terms of lubrication (p=0.25) and pain during intercourse (p=0.776). In postmenopausal women with sexual dysfunction, massaging the pubic area and perineum with qust oil for at least four weeks significantly improves desire, arousal, orgasm, and sexual satisfaction.

Testosterone use for hypoactive sexual desire disorder in postmenopausal women.

Testosterone is an important evidence-based therapy for hypoactive sexual desire disorder (HSDD) in postmenopausal women. Clinical practice guidelines based on the most comprehensive meta-analysis of benefits and risks of testosterone therapy to date state that the sole evidence-based indication for testosterone therapy is HSDD in postmenopausal women. The guidelines also provide recommendations regarding identification of patients, dosing, monitoring, and follow-up. This Practice Pearl will discuss evidence-based testosterone therapy for management of HSDD in postmenopausal women.

Clinical management of hypoactive sexual desire disorder in postmenopausal women.

Approximately 10% to 12% of women meet the criteria for hypoactive sexual desire disorder, with the highest prevalence in midlife women, ranging from 14.5% to 33%. Despite the negative effect on health and quality of life, most women are reluctant to discuss sexual concerns with healthcare professionals. Although healthcare professionals have the best opportunities to address these problems, most of them have limited awareness, education, and comfort about addressing sexual concerns, resulting in a conspiracy of silence. The purpose of this Practice Pearl is to improve the understanding of hypoactive sexual desire disorder, including symptoms, etiology, diagnosis, and treatment.

Androgen supplementation for hypoactive sexual desire disorder in postmenopausal women: A systematic review and meta-analysis

Androgen supplementation for hypoactive sexual desire disorder in postmenopausal women: A systematic review and meta-analysis

Facilitation of sexual behavior in ovariectomized rats by estradiol and testosterone: A preclinical model of androgen effects on female sexual desire

In the United States and Canada, there are no approved treatments for hypoactive sexual desire disorder in postmenopausal women. Testosterone improves female sexual desire in naturally- and surgically-menopausal women maintained on estrogen replacement therapy, and long-term safety data from randomized placebo-controlled clinical trials has yielded promising results. However, the mechanisms associated with its efficacy are not known, and could be addressed using preclinical rodent models; yet there is no systematic evaluation of the effects of estradiol and testosterone on female rat sexual behavior. The aim of these studies was to assess whether testosterone propionate (TP) facilitates sexual behaviors, particularly appetitive sexual behaviors, in Long-Evans and Wistar ovariectomized (OVX) rats primed with estradiol benzoate (EB). In Experiment 1, Long-Evans OVX rats were treated with Oil (O), 10μg EB+O, O+200μg TP, 10μg EB+500μg progesterone (P), or 10μg EB+200μg TP. In Experiment 2a, Wistar OVX rats were treated with varying doses of EB (2.5, 5, or 10μg) 48h prior, and TP (0, 200, or 400μg) 4h prior to testing in a Latin-Square design. A subset of animals was used in Experiment 2b and treated sequentially with EB (0, 2.5, 5, or 10μg) followed by TP (0, 200, or 400μg, in a Latin-Square design) 48h prior to sexual behavior testing. All tests occurred in the bilevel pacing chamber. Frequencies of female appetitive (hops/darts, solicitations, level changes) and consummatory (lordosis quotient and magnitude) sexual behaviors as well as the number of defensive behaviors towards males were scored. Number of mounts, intromissions and ejaculations from males were also scored. In EB-primed OVX Long-Evans rats, 200μg TP administered 4h prior to testing facilitated hops/darts and lordosis ratings beyond EB alone, and to levels equivalent to EB+P. In contrast, that regimen was not successful in EB-primed OVX Wistar rats. When EB and TP were co-administered 48h prior to testing, 10μg EB+200μg TP significantly increased hops/darts and level changes beyond that observed by 10μg EB alone. In summary, the administration of EB and TP to OVX Long-Evans and Wistar rats facilitates appetitive measures of sexual behavior. Strain differences exist that likely reflect underlying differences in sensitivities to EB, and the EB-primed OVX Long-Evans rat may be useful for studying mechanisms of TP-facilitation of desire due to higher baseline sexual inhibition.

Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women: a randomized, double-blinded, placebo-controlled trial.

