An update on the pharmacological management of female sexual dysfunction

Antidepressants' effects on testosterone and estrogens: What do we know?

Various antidepressants are commonly used to treat depression and anxiety disorders, and sex differences have been identified in their efficacy and side effects. Steroids, such as estrogens and testosterone, both in the periphery and locally in the brain, are regarded as important modulators of these sex differences. This review presents published data from preclinical and clinical studies that measure testosterone and estrogen level changes during and/or after acute or chronic administration of different antidepressants. The majority of studies show an interaction between sex hormones and antidepressants on sexual function and behavior, or in depressive symptom alleviation. However, most of the studies omit to investigate antidepressants' effects on circulating levels of gonadal hormones. From data reviewed herein, it is evident that most antidepressants can influence testosterone and estrogen levels. Still, the evidence is conflicting with some studies showing an increase, others decrease or no effect. Most studies are conducted in male animals or humans, underscoring the importance of considering sex as an important variable in such investigations, especially as depression and anxiety disorders are more common in women than men. Therefore, research is needed to elucidate the extent to which antidepressants can influence both peripheral and brain levels of testosterone and estrogens, in males and females, and whether this impacts the effectiveness or side effects of antidepressants.

Female Sexual Dysfunction

Female sexual dysfunction can drastically diminish quality of life for many women. It is estimated that in the United States 40% of women have sexual complaints. These conditions are frequently underdiagnosed and undertreated. Terminology and classification systems of female sexual dysfunction can be confusing and complicated, which hampers the process of clinical diagnosis, making accurate diagnosis difficult. There are few treatment options available for female sexual dysfunctions, however, some interventions may be of benefit and are described. Additional treatments are in development. The development of clear clinical categories and diagnostic guidelines for female sexual dysfunction are of utmost importance and can be of great benefit for clinical and public health uses and disease-related research.

Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period.

Female Sexual Dysfunction

Female sexual dysfunction can drastically diminish quality of life for many women. It is estimated that in the United States 40% of women have sexual complaints. These conditions are frequently underdiagnosed and undertreated. Terminology and classification systems of female sexual dysfunction can be confusing and complicated, which hampers the process of clinical diagnosis, making accurate diagnosis difficult. There are few treatment options available for female sexual dysfunctions, however, some interventions may be of benefit and are described. Additional treatments are in development. The development of clear clinical categories and diagnostic guidelines for female sexual dysfunction are of utmost importance and can be of great benefit for clinical and public health uses and disease-related research.

Survivorship: sexual dysfunction (female), version 1.2013

Cancer treatment, especially hormonal therapy and therapy directed toward the pelvis, can contribute to sexual problems, as can depression and anxiety, which are common in cancer survivors. Thus, sexual dysfunction is common in survivors and can cause increased distress and have a significant negative impact on quality of life. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and treatment recommendations for female sexual problems, including those related to sexual desire, arousal, orgasm, and pain.

Pharmacologic therapy for female sexual dysfunction

Female sexual dysfunction (FSD) is a common health issue that can have significant negative effects on overall well-being and quality of life. The primary purpose of this article is to review commonly noted pharmacologic therapies for FSD. The pathophysiology, clinical evaluation, and selected nonpharmacologic therapies are also briefly addressed as well as recommendations for practice.

Effects of yoga on sexual function in women with metabolic syndrome: a randomized controlled trial

INTRODUCTION

Female sexual dysfunction is an important public health issue; it has a high global prevalence, but no effective and safe treatment options. The prevalence of sexual dysfunction is higher in women with metabolic syndrome than in the general population.

AIM

The aim of this study was to investigate the efficacy of yoga as a treatment for sexual dysfunction in women with metabolic syndrome.

METHODS

In this randomized, controlled study, 41 women with metabolic syndrome (age 30-60 years) were assigned to a 12-week yoga exercise group (n=20) or a wait-listed control group (n=21).

MAIN OUTCOME MEASURES

Primary end points were changes in total and individual domain scores on the Female Sexual Function Index.

RESULTS

The 12-week yoga intervention resulted in significant improvement in arousal (0.74±1.18 vs. 0.16±0.82, respectively; P=0.042) and lubrication (0.72±1.12 vs. 0.06±0.87, respectively; P=0.008) compared with the control group. Systolic blood pressure showed significantly greater improvement in the yoga group than in the control group at the 12-week follow up (-3.5±13.7 vs. 2.0±14.7, respectively; P=0.040).

CONCLUSION

These findings suggest that yoga may be an effective treatment for sexual dysfunction in women with metabolic syndrome as well as for metabolic risk factors.

Sexuality and breast cancer: prime time for young patients

Sexuality and sexual functioning is a cardinal domain of health-related quality of life in breast cancer patients, namely in the younger population. Young women below 40 years of age go through a time in their lives where sexual self-identity has recently matured, their professional obligations are demanding and they bear interpersonal and childbearing expectations, all of which can suffer a devastating turnaround with cancer diagnosis and its physical and psychological aftermath. Although these women's sexuality and directed interventions have remained largely unaddressed so far, concepts are evolving and treatment options are becoming diversified, chiefly on the field of non-hormonal pharmacological therapy of sexual dysfunction. This review will examine the definitions of female sexual dysfunction, the etiology of the disorders in young breast cancer patients, the assessment methods, the non-pharmacological and pharmacological treatment options and the challenges that lie ahead.