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Drugs of limited use in female sex dysfunction.

YOSEMITE, CALIF. -- Most of the research on drug treatment of female sexual desire disorder and sexual arousal disorder has shown modest or no benefit and suggests limited application, Dr. Mary C. Ciotti said at a meeting on obstetrics and gynecology sponsored by Symposia Medicus.

For most patients, low libido or problems with arousal have a multifactorial origin, so medication is likely to be only part of the solution, said Dr. Ciotti of the University of California, Davis.

Many women, however, will want to give medication a try. Pharmacologic levels of testosterone have been shown to increase libido. This agent may help some women, although its use should probably be limited to postmenopausal women because it has not been well studied in premenopausal women and, in the few studies that have been conducted in this population, it has not been shown to be beneficial, Dr. Ciotti said.

Even with postmenopausal women, however, clinicians should not expect improvement with many patients. The treatment is probably going to be empiric, based on an overall clinical impression, since laboratory measurements of testosterone are not very meaningful. That means you won't really know if the patient's testosterone level is deficient or what dosage you need to restore her libido, Dr. Ciotti said at the meeting.

In her experience a trial of testosterone treatment often is not successful. Moreover, the study in postmenopausal women that showed the most significant increase in well-being and libido was conducted in women who had undergone surgical menopause and used a patch (Intrinsa, Procter & Gamble Pharmaceuticals) that is not yet approved in the United States (N. Engl. J. Med. 343[10]:682-88, 2000).

Estratest is the one approved testosterone replacement medication for U.S. women, containing conjugated estrogen and 1.25 mg or 2.5 mg of methyltestosterone. Estratest is approved only for the treatment of moderate to severe vasomotor symptoms associated with menopause in patients who did not improve with estrogen alone.

There are other testosterone alternatives, such as a topical testosterone preparation or micronized testosterone obtained from a compounding pharmacy. "But in terms of being able to determine what you might want to try a patient on, there really are no studies," Dr. Ciotti said.

Dehydroepiandrosterone has been shown to have some benefit to libido in studies conducted outside the United States, and the recommended dosage is 12.5 mg/day. In this country it is available over the counter in health food stores, but analysis of the products has shown that the actual amount of testosterone can vary from a high dosage to none.

The testosterone patch is only available in doses that are designed for men (5%).

The other medical treatment that has received much attention is bupropion. However, the main study of its use in nondepressed women with normal testosterone levels lasted only 8 weeks, and the response rate was only 29%. An expected placebo response rate would be at least 20%, Dr. Ciotti said (J. Sex Marital Ther. 27[3]:303-16, 2001).

Sildenafil (Viagra) is used off-label for women with sexual arousal disorder, and it has been shown to be most beneficial in women on a selective serotonin reuptake inhibitor antidepressant.

One trial of 51 women reported improvement in premenopausal women. It has not been effective for postmenopausal women.

Avlimil is an herbal preparation many women may have heard about and may want to use for problems with libido or arousal, Dr. Ciotti said.

It contains ingredients such as red clover, which has phytoestrogens, and valerian, which may be anxiolytic, but there is no definite reason to think any of the ingredients are specifically helpful, and it has not been studied.


Sacramento Bureau
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Title Annotation:Gynecology
Author:Kirn, Timothy F.
Publication:OB GYN News
Date:Oct 1, 2004
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