The objective of this study was to evaluate the efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women and evaluate its effect on the serum levels of testosterone. We performed a prospective randomized, double-blinded, placebo-controlled study, during 18 months. A total of 45 healthy sexually active postmenopausal women reporting diminished libido were selected to participate in the study and were randomly assigned to receive 750 mg/d of T terrestris or placebo for 120 days. Randomization was performed using sealed envelopes. All participants answered the Female Sexual Function Index and the Sexual Quotient-female version questionnaires and had their serum levels of prolactin, thyroid-stimulating hormone, total testosterone, and sex hormone-binding globulin measured. A total of 36 participants completed the study, because 3 from each group were excluded due to side effects and 3 dropped out due to personal reasons. FSFI questionnaire results demonstrated an improvement in all domains in both groups (P < 0.05) except for lubrication which was improved only in the study group. QS-F results showed a significant improvement in the domains of desire (P < 0.01), arousal/lubrication (P = 0.02), pain (P = 0.02), and anorgasmia (P < 0.01) in women who used T terrestris, whereas no improvement was observed in the placebo group (P > 0.05). Moreover, free and bioavailable testosterone levels showed a significant increase in the T terrestris group (P < 0.05). Tribulus terrestris might be a safe alternative for the treatment of hypoactive sexual desire disorder in postmenopausal women, because it was effective in reducing symptoms with few side effects. Its probable mechanism of action involves an increase in the serum levels of free and bioavailable testosterone.

Therapy of Hypoactive Sexual Desire Disorder in Postmenopausal Women: A Functional Food Approach

Therapy of Hypoactive Sexual Desire Disorder in Postmenopausal Women: A Functional Food Approach

Safety of testosterone therapy indicated for hypoactive sexual desire disorder in postmenopausal women

Safety of testosterone therapy indicated for hypoactive sexual desire disorder in postmenopausal women

Androgens in Women before and after the Menopause and Post Bilateral Oophorectomy: Clinical Effects and Indications for Testosterone Therapy

In postmenopausal women, the ovaries produce significant amounts of androgens for many years after the menopause. Bilateral oophorectomy markedly reduces circulating testosterone (T) in both pre- and postmenopausal women. Oral estrogen therapy in postmenopausal women increases sex hormone-binding globulin and decreases T bioavailablity. Circulating androgens decrease with increasing age. The occurrence of an androgen deficiency syndrome associated with loss of libido and sense of well-being is disputed, but in several randomized controlled trials, transdermal T patches produced a significant improvement in hypoactive sexual desire disorder in postmenopausal women who had bilateral oophorectomy and in some women who had a natural menopause. T therapy is legitimate and is clinically indicated in such women. T therapy may have other benefits in postmenopausal women including an increase in lean body mass and bone mineral density. T therapy should become an integral part of hormone therapy in selected postmenopausal women in the future.

Efficacy and Safety of Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women

Hypoactive sexual desire disorder (HSDD) is a common problem in postmenopausal women, but in the absence of an approved medical treatment in the United States, off-label testosterone use is widespread. Large, randomized controlled studies have demonstrated that transdermal testosterone improves sexual function and activity in postmenopausal women and has favorable short-term safety. However, a longer-term safety profile of testosterone must be established before a testosterone product for women is approved. To review current knowledge of the efficacy and safety of transdermal testosterone based on presentations at a satellite symposium during the 2011 annual meeting of the International Society for the Study of Women's Sexual Health. Pertinent information included in the presentations was augmented with relevant articles from the peer-reviewed literature. The rationale for testosterone therapy and results from phase III and other clinical studies with the testosterone patch in postmenopausal women with HSDD and findings from studies investigating the cardiovascular, breast, and endometrial effects of testosterone therapy. Randomized, double-blind, placebo-controlled studies have established the efficacy of the transdermal testosterone patch for relieving symptoms of HSDD in surgically and naturally menopausal women with and without concomitant estrogen or estrogen/progestin therapy. The main side effects reported in clinical trials were increased hair growth and acne. Available safety data for testosterone, although not conclusive, were reassuring with respect to cardiovascular, breast, and endometrial outcomes. Interim data from a long-term phase III safety trial of a testosterone gel demonstrate a continued low rate of cardiovascular events and breast cancer in postmenopausal women at increased cardiovascular risk. Transdermal testosterone appears to be an effective and safe therapy for postmenopausal women with HSDD.

