Materiały źródłowe

• #1 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  The evaluation and treatment of male sexual dysfunction has developed considerably since the release of sildenafil (Viagra) as a treatment for erectile dysfunction in 1998. […] Unfortunately, despite robust clinical and academic interest in male sexual dysfunction, women with sexual complaints have been largely overlooked. […] Fortunately, over the past decade there has been an increase in the clinical and academic interest in female sexual function. […] There are now U.S. FDA-approved therapies for both low desire and sexual pain that will possibly be available in Canada in the future. […] This review provides a practical, evidence-based guide to the evaluation and management of FSD that is adaptable for clinical practice in Canada. […] A symptom-based approach is the most effective means to organize the initial medical evaluation and treatment of women with sexual complaints to encourage collaboration and communication between healthcare providers.

• #2 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  Treatment is patient-specific and requires a multidisciplinary team. […] A 2017 systematic review of 43 studies, including seven randomized control trials, demonstrated significant reduction in pain and improvement in sexual function with pelvic physiotherapy. […] Many clinicians address vulvar pain prior to treating pelvic muscle floor dysfunction as superficial vulvar pain, which may make pelvic physiotherapy exceedingly difficult. […] This can be treated by switching to another form of contraception and the use of vestibular and vaginal hormonal therapy in the form of estrogen or a mixture of estrogen and testosterone. […] A recent study reported that intravaginal testosterone and estradiol-releasing vaginal rings demonstrated a favourable safety profile in the short-term in women on aromatase inhibitors.

• #3 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Sexual dysfunction in women is a common and often distressing problem that has a negative impact on quality of life and medication compliance. […] Treatment depends on the etiology. Estrogen is effective for the treatment of dyspareunia associated with genitourinary syndrome of menopause. […] Bupropion has been shown to improve the adverse sexual effects associated with antidepressant use; however, data are limited. Psychotherapy or sex therapy is useful for management of the psychological, relational, and sociocultural factors impacting a woman’s sexual function. […] Female sexual dysfunction is a general term comprising several sexual health concerns that can be distressing for patients, including female sexual interest/arousal disorder, female orgasmic disorder, and genito-pelvic pain/penetration disorder.

• #4 Low sex drive in women – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/diagnosis-treatment/drc-20374561

  If low sex desire concerns you, talk with your gynecologist or another member of your healthcare team. […] Your healthcare professional can look for reasons that your sex drive isn’t as high as you’d like. […] A counselor or sex therapist can help check for emotional and relationship factors that can cause low sex drive. […] Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling, and sometimes medicine and hormone therapy. […] Therapy often includes education about sexual response and techniques. […] Your healthcare professional reviews any medicines you take. The review is done to see if any of the medicines tend to cause sexual side effects. […] If your antidepressant might be the cause of your low sex drive, your healthcare professional may recommend that you: Wait to see if your sex drive improves.

• #5 Female sexual dysfunction | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20372532/

  Female sexual dysfunction is a medical term for ongoing sexual problems that upset you or your partner. […] Treatment often involves more than one approach. […] If sexual problems affect your relationship or worry you, make an appointment with a member of your healthcare team. […] Sexual dysfunction is a problem only if it bothers you. If it doesn’t bother you, you don’t need treatment. But if your sexual dysfunction hurts your relationship with your partner, then seeing a counselor or therapist together may be helpful. […] You also need to know how your body responds to sex and what you want from sex. These will help with choosing a treatment and knowing whether it works for you. […] Most often, a mix of treatments that includes medical, relationship and emotional issues works best.

• #6 Female sexual dysfunction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556

  To diagnose female sexual dysfunction, your healthcare professional may: […] Your healthcare professional also may suggest that you see a counselor or therapist who treats sexual and couples’ problems. […] If your sexual dysfunction hurts your relationship with your partner, then seeing a counselor or therapist together may be helpful. […] You need to tell your healthcare professional your concerns. […] Most often, a mix of treatments that includes medical, relationship and emotional issues works best. […] To treat sexual dysfunction, your healthcare professional might suggest the following: […] Talk with a counselor or therapist who works with sexual problems. Therapy often includes learning about your body and ways to be closer to your partner. […] Treatment for sexual dysfunction often involves dealing with a medical condition or hormonal change.

