Update on pharmacological management of female sexual dysfunctions

Currently, there are no approved drugs for the treatment of the most common female sexual dysfunctions (FSDs). In response to an overwhelming demand for treatments for FSDs, several drugs are being developed and tested. The only one marketed, flibanserin, has only been studied in non-menopausal women with a long-term relationship, with an acquired or generalized hypoactive sexual desire disorder (HSDD) However, despite a theoretically effective biochemical mechanism, the rather modest results in clinical practice have not been equal to laboratory tests, perhaps because of the multiplicity of factors affecting sexual desire. Women whose symptoms of HSDD are due to brain systems that are relatively insensitive to sexual signals can be improved with testosterone in combination with a PDE5 inhibitors. Finally, the mechanisms of sexual inhibition due to hyperprolactinemia could be treated with dopaminergic drugs. Apomorphine is a non-selective dopamine agonist that is supposed to improve the response to sexual stimuli. On the other hand, it is interesting to note that neurosteroids can improve in women with low sexual interest and excitement who are undergoing drug-free psychosexual therapy; promoting changes in the subject’s psychosocial and relational conditions can induce an accumulation of androgens and estrogens in the CNS. When sexual arousal disorders are dependent on peripheral discomfort, such as vaginal dryness, chronic pelvic pain or dyspareunia, specific drug therapies may be adopted. There is growing interest in oxytocin (OXT), a neuropeptide that facilitates sexual arousal and orgasm. The crucial role played by the OXT in sex, reproduction and emotional ties paves the way for multidimensional biopsychosocial research on sexual and relational problems. Concerning postmenopausal women with vulvar and vaginal atrophy they can benefit from ospemifene. In addition, intravaginal DHEA has shown promise in the treatment of vaginal atrophy in postmenopausal women without increasing systemic hormone levels, and may also improve desire. In conclusion, although theevidence supports an integrated biopsychosocial approach to the treatment of FSDs, biologicaland psychological factors are too often artificially separated in clinical practice. And cliniciansthat usually adopt a complete integrative model to treat FSD, use drugs in off-label procedures.© 2019 Published by Elsevier Masson SAS.