title: Role of Estrogens and Estrogen-Like Compounds in Female Sexual Function and Dysfunction.
abstract: BACKGROUND
  Sex steroids are important in female sexual function and dysfunction.
  
  
  OBJECTIVE
  To review the role of estrogens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of estrogen therapy for female sexual dysfunction to update the previously published International Society of Sexual Medicine Consensus on this topic.
  
  
  METHODS
  Panel members reviewed the published literature using online databases for studies pertaining to estrogen in female sexual function and dysfunction. Attention was specifically given to clinical trials that had reported on sexual function outcomes in women treated with estrogen.
  
  
  METHODS
  Quality of data published in the literature and recommendations were based on the GRADES system.
  
  
  RESULTS
  Observational studies that have considered relationship factors and physical or mental health have reported that these factors contribute more to sexual functioning than menopausal status or estrogen levels. Few clinical trials have investigated estrogen therapy with sexual function as a primary outcome. The available data do not support systemic estrogen therapy for the treatment of female sexual dysfunction. Topical vaginal estrogen therapy improves sexual function in postmenopausal women with vulvovaginal atrophy (VVA) and is considered first-line treatment of VVA. Oral ospemifene, a selective estrogen receptor modulator, is effective for the treatment of VVA and might have independent systemic effects on female sexual function.
  
  
  CONCLUSIONS
  For sexual problems, the treatment of VVA remains the most pertinent indication for estrogen therapy. When systemic symptoms are absent, estrogen therapy ideally can be administered by a vaginal preparation alone. Systemic estrogen therapy with combined estrogen and progestin in non-hysterectomized women is indicated for women who require treatment for vasomotor and/or other systemic estrogen deficiency symptoms. The improvement in well-being achieved by relief of vasomotor and other symptoms might improve libido in some women and abrogate further intervention.
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Nanette
authors.initials: N
authors.lastname: Santoro
authors.affiliation: The Women's Health Research Program, School of Public Health and Preventive Medicine, Melbourne, VIC, Australia.
authors.forename: Roisin
authors.initials: R
authors.lastname: Worsley
authors.affiliation: Neuroendocrine Research Program in Women's Health and Neuroendocrine and Pituitary Clinical Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Miller
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Parish
authors.affiliation: The Women's Health Research Program, School of Public Health and Preventive Medicine, Melbourne, VIC, Australia. Electronic address: Susan.Davis@monash.edu.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Davis
mesh_terms: D000282:Administration, Intravaginal; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000379:methods*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D064887:Observational Studies as Topic; D017698:Postmenopause; D017410:Practice Guidelines as Topic; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy* / Q000503:physiopathology; D014621:Vagina / Q000187:drug effects / Q000503:physiopathology*; D014622:Vaginal Creams, Foams, and Jellies; D016387:Women's Health
chemical_list: D003271:Contraceptive Agents, Female; D004967:Estrogens; D020845:Selective Estrogen Receptor Modulators; D014622:Vaginal Creams, Foams, and Jellies
keywords: Estrogen; Female Sexual Dysfunction; Hormones