• #7 Overview of sexual dysfunction in females: Management – UpToDate

  https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-females-management

  Female sexual dysfunction is multifactorial, often with several different etiologies contributing to the problem. Nonetheless, careful evaluation and use of available therapies can improve sexual function for many patients. […] Complete the evaluation and diagnosis — Evaluate the patient for the range of sexual issues and physical, psychological, and relationship factors associated with their concerns before starting treatment. Most patients with sexual concerns have clinical issues that impact more than one aspect of sexual function. The problem may involve more than one phase of the normal sexual response cycle (desire, arousal, orgasm), sexual pain, or a general decrease in sexual satisfaction. As an example, if a patient complains of decreased libido, a full evaluation may also reveal issues with arousal or pain.

• #8 Diagnosis and Treatment of Female Sexual Dysfunction | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0301/p635.html

  Female sexual complaints are common, occurring in approximately 40 percent of women. […] A complete history combined with a physical examination is warranted for the evaluation of women with sexual complaints or concerns. […] The PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) or ALLOW (Ask, Legitimize, Limitations, Open up, Work together) method can be used to facilitate discussions about sexual concerns and initiation of treatment. […] Although sexual therapy and education (e.g., cognitive behavior therapy, individual and couple therapy, physiotherapy) form the basis of treatment, there is limited research demonstrating the benefit of hormonal and nonhormonal drugs. […] Testosterone improves sexual function in postmenopausal women with hypoactive sexual desire disorder, although data on its long-term safety and effectiveness are lacking.

• #9 Female Sexual Dysfunction Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/2500107-treatment

  Reassurance and education, when appropriate, go far in allaying patient concerns and improving treatment success. Setting reasonable goals and expectations is important, and the provider may explain that improvement may take time and require multiple visits. Sexual dysfunction, particularly when it is of long duration, is unlikely to resolve quickly. Usually starting with the problem bothering the patient the most is most helpful, although this order may need to be changed at the providers discretion. […] The PLISSIT model has also been found to be helpful. In this model, the health care provider first gives the patient Permission to discuss the sexual problem, then provides Limited Information to the patient about the sexual problem. Specific Suggestions are next, where the healthcare provider provides concrete next steps to the patient, followed by a referral for Intensive Therapy if needed, so the patient can pursue a long-term appropriate solution that meets the stated treatment goals.

• #10 Female sexual dysfunction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556

  To diagnose female sexual dysfunction, your healthcare professional may: […] Your healthcare professional also may suggest that you see a counselor or therapist who treats sexual and couples’ problems. […] If your sexual dysfunction hurts your relationship with your partner, then seeing a counselor or therapist together may be helpful. […] You need to tell your healthcare professional your concerns. […] Most often, a mix of treatments that includes medical, relationship and emotional issues works best. […] To treat sexual dysfunction, your healthcare professional might suggest the following: […] Talk with a counselor or therapist who works with sexual problems. Therapy often includes learning about your body and ways to be closer to your partner. […] Treatment for sexual dysfunction often involves dealing with a medical condition or hormonal change.

• #11 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  There are a number of non-hormonal treatments that have demonstrated success in the treatment of vulvodynia. […] Refractory and severe cases of vulvodynia can ultimately be managed surgically with the resection of vestibular tissues with posterior vaginal advancement flap (vestibulectomy). […] A multidisciplinary approach to low desire is important. […] There are a number of medical treatments with evidence to support their use in patients with low desire. […] The Endocrine Society recommends a trial of testosterone therapy for 36 months in postmenopausal women with low androgen levels that are comfortable with off-label use and close monitoring. […] The management of comorbid conditions, such as diabetes and hypertension, should be optimized. […] The medical treatment of orgasmic problems is challenging, although there have been reports of success with mindfulness, yoga, the use of sex toys, and sex therapy. […] There is a strong basis for the evidenced-based evaluation and management of FSD. […] A common and multidisciplinary approach to FSD promotes better communication and outcome.