Hypoactive Sexual Desire Disorder in Postmenopausal Women: Quality of Life and Health Burden

Objectives To describe the health-related quality of life (HRQOL) implications of hypoactive sexual desire disorder (HSDD) in a national sample of postmenopausal women ages 30–70. Methods The Nationwide Survey of Female Sexual Health, a random-digit telephone survey of US households, collected information on female sexual function, demographic characteristics, HRQOL, and the presence of specific medical disorders from 1189 naturally or surgically postmenopausal women in stable relationships of ≥3 months duration. HSDD was defined as <40 on the Profile of Female Sexual Function© scale and <60 on the Personal Distress Scale©. Short Form-12 Health Survey (SF-12) summary and domain scores, and EuroQol (EQ-5D) index score and dimensions were compared with population-based norms for healthy individuals and selected chronic conditions. Results HSDD was associated with significant HRQOL decrements, with the largest SF-12 score differences in mental health (HSDD: 45.4 [standard error 1.9] vs. no HSDD: 51.0 [0.6], P < 0.01), vitality (HSDD: 47.7 [1.3] vs. no HSDD: 52.0 [0.7], P < 0.01), social function (HSDD: 47.3 [1.4] vs. no HSDD: 50.9 [0.7], P < 0.05), and bodily pain (HSDD: 41.4 [2.2] vs. no HSDD: 46.7 [0.9], P < 0.05). EQ-5D index was 0.08 points lower (HSDD: 0.76 [0.03] vs. no HSDD: 0.84 [0.02], P < 0.05) for those with HSDD compared with those without. HSDD was associated with a 0.1-point decrement in naturally menopausal women (HSDD: 0.78 [0.03] vs. no HSDD 0.88 [0.01], P < 0.01). Women with HSDD showed more HRQOL impairment than healthy population norms but were similar to adults with other chronic conditions such as diabetes and back pain. Conclusions Women with HSDD showed substantial impairment in HRQOL. Given a prevalence of 6.6% to 12.5% among US women, HSDD represents an important burden on quality of life.

Hypoactive Sexual Desire Disorder in Postmenopausal Women: Quality of Life and Health Burden

Hypoactive Sexual Desire Disorder in Postmenopausal Women: Quality of Life and Health Burden

Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen

The efficacy and safety of testosterone treatment for hypoactive sexual desire disorder in postmenopausal women not receiving estrogen therapy are unknown. We conducted a double-blind, placebo-controlled, 52-week trial in which 814 women with hypoactive sexual desire disorder were randomly assigned to receive a patch delivering 150 or 300 microg of testosterone per day or placebo. Efficacy was measured to week 24; safety was evaluated over a period of 52 weeks, with a subgroup of participants followed for an additional year. The primary end point was the change from baseline to week 24 in the 4-week frequency of satisfying sexual episodes. At 24 weeks, the increase in the 4-week frequency of satisfying sexual episodes was significantly greater in the group receiving 300 microg of testosterone per day than in the placebo group (an increase of 2.1 episodes vs. 0.7, P<0.001) but not in the group receiving 150 microg per day (1.2 episodes, P=0.11). As compared with placebo, both doses of testosterone were associated with significant increases in desire (300 microg per day, P<0.001; 150 microg per day, P=0.04) and decreases in distress (300 microg per day, P<0.001; 150 microg per day, P=0.04). The rate of androgenic adverse events - primarily unwanted hair growth - was higher in the group receiving 300 microg of testosterone per day than in the placebo group (30.0% vs. 23.1%). Breast cancer was diagnosed in four women who received testosterone (as compared with none who received placebo); one of the four received the diagnosis in the first 4 months of the study period, and one, in retrospect, had symptoms before undergoing randomization. In postmenopausal women not receiving estrogen therapy, treatment with a patch delivering 300 microg of testosterone per day resulted in a modest but meaningful improvement in sexual function. The long-term effects of testosterone, including effects on the breast, remain uncertain. (ClinicalTrials.gov number, NCT00131495.)

EDITORIAL: Editorial Comments on “The Current Outlook for Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women”

“The Current Outlook for Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women” originates from a widely attended Continuing Medical Education symposium held at the San Diego 2008 annual meeting of the International Society for the Study of Women's Sexual Health (ISSWSH). The Journal of Sexual Medicine is proud to publish this fourth women's sexual health industry‐supported supplement on a clinically relevant women's sexual health concern, management of a very prevalent problem, hypoactive sexual desire disorder.

