Genital and Subjective Measurement of the Time Course Effects of an Acute Dose of Testosterone vs. Placebo in Postmenopausal Women

INTRODUCTION

Recent research on the impact of testosterone (T) on female sexual function has yielded inconsistent results, and few studies have used physiological measures of genital arousal.

AIM

This study examined the effects of an acute dose of methyltestosterone (MT) on physiological (genital) and subjective sexual response in postmenopausal women.

MAIN OUTCOME MEASURES

Vaginal pulse amplitude (VPA) and self-reported sexual response.

METHODS

Randomized, double-blind, crossover, placebo-controlled trial of 5 mg MT, consisting of two separate 8-hour visits. Participants were 10 postmenopausal women without sexual dysfunction. Participants viewed both neutral and erotic video segments during five post-dose trials while their genital and subjective responses were monitored.

RESULTS

The Wilcoxon signed rank test indicated a significant difference in VPA between the T (M = 0.018, SD = 0.018) and placebo (M = 0.016, SD = 0.017) conditions at 4.5 hours post-dose (P = 0.03). Higher difference scores were noted for 80% of subjects during the T condition at 4.5 hours, in contrast with only 50% of subjects responding to T at the other four time points. No differences were found on VPA relative change scores or subjective sexual arousal scores. When summed across all five time points, genital and subjective measures were correlated regardless of medication condition (0.62 and 0.60 for self-reported physical and mental sexual arousal scores, respectively).

CONCLUSIONS

These findings in postmenopausal women combined with those of two previous investigations in premenopausal women demonstrate a probable acute-dose time delay for genital sexual effects of exogenous T with no change in self-reported sexual arousal. Further investigation is needed to determine whether acute dosing of T has a consistent and predictable impact on genital arousal that has promise for the treatment of any subgroup of women with sexual disorders.

Topical alprostadil (PGE1) for the treatment of female sexual arousal disorder: in-clinic evaluation of safety and efficacy

This multi-center, randomized, placebo-controlled, crossover design study evaluated the effects of a topical alprostadil solution for the treatment of female sexual arousal disorder (FSAD). A total of 79 naturally or surgically post menopausal women with FSAD were treated with either 100 or 400 micrograms of alprostadil solution and placebo, delivered on separate clinic visits in random order. Study drug was applied to the external genitalia and was followed by 30 minutes of visual sexual stimulation. Study evaluations included investigator assessments of genital vasocongestion and patient assessments of physical and emotional sexual arousal, and sexual satisfaction. Genital vasocongestion in response to PGE1 was significantly greater than placebo (p < 0.0001) at each dose level and at all post dosing time points. Patient assessments of physical and emotional arousal and sexual satisfaction were significantly greater than placebo with the 400 mcg dose, but not with the 100 mcg dose of alprostadil. Topical alprostadil was well tolerated with no reports of significant systemic side effects. The most common adverse event was mild, transient genital burning typically < 1 minute duration. Other side effects were mild-moderate, resolving within two hours of application. These data suggest topical alprostadil should be further researched as a potentially appropriate on-demand therapeutic choice for women experiencing FSAD.