• #12 Behavioral Therapies for Treating Female Sexual Dysfunctions: A State-of-the-Art Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9144766/

  In this article, we present a state-of-the-art review of behavioral therapies that have empirical support in the treatment of female sexual dysfunction disorders. We focus on two types of psychotherapies, cognitive-behavioral and mindfulness-based therapies, given the studies conducted to date on these approaches. We consider the existing data with respect to the support for these treatments and highlight existing gaps where further research appears indicated. […] Cognitive-behavioral therapy (CBT) is a short-term, symptom-focused psychotherapy that considers that thoughts and decisional actions are malleable treatment targets. A central objective is to break maladaptive cognitive-affective-behavioral chains. Some main CBT strategies may include cognitive restructuring (modification of maladaptive thoughts associated with emotional distress), behavioral activation (increasing involvement with activities), exposure (having gradual contact with factors that generate anxiety), and problem solving. When addressing female sexual dysfunctions, CBT has typically included other non-pharmacological strategies, such as directed masturbation, sex therapy, sensate focus, communication training, systematic desensitization, anxiety-reduction strategies, bibliotherapy, counseling, and psychoeducation, among others.

• #13 Behavioral Therapies for Treating Female Sexual Dysfunctions: A State-of-the-Art Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9144766/

  CBT appears effective for treating female sexual dysfunctions, especially if sexual dysfunction is considered as frequency of sexual stimulation, sexual responses, and sexual contingencies. CBT may help women with sexual dysfunctions to identify which factors enhance and which factors generate sexual limitations, as well as to restructure maladaptive thoughts about their sexuality, and reduce the tendency to avoid certain sexual behaviors. […] CBT has been proposed for different types of female sexual dysfunctions. Although the central objective of CBT in these dysfunctions is an improvement in sexual function and sexual satisfaction, there are specific aspects to be addressed in each form of female sexual dysfunction. For example, in the case of female orgasmic disorder, the central goal of CBT is for women to improve their abilities to experience orgasm, increase their sexual satisfaction, and reduce high levels of anxiety often associated with this dysfunction. CBT focuses on promoting changes in women’s attitudes and behaviors through exercises and techniques, such as Kegel exercises, communication skills training, sex education, directed masturbation, and systematic desensitization. It has been suggested that CBT is effective in improving orgasmic response.

• #14 Behavioral Therapies for Treating Female Sexual Dysfunctions: A State-of-the-Art Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9144766/

  In the case of female sexual interest/arousal disorder, CBT aims to increase rewards in order to increase motivation for sexual activities. Three controlled trials support CBT for addressing the symptomatology of this disorder. In addition, CBT has been found to be efficacious improving factors associated with the disorder, such as marital functioning. […] Regarding genito-pelvic pain/penetration disorder, CBT aims to achieve pain control in sexual contexts. CBT may help increase the frequency of sexual intercourse, decrease the fear of coitus, and enhance successful non-coital penetration, in comparison with no treatment. In addition, CBT for genito-pelvic pain/penetration disorder appears effective in reducing anxious symptomatology and improving marital harmony. […] Mindfulness has been understood as an awareness that emerges through paying attention, on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment by moment. Mindfulness-based approaches have begun to be used in clinical practice, either as an adjunct to other therapies (usually CBT) or as a stand-alone therapy. An approach with arguably the most evidence to date is mindfulness-based cognitive therapy (MBCT). MBCT is a treatment program that includes education related to cognitive modeling, training in decentering, and promotion of abilities or tendencies to perceive cognitions and feelings as mental events, not necessarily as reality. In addition, mindfulness may promote acceptance, compassion, and better management of ruminative and intrusive thoughts.

• #15 Behavioral Therapies for Treating Female Sexual Dysfunctions: A State-of-the-Art Review

  https://www.mdpi.com/2077-0383/11/10/2794

  CBT appears effective for treating female sexual dysfunctions, especially if sexual dysfunction is considered as frequency of sexual stimulation, sexual responses, and sexual contingencies. CBT may help women with sexual dysfunctions to identify which factors enhance and which factors generate sexual limitations, as well as to restructure maladaptive thoughts about their sexuality, and reduce the tendency to avoid certain sexual behaviors. […] In addition to evaluating the efficacy of CBT in each particular female sexual dysfunction, some studies have evaluated CBT in all of them together. For example, McCabe administered a 22-week CBT program to 54 women with female sexual dysfunction and observed that CBT was associated with improved levels of sexual dysfunction. […] CBT may also be more effective than sildenafil in improving female sexual function in women with arousal and orgasm dysfunction.