ORIGINAL ARTICLE: The Current Outlook for Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women

ABSTRACT Introduction Hypoactive sexual desire disorder (HSDD) is a common clinical problem in women, especially those who have experienced surgical menopause. Because androgen levels decline with age and drop dramatically following bilateral oophorectomy, it has been hypothesized that reduced levels of testosterone are related to diminished desire. Aim As presented at a continuing medical education satellite symposium during the 2008 annual meeting of the International Society for the Study of Women's Sexual Health, to review the current state of knowledge about the physiologic effects of testosterone in postmenopausal women, the effects of transdermal testosterone delivery in surgically menopausal women with HSDD, and ongoing studies of a transdermal testosterone gel. Methods A review of the pertinent literature, including recent presentations. Main Outcome Measures Results from the Women's International Study of Health and Sexuality; and studies utilizing the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and validated instruments that assess female sexual function: the Sexual Activity Log©, the Profile of Female Sexual Function©, and the Personal Distress Scale©. Results Surgically menopausal women receiving testosterone experience significant increases in total satisfying sexual activity vs. women receiving placebo, significant improvement in all domains of sexual function, and decreases in personal distress, with a favorable safety profile. Conclusion Testosterone deficiency may be considered among the underlying causes of HSDD. Currently, testosterone is available to women in the United States only via off-label prescribing or by unregulated compounding of testosterone preparations. New safety trials will examine the long-term safety of testosterone gel in surgically menopausal women with HSDD who are at high risk of cardiovascular disease or breast cancer.

Hypoactive sexual desire disorder in postmenopausal women: is there a relation with hormone replacement therapy and sex steroid hormonal levels?

To investigate whether there is an association between hormone replacement therapy (HRT), serum hormonal levels and the prevalence of Hypoactive Sexual Desire Disorder (HSDD) in postmenopausal women. Cross-sectional study. Women attending outpatient gynecologic clinic completed questionnaires evaluating sexual function. These included the Brief Index of Sexual Functioning, the Profile of Female Sexual Function, and the Personal Distress Scale. The participants' serum levels of estradiol, androgens, and sex hormone binding globulins (SHBG) were determined. The main outcomes measured were the demographics of the interviewees, the impact of hurricane Katrina, HRT use, presence of HSDD, and hormone levels. Student's t, chi-square, and ANOVA tests were used. Odds ratios (OR) were calculated using the Cochran-Mantzel-Haenszel test. An α = 0.05 and a power of 80% were used. All analysis were performed using SAS version 9.0. TableStudy Participants and HRTHRT (n)No HRT (n)Race∗∗ White3524 Non-White411Age 30–49188 50–591622 >6055BMI (Kg/m2)∗∗ 18.5–24.92310 25–29.9610 >30914Katrina PreKatrina76 PostKatrina3229Menopause type∗ Natural1327 Surgical268Clinical history∗ Prior hysterectomy3313 Prior oophorectomy2721HSDD HSDD1714 No HSDD2221∗ P<0.005; ∗∗ P<0.05. Open table in a new tab ∗ P<0.005; ∗∗ P<0.05. Seventy five menopausal women, ages 32 to 66 years, were recruited from two clinics in New Orleans and Houma. HRT use was more common in women who were White (60% vs. 27% in non-Whites, P=0.049), younger than 50, had oophorectomies (69% vs. 31%, P=0.0002), had a hysterectomy (85% vs.15%, P<0.0001), or had a normal body mass index (BMI) (59% vs.15% in overweight and 23% in obese, P=0.029). The majority of women on HRT were using estrogen alone (ERT) (84%). ERT users had a significantly higher SHBG (P<0.05). They also had a higher estradiol level and a lower percent free testosterone, although not statistically different. The use of HRT was not associated with HSDD (OR = 1.16; CI 0.46–2.93). Furthermore there were no differences in hormone levels among women affected with HSDD. This study confirms that HSDD cannot be correlated to sex hormone levels and is not affected by HRT use. Although they had a higher SHBG, ERT users did not have a higher prevalence of HSDD. The elevated SHBG level, which is associated with a lower bioactive androgen, seems to be counterbalanced by an elevated estradiol that has a positive impact on the vagina. This reflects the multifactorial etiology of sexual dysfunction.

