Advances in pharmacotherapy for treating female sexual dysfunction.
BACKGROUND
'Female sexual dysfunction' (FSD) is an umbrella term comprising a range of common disorders, including hypoactive sexual desire, reduced subjective and/or physical genital arousal (poor sensation, vasocongestion, lubrication), sexual pain and inability to achieve orgasm/satisfaction, which are multidimensional by nature and often coexisting. Psychological and contextual factors have a significant influence on organic components of sexual response and behavior and a tailored medical approach to sexual symptoms is inevitably limited.


METHODS
The paper reports the most recent advances in pharmacotherapy for women taking into account the biopsychosocial model. Hormone therapy, including estrogens, testosterone, tibolone and dehydroepiandrosterone, are discussed in term of efficacy and safety in postmenopausal women both for female sexual interest/arousal disorder (FSIAD) and genito-pelvic pain/penetration disorder. Ospemifene, a selective estrogen receptor modulator, approved to treat dyspareunia at menopause, is also discussed. Data on psychoactive agents for treatment of FSIAD in premenopausal women are discussed, including the potential use of on-demand combined hormonal (testosterone) and non-hormonal (buspirone or sildenafil) treatments to address possible neurophysiological profiles of women.


CONCLUSIONS
We are still waiting for an approved pharmacotherapy for FSD. This is not the result of gender inequality in sexual medicine, but it reflects the need of balancing benefits and risks in order to provide effective and safe treatments to women of any age.
University of Pavia, Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, Section of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, IRCCS Policlinico San Matteo , Piazzale Golgi 2, 27100 Pavia , Italy +39 0382 501561 ; +39 0382 423233 ; renappi@tin.it.
Rossella E
RE
Nappi
Laura
L
Cucinella
D002065:Buspirone / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008593:Menopause; D009652:Norpregnenes / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000627:therapeutic use; D013629:Tamoxifen / Q000031:analogs & derivatives / Q000627:therapeutic use; D013739:Testosterone / Q000627:therapeutic use
D004967:Estrogens; D009652:Norpregnenes; D010879:Piperazines; D011687:Purines; D020845:Selective Estrogen Receptor Modulators; D013449:Sulfonamides; D013629:Tamoxifen; D013739:Testosterone; C119141:Ospemifene; D000068677:Sildenafil Citrate; C027385:tibolone; D002065:Buspirone
dehydroepiandrosterone; female sexual interest/arousal disorder; genito-pelvic pain/penetration disorder; hormone therapy; local estrogen therapy; ospemifene; psychoactive drugs; testosterone