• #16 Behavioral Therapies for Treating Female Sexual Dysfunctions: A State-of-the-Art Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9144766/

  Although MBCT was initially designed to address other pathologies, some authors suggested that the integration of mindfulness training in female sexual dysfunctions could be effective for the improvement of well-being and sexual function. Therefore, MBCT for sexuality (MBCT-S) has been tested, for example, in women with sexual interest/arousal disorder. […] The use of brief MBCT interventions has been suggested, with promising results for women with sexual distress, sexual difficulties, and histories of childhood sexual abuse, gynecologic cancers and sexual dysfunctions, low sexual desire and arousal, sexual difficulties and multiple sclerosis and spinal cord injuries, and sexual dysfunctions after risk-reducing salpingo-oophorectomy. […] Other treatments for female sexual dysfunctions have been suggested, such as acceptance and commitment therapy and psychoeducational interventions. In addition, the effects of traditional Chinese approaches to treating female sexual dysfunctions (besides mindfulness) have also been begun to be studied, mainly including acupuncture, yoga, and herbal products. Although these eastern techniques may have preliminary promising results in the treatment of female sexual dysfunctions, the literature is scarce, so it is not possible to draw solid conclusions about their efficacies.

• #17

• #18 Overview of Sexual Function and Dysfunction in Women – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/sexual-function-and-dysfunction-in-women/overview-of-sexual-function-and-dysfunction-in-women

  Couples therapy may be helpful to improve communication or address relationship issues. Sex therapy often helps women and their partner deal with issues that affect their sexual life, such as specific sexual problems and their relationship with each other. […] Several types of physical therapy may be useful in women with genito-pelvic pain/penetration disorder. […] Vaginal lubricants and moisturizers can reduce vaginal dryness, which causes pain during intercourse.

• #19 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Sexual pain with deeper vaginal penetration suggests the possibility of a musculoskeletal component. […] Psychotherapy or sex therapy is useful for women who have relational or sociocultural factors contributing to their pain, and for those who experience anxiety in conjunction with their pain. […] Group cognitive behavior therapy may be effective for low sexual desire. […] Mindfulness-based interventions have been shown to effectively treat several types of female sexual dysfunction, including low sexual desire and arousal, and acquired anorgasmia. […] Directed masturbation training is the treatment of choice for lifelong anorgasmia.

• #20 Orgasmic dysfunction in women: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001953.htm

  Orgasmic dysfunction is when a woman either cannot reach orgasm, or has trouble reaching orgasm when she is sexually excited. […] Important goals when treating problems with orgasms are: A healthy attitude toward sex, and education about sexual stimulation and response. […] Treatment can involve education and learning to reach orgasm by focusing on pleasurable stimulation and directed masturbation. […] Most women require clitoral stimulation to reach an orgasm. Including clitoral stimulation in sexual activity may be all that is necessary. […] Treatment may include sexual counseling that includes a series of couples’ exercises to: Learn and practice communication, Learn more effective stimulation and playfulness. […] Women do better when treatment involves learning sexual techniques or a method called desensitization. This treatment works to gradually decrease the response that causes lack of orgasms. Desensitization is helpful for women with significant sexual anxiety.

• #21 Sex therapy for female sexual dysfunction | International Archives of Medicine | Full Text

  https://intarchmed.biomedcentral.com/articles/10.1186/1755-7682-6-37

  The most studied treatment protocol was that of Masters and Johnson (MJ). Several clinical trials attempted to demonstrate the efficacy of it. In this treatment, sexual intercourse was banned for a period, sensate focus exercises were used, women on top position was recommended and the therapy was conducted by a couple of female and male therapists. […] Another study compared MJ treatment to a therapy focused on communication with no sexual interventions. Their goal was to determine if improvement in couples communication could enhance sexual functioning. […] The results showed that women seemed to benefit from both forms of therapy, but sex therapy had more rapid results than communication therapy. Sex therapy also produced better outcomes in women’s self-esteem. […] The heterogeneity of sexual dysfunctions can difficult the establishment of a treatment protocol, demanding more studies addressing specific dysfunctions, in order to evaluate which techniques are more effective to each problem. Orgasmic and sexual pain disorders are the most extensively studied disorders and those in which sex therapy seems to have better outcomes. […] This paper points out the need to systematically evaluate sex therapy for all sorts of sexual disorders, populations, searching for the most effective interventions and establishing the treatment efficacy, when compared to other forms of treatment.