Testosterone Treatment for Hypoactive Sexual Desire Disorder in Postmenopausal Women

The reduced levels of testosterone in postmenopausal women are associated with loss of libido, decreased sexual activity, diminished feelings of physical well-being, and fatigue. A bilateral oophorectomy can lead to decreases in sexual desire in 50% of cases by removing ovarian contribution to the circulating levels of testosterone. Testosterone therapy is an option for the restoration of sexual drive. Transdermal testosterone administration may bypass the effects of first pass hepatic metabolism. To this end a series of studies have been carried out using a novel transdermal testosterone system. A review of the results from these studies are presented here. A key feature of these studies was the use of validated study instruments to measure sexual function: Sexual Activity Log (SAL), Profile of Female Sexual Function (PFSF) and Personal Distress Scale. The data from the Phase III studies, known as the Investigation of Natural Testosterone in Menopausal women Also Taking Estrogen in Surgically Menopausal women (INTIMATE SM) 1 and 2 were reviewed and the salient information is presented here. Both INTIMATE 1 and 2 showed a significant increase in total satisfying sexual activity, via the SAL in those women receiving testosterone, compared with those women in the placebo group. Total satisfying sexual activity increased by 74% and 51% for INTIMATE 1 and 2, respectively. The PFSF instrument demonstrated significant improvements in INTIMATE 1 and 2 in all domains of sexual function in testosterone-treated women compared with the placebo patients. In both studies, personal distress decreased in those patients receiving testosterone, compared with the placebo group. The most commonly reported adverse events were application site reactions. Eight-five percent of patients said they would probably or definitely continue treatment. Conclusions. The transdermal testosterone patch is an effective treatment for hypoactive sexual desire disorder in surgically postmenopausal women receiving concomitant estrogen therapy. The treatment has a favorable safety profile.

ORIGINAL RESEARCH—OUTCOMES ASSESSMENT: A Methodology Study to Develop and Validate a Screener for Hypoactive Sexual Desire Disorder in Postmenopausal Women

Current methods for diagnosing hypoactive sexual desire disorder (HSDD) can be complicated and time-consuming. A previous study reported validity and reliability of a structured diagnostic method created for clinical trials that can be performed in approximately 1 hour. A more succinct tool is needed for incorporation into busy physician practices. Therefore, a brief HSDD screening tool was developed consisting of four self-report questions with an interpretable cut-score and concise confirmatory physician interview. Accuracy of the HSDD screener cut-score alone, and in combination with physician interview, was then separately evaluated when compared with in-depth interview diagnosis. RESULTS. The results showed good agreement between the two diagnoses (kappa of 0.669 and 0.562 for cut-score alone and cut-score in combination with physician interview, respectively). The HSDD screener can reliably detect the likely presence of HSDD in postmenopausal women.

Prevalence of hypoactive sexual desire disorder in postmenopausal women: results from the WISHeS Trial

Prevalence of hypoactive sexual desire disorder in postmenopausal women: results from the WISHeS Trial

Hypoactive sexual desire disorder in postmenopausal women: US results from the Women's International Study of Health and Sexuality (WISHeS)

To determine the prevalence of hypoactive sexual desire disorder (HSDD) among US women by reproductive status and age and to explore the correlates of sexually related distress. The Women's International Study on Health and Sexuality questionnaire was mailed to a national sample of US women in 2000. The survey included validated questionnaires: the Short Form-36, which measures overall health status; the Profile of Female Sexual Function, which assesses sexual desire; and the Personal Distress Scale, which measures distress caused by low desire. Four groups of women were studied: surgically postmenopausal, aged 20 to 49 years and 50 to 70 years; premenopausal, aged 20 to 49 years; and naturally postmenopausal, aged 50 to 70 years. Clinically derived cutoff Profile of Female Sexual Function and Personal Distress Scale scores were used to classify women with HSDD and determine its prevalence. The relations between sexual desire and frequency of sexual activity or relationship satisfaction were assessed. Overall health status of HSDD women and women with normal desire were compared. The prevalence of HSDD ranged from 9% in naturally postmenopausal women to 26% in younger surgically postmenopausal women. The prevalence of HSDD was significantly greater among surgically postmenopausal women, aged 20 to 49 years, than premenopausal women of similar age, whereas there were no significant differences in the prevalence between surgically postmenopausal women, aged 50 to 70 years, and naturally postmenopausal women. For many women, HSDD was associated with emotional and psychological distress as well as significantly lower sexual and partner satisfaction. HSDD was also associated with significant decrements in general health status, including aspects of mental and physical health. HSDD is prevalent among women at all reproductive stages, with younger surgically postmenopausal women at greater risk, and is associated with a less active sex life and decreased sexual and relationship satisfaction.