title: Toward personalized sexual medicine (part 2): testosterone combined with a PDE5 inhibitor increases sexual satisfaction in women with HSDD and FSAD, and a low sensitive system for sexual cues.
abstract: BACKGROUND
  Low sexual desire in women may result from a relative insensitivity of the brain for sexual cues. Administration of sublingual 0.5 mg testosterone (T) increases the sensitivity of the brain to sexual cues. Sexual stimulation in the brain is necessary for phosphodiesterase type 5 inhibitor (PDE5i)-mediated increase in genital sexual response. Accordingly, a single dose of T+PDE5i might enhance sexual responsiveness, especially in women with low sensitivity for sexual cues.
  
  
  OBJECTIVE
  To assess the hypothesis that treatment with on-demand use of T+PDE5i improves sexual functioning, particularly in women who suffer from Hypoactive Sexual Desire Disorder (HSDD) as the result of a relative insensitivity for sexual cues.
  
  
  METHODS
  In a randomized, double-blind, placebo-controlled, crossover design, 56 women with HSDD underwent three medication treatment regimes (placebo, T+PDE5i, and T with a serotonin receptor agonist; see also parts 1 and 3), which lasted 4 weeks each. In a participant-controlled ambulatory psychophysiological experiment at home (the first week of each drug treatment), physiological and subjective indices of sexual functioning were measured. In a bedroom experiment (the subsequent 3 weeks), sexual functioning was evaluated following each sexual event after the self-administration of study medication. Subjective evaluation of sexual functioning was also measured by weekly and monthly reports.
  
  
  METHODS
  Subjective: sexual satisfaction, experienced genital arousal, sexual desire. Physiological: vaginal pulse amplitude. Cognitive: preconscious attentional bias.
  
  
  RESULTS
  T+PDE5i, as compared with placebo, significantly improved physiological and subjective measures of sexual functioning during ambulatory psychophysiological lab conditions at home and during the sexual events, in women with low sensitivity for sexual cues.
  
  
  CONCLUSIONS
  The present study demonstrated that on-demand T+PDE5i is a potentially promising treatment for women with HSDD, particularly in women with low sensitivity for sexual cues.
authors.affiliation: Emotional Brain BV, Almere, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: Poels
authors.forename: Jos
authors.initials: J
authors.lastname: Bloemers
authors.forename: Kim
authors.initials: K
authors.lastname: van Rooij
authors.forename: Irwin
authors.initials: I
authors.lastname: Goldstein
authors.forename: Jeroen
authors.initials: J
authors.lastname: Gerritsen
authors.forename: Diana
authors.initials: D
authors.lastname: van Ham
authors.forename: Frederiek
authors.initials: F
authors.lastname: van Mameren
authors.forename: Meredith
authors.initials: M
authors.lastname: Chivers
authors.forename: Walter
authors.initials: W
authors.lastname: Everaerd
authors.forename: Hans
authors.initials: H
authors.lastname: Koppeschaar
authors.forename: Berend
authors.initials: B
authors.lastname: Olivier
authors.forename: Adriaan
authors.initials: A
authors.lastname: Tuiten
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D000704:Analysis of Variance; D000728:Androgens / Q000627:therapeutic use*; D003071:Cognition / Q000502:physiology; D018592:Cross-Over Studies; D003463:Cues; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004882:Erotica; D005260:Female; D006801:Humans; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D017156:Photoplethysmography; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines / Q000627:therapeutic use; D058825:Serotonin 5-HT1 Receptor Agonists / Q000627:therapeutic use; D012725:Sexual Behavior / Q000187:drug effects; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy*; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000627:therapeutic use*; D014621:Vagina / Q000098:blood supply
chemical_list: D000728:Androgens; D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D058825:Serotonin 5-HT1 Receptor Agonists; D013450:Sulfones; D013739:Testosterone; D000068677:Sildenafil Citrate