• #22

  https://link.springer.com/article/10.1007/s43076-024-00358-3

  Female sexual health care has been highlighted due to the high prevalence of female sexual dysfunctions (FSDs). […] Previous research indicates that psychotherapy is an effective intervention in the treatment of FSDs, but few studies have tested the effectiveness of group psychotherapy interventions. […] This systematic review aims to investigate the effectiveness of group psychotherapies in the treatment of FSDs. […] The main findings suggest that Group Cognitive-Behavioral Therapy (GCBT; d = 0.461.92) and Mindfulness-Based Group Therapy (MBGT; d = 0.41.04) were the most effective for improving female sexual function. […] GCBT was also the most effective in treating vulvar pain (d = 0.471.39) and pain during intercourse (d = 0.691.18). […] MBGT showed the largest effect sizes in the treatment of sexual desire and interest (d = 0.971.29).

• #23

  https://link.springer.com/article/10.1007/s43076-024-00358-3

  Therefore, group psychotherapies present promising evidence of efficacy in the treatment of FSDs. […] However, there are few clinical trials, and new research is needed to verify the effects of these interventions on different contexts and FSDs. […] Studies are also needed in other countries and cultures, as most clinical trials have been performed in Canada.

• #24 Female sexual dysfunction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556

  Treatments for female sexual dysfunction might include: […] You can apply estrogen to the vagina using a vaginal cream, tablet or ring. […] This selective estrogen receptor modulator (SERM) medicine treats painful intercourse linked to the thinning of vaginal tissue. […] If you want testosterone therapy, talk with a member of your healthcare team about the risks and benefits. […] This daily pill may boost sex drive. […] Bremelanotide is another FDA-approved treatment for low sexual desire in premenopausal people. […] You put this insert or suppository of human-made hormone dehydroepiandrosterone (DHEA) into the vagina. […] Researchers are studying these treatments for female sexual dysfunction: […] Because female sexual dysfunction is complex, even the best medicines aren’t likely to work if other emotional or social factors are not resolved.

• #25 Low sex drive in women – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/diagnosis-treatment/drc-20374561

  Along with recommending counseling, your healthcare professional may prescribe a medicine to boost your libido. […] Some hormone medicines that aim to relieve GSM symptoms could help make sex more comfortable. […] Estrogen comes in many forms. […] Testosterone plays a key role in female sexual function, even though testosterone level is much lower in women than in men. […] This vaginal insert delivers the hormone dehydroepiandrosterone directly to the vagina to help ease painful sex. […] This medicine isn’t approved for women who’ve had breast cancer or who have a high risk of breast cancer.

• #26 Female Sexual Dysfunction Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/2500107-treatment

  One medication that is approved by the US Food and Drug Administration (FDA) to treat female sexual interest/arousal disorder is flibanserin, a 5HT1A/2B agonist/antagonist. It is indicated for premenopausal women with low sexual desire. […] The FDA approved bremelanotide in 2019 for acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. […] Supplemental androgens have not been approved in the United States for sexual dysfunction. However, multiple randomized controlled trials have demonstrated a positive effect of testosterone in improving sexual desire in postmenopausal patients complaining of decreased libido, particularly in surgically menopausal women. […] When sexual pain is insertional and associated with vaginal dryness, treatment may be helpful to reverse vaginal atrophy.

• #27 Treating Sexual Dysfunction in Women | 2019-10-03 | CARLAT PUBLISHING

  https://www.thecarlatreport.com/articles/3010-treating-sexual-dysfunction-in-women

  With the marketing of two new treatments for female sexual dysfunction, one thing is certain: You can expect to see more patients asking for these medications. Whats less certain is whether they will work. Flibanserin (Addyi) and bremelanotide (Vyleesi), the two FDA-approved treatments, both have small effect sizes (0.30.4) on various measures of libido. […] Non-medication treatment: Sex therapy, both individual and couples, can be very effective, as can mindfulness and cognitive behavioral therapy. The aim of mindfulness is to reduce distraction and increase awareness of pleasure during sex, while CBT works by altering underlying beliefs and behaviors that contribute to the problem. […] There are two FDA-approved options: flibanserin and bremelanotide. Neither one is my first choice, for reasons Ill explain below.

• #28 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  Flibanserin is a centrally acting drug which activates 5-HT1A receptors in the prefrontal cortex, increasing dopamine and adrenaline (norepinephrine) levels and decreasing serotonin levels. […] Early trials suggested that sildenafil improved the ability to achieve orgasm and arousal and could significantly improve clitoral blood flow in postmenopausal women with orgasmic dysfunction, although evidence has been mixed.

