Double Standards For Female Sexual Dysfunction
While there are several therapies and treatments for male sexual dysfunction those for women are still lacking. The good news is the tides may be changing with the support of the FDA following a Patient-Focused Drug Development meeting in October last year (2014). Patient perspectives on current treatments for female sexual dysfunction (FSD) indicate that there is real need in the community for new treatments and more understanding of what causes FSD.
FSD can be divided into three classifications, symptoms need to be present 75% to 100% of the time and cause significant distress for a diagnosis to be made.
- Female Sexual Interest/Arousal Disorder (FSIAD)
- Female Orgasmic Disorder
- Genito-Pelvic Pain/Penetration Disorder
It certainly isn’t as easy to ‘measure’ the sexual response of women compared to men. For men the number of erections can be used as a guide but for women although they may be participating in sex are these events satisfying? The number of satisfying sexual events is what needs to be measured. Thrown into the mix is the complex interactions that also occur between physiology, emotions, relationship with partner, prior experiences and culture/beliefs. Any change to this mix can alter desire and response.
Low libido in not uncommon and may happen during a women life as a result of illness, stress, childbirth, menopause etc, and what is considered an appropriate number of satisfying sexual events is variable. However for at least 12% of women, sexual problems with related personal distress occurs. It is this group of women that deserve more treatment options.
Just as libido for women is multifactorial so is the treatment approach combining medications, psychology, physiotherapy, sex therapy, marital therapy etc. There is not one standard approach for every women and before a prescription is ever written a thorough evaluation is required. Is the sexual dysfuction a result of depression, anxiety or marital issues? Is painful sex occurring due to vaginal atrophy caused by menopause?
On occasion treating the underlying cause is the key but if this isn’t the case what medications can be considered for treating FSD? Low testosterone levels are associated with low libido. Testosterone has been used for many decades around the world to treat low libido but the lack of an approved women’s testosterone product has seen off-label male treatments or compounded products prescribed. The Intrinsa testosterone patch was approved in Europe but lacked clinician support and was withdrawn. On the other hand in Australia, AndroFeme testosterone cream is available and is gaining significant support from doctors and patients alike.
Two new medications are currently undergoing clinical trials, flibanserin (a serotonin receptor 1A agonist/serotonin receptor 2A antagonist) and bremelanotide (a novel heptapeptide melanocortin receptor-4 agonist). Both have shown to increase the number of satisfying sexual events that a women with FSD experiences but need to still prove safety to the FDA. This does show that there are drug companies taking FSD seriously and investing time and money into this issue. Looking to the future it is anticipated that women will have several choices of treatments for FSD ranging from medications to psychotherapy.