• #29 Female Sexual Dysfunction: New Treatments on the Way – MGH Center for Women’s Mental Health

  https://womensmentalhealth.org/posts/female-sexual-dysfunction-new-treatments-on-the-way/

  Hypoactive sexual desire disorder (HSDD) is the most common type of female sexual dysfunction, affecting approximately 10% of all adult women. […] Currently, flibanserin is the only medication approved by the Food and Drug Administration to treat women with HSDD. […] The use of flibanserin has been limited as it is has been FDA-approved only for premenopausal women with acquired HSDD (which is HSDD developing in a woman who has previously had no problems with sexual desire). […] There is another drug for HSSD coming down the pipeline. Bremelanotide is a peptide which acts as a melanocortin receptor agonist. […] In subsequent trials, injectable bremelanotide was used to treat female sexual dysfunction (administered 45 minutes before sexual contact) and demonstrated only transient elevation of blood pressure. […] Other treatments for female sexual dysfunction are currently under development, including Lorexys (combining bupropion and trazodone), Librido (sildenanil and testosterone), Libridos (testosterone and buspirone), and intranasal testosterone.

• #30 Female sexual disorders: Treatment options in the pipeline

  https://www.managedhealthcareexecutive.com/view/female-sexual-disorders-treatment-options-pipeline

  Femprox is an alprostadil-based cream intended for treatment of FSAD. […] Apomorphine is a dopamine agonist that has been used as a subcutaneous (SQ) injection for treatment of Parkinson disease and researched in oral form for treatment of arousal disorder. […] Bremelanotide is a melanocortin receptor 4 agonist (MCR4 agonist) for treatment of HSDD and FSAD. […] Intravaginal dehydroepiandrosterone (DHEA) is currently under investigation for treatment of vulvovaginal atrophic changes. […] Ospemifene is a novel estrogen agonist and antagonist that has been studied as an oral agent for treatment of vulvovaginal atrophy (VVA) and, therefore, would be effective for VVA-related sexual pain. […] Viveve (Sunnyvale, Calif.) has developed a monopolar radiofrequency (RF) thermal therapy to improve laxity of the vaginal introitus and sexual satisfaction in women after vaginal deliveries.

• #31 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Local vaginal estrogen therapy is recommended and preferred over systemic estrogen therapy for treatment of genitourinary syndrome of menopause and related dyspareunia when vaginal dryness is the primary concern. […] Ospemifene (Osphena) is modestly effective for treatment of dyspareunia. […] Transdermal testosterone, with or without concomitant estrogen therapy, has been shown to be effective for short-term treatment of low sexual desire or arousal in natural and surgically induced menopause. […] Although female sexual dysfunction often requires multidisciplinary treatment, even the initial visit can be beneficial. […] The unique predisposing, precipitating, and maintaining factors for a woman’s sexual dysfunction will determine the treatment plan. […] Strategies for managing antidepressant-induced dysfunction include reducing the dose if possible, switching to an antidepressant with fewer sexual adverse effects, or adding bupropion (Wellbutrin) as an adjunct.

• #32 Low sex drive in women – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/diagnosis-treatment/drc-20374561

  Along with recommending counseling, your healthcare professional may prescribe a medicine to boost your libido. […] Some hormone medicines that aim to relieve GSM symptoms could help make sex more comfortable. […] Estrogen comes in many forms. […] Testosterone plays a key role in female sexual function, even though testosterone level is much lower in women than in men. […] This vaginal insert delivers the hormone dehydroepiandrosterone directly to the vagina to help ease painful sex. […] This medicine isn’t approved for women who’ve had breast cancer or who have a high risk of breast cancer.

• #33 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  There are a number of non-hormonal treatments that have demonstrated success in the treatment of vulvodynia. […] Refractory and severe cases of vulvodynia can ultimately be managed surgically with the resection of vestibular tissues with posterior vaginal advancement flap (vestibulectomy). […] A multidisciplinary approach to low desire is important. […] There are a number of medical treatments with evidence to support their use in patients with low desire. […] The Endocrine Society recommends a trial of testosterone therapy for 36 months in postmenopausal women with low androgen levels that are comfortable with off-label use and close monitoring. […] The management of comorbid conditions, such as diabetes and hypertension, should be optimized. […] The medical treatment of orgasmic problems is challenging, although there have been reports of success with mindfulness, yoga, the use of sex toys, and sex therapy. […] There is a strong basis for the evidenced-based evaluation and management of FSD. […] A common and multidisciplinary approach to FSD promotes better communication and outcome.

• #34 Diagnosis and Treatment of Female Sexual Dysfunction | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0301/p635.html

  Although patient education and therapy are the foundation of treatment, limited research has demonstrated the benefit of pharmacotherapy. […] Nonpharmacologic treatment is aimed at education, therapy, and treatment of contributing factors. […] Pharmacologic treatment is limited. […] Education is a key component in the treatment of female sexual arousal disorder. […] Dyspareunia has many potential etiologies, including infection, vaginal atrophy, and endometriosis. […] Addressing the underlying cause is the first step in treatment. […] Physiotherapy (e.g., hands-on techniques, biofeedback, pelvic floor electrical stimulation, perineal ultrasonography, use of vaginal dilators) is a treatment option for sexual pain disorders such as vulvar vestibulitis and vaginismus. […] Cognitive behavior therapy (provided in a group setting over six months) that focuses on pain’s relationship to anxiety, muscle contractions’ relationship to pain perception, and general sexual education has been shown to decrease pain with intercourse and improve sexual satisfaction in women with vulvar vestibulitis. […] Pharmacologic therapy of sexual pain disorders includes treatment of the underlying cause, such as estrogen for vaginal atrophy or medication for vulvovaginal candidiasis.

• #35 Low sex drive in women – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/diagnosis-treatment/drc-20374561

  Along with recommending counseling, your healthcare professional may prescribe a medicine to boost your libido. […] Some hormone medicines that aim to relieve GSM symptoms could help make sex more comfortable. […] Estrogen comes in many forms. […] Testosterone plays a key role in female sexual function, even though testosterone level is much lower in women than in men. […] This vaginal insert delivers the hormone dehydroepiandrosterone directly to the vagina to help ease painful sex. […] This medicine isn’t approved for women who’ve had breast cancer or who have a high risk of breast cancer.

• #36 Female sexual dysfunction | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20372532/

  Testosterone therapy. Testosterone plays a role in healthy sexual function in women as well as men. […] Flibanserin (Addyi). This was first used as an antidepressant. The Food and Drug Administration (FDA) has approved it for use before menopause to treat low sexual desire. […] Bremelanotide (Vyleesi). Bremelanotide is another FDA-approved treatment for low sexual desire in premenopausal people. […] Prasterone (Intrarosa). You put this insert or suppository of human-made hormone dehydroepiandrosterone (DHEA) into the vagina. It helps ease vaginal dryness and pain with intercourse. […] More research is needed, but therapies that may help improve sex include: […] Talk to your healthcare professional before trying any herbal or topical oil products.

• #37 Female sexual dysfunction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556

  Treatments for female sexual dysfunction might include: […] You can apply estrogen to the vagina using a vaginal cream, tablet or ring. […] This selective estrogen receptor modulator (SERM) medicine treats painful intercourse linked to the thinning of vaginal tissue. […] If you want testosterone therapy, talk with a member of your healthcare team about the risks and benefits. […] This daily pill may boost sex drive. […] Bremelanotide is another FDA-approved treatment for low sexual desire in premenopausal people. […] You put this insert or suppository of human-made hormone dehydroepiandrosterone (DHEA) into the vagina. […] Researchers are studying these treatments for female sexual dysfunction: […] Because female sexual dysfunction is complex, even the best medicines aren’t likely to work if other emotional or social factors are not resolved.

• #38 Female Sexual Dysfunction (FSD) – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/500_599/0574.html

  In a review on Female sexual disorders: Treatment options in the pipeline, Krychman (2013) noted that Viveve (Sunnyvale, CA) has developed a monopolar RF thermal therapy to improve laxity of the vaginal introitus and sexual satisfaction in women after vaginal deliveries. […] Ospemifene is an estrogen agonist/antagonist with tissue selective effects. […] Osphena (ospemifene) is approved by the U.S. Food and Drug Administration (FDA) for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause. […] Ospemiphene should not be used in women with the following concomitant conditions: Abnormal genital bleeding, Known or history of estrogen-dependent neoplasia, Active DVT, pulmonary embolism (PE), or a history of these conditions, Active arterial thromboembolic disease (eg. stroke and myocardial infarction), or a history of these conditions.

• #39 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Bupropion (Wellbutrin) in higher dosages (150 mg twice daily) has been shown to be effective as an adjunct for antidepressant-induced sexual dysfunction in women. […] Sildenafil (Viagra) may benefit women with sexual dysfunction induced by selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor use. […] Female genital sexual pain disorders are complex and most effectively managed with a comprehensive, multidisciplinary approach that addresses contributing biopsychosocial factors. […] Group cognitive behavior therapy has been shown to effectively treat low sexual desire. […] Mindfulness-based interventions have been shown to effectively treat low sexual desire and arousal, and acquired anorgasmia. […] Directed masturbation is recommended for lifelong anorgasmia.

• #40 Treating Sexual Dysfunction in Women | 2019-10-03 | CARLAT PUBLISHING

  https://www.thecarlatreport.com/articles/3010-treating-sexual-dysfunction-in-women

  Zestra is a proprietary botanical cream worth trying in FHSDD. In two randomized controlled trials, it improved desire and arousal in 276 women. […] Though rejected by the FDA in 2004, transdermal testosterone has been approved in Europe since 2007 for FHSDD in postmenopausal women. This patch notably improves sexual desire and the frequency of satisfying sexual events, doubling those events from 23/month up to 5/month, in multiple trials of postmenopausal women with FHSDD. […] For distressed patients, consider a referral to endocrinology for transdermal testosterone as a second- or third-line agent. Endocrinologists can better evaluate and monitor its risks. […] TCPR Verdict: Screen for FHSDD with direct questions. Before jumping to treatment, look for modifiable causes. Referrals are often needed (to couples or sex therapy, primary care, OB-GYN, or endocrinology). After therapy, bupropion is a good first choice. Flibanserin and bremelanotide may have larger studies, but they have small benefits and concerning side effects.

• #41 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  Treatment is patient-specific and requires a multidisciplinary team. […] A 2017 systematic review of 43 studies, including seven randomized control trials, demonstrated significant reduction in pain and improvement in sexual function with pelvic physiotherapy. […] Many clinicians address vulvar pain prior to treating pelvic muscle floor dysfunction as superficial vulvar pain, which may make pelvic physiotherapy exceedingly difficult. […] This can be treated by switching to another form of contraception and the use of vestibular and vaginal hormonal therapy in the form of estrogen or a mixture of estrogen and testosterone. […] A recent study reported that intravaginal testosterone and estradiol-releasing vaginal rings demonstrated a favourable safety profile in the short-term in women on aromatase inhibitors.

• #42 Female Sexual Dysfunction | Doctor

  https://patient.info/doctor/female-sexual-dysfunction-pro

  Psychotherapy may help remove inhibitions and enhance interpersonal relations and sexual motivation levels. […] The sexual function of women with chronic pain can be significantly enhanced by a cognitive behavioural treatment group delivered within an interdisciplinary rehabilitation pain programme. […] The role of the pelvic floor in arousal and orgasm is significant and women can easily be taught simple pelvic floor exercises. Several studies report improvements in desire, arousal, lubrication, orgasm and satisfaction with sex. […] A number of different drugs are used to treat FSD but in the UK none is currently licensed for this indication. […] Oestrogens are the most commonly used medications for the treatment of FSD, especially in perimenopausal and postmenopausal women. […] Testosterone is one of the most frequently prescribed (off-label) medications for women with sexual interest/arousal disorder.

• #43 Sexual dysfunction in women: Symptoms and treatment

  https://www.medicalnewstoday.com/articles/sexual-dysfunction-in-women

  Dilator training: People with vaginismus can try dilator training, which involves inserting a smooth plastic dilator into the vagina while trying to relax the pelvic floor muscles. […] Pelvic floor exercises: Other types of pelvic floor exercise, such as Kegels, aim to strengthen the pelvic floor due to injury or weakness. […] Other medications: Drugs such as flibanserin (Addyi) and bremelanotide (Vyleesi), which some call female Viagra, aim to increase sexual desire. […] Surgery: In some cases, surgery may be necessary to correct structural problems around the vulva or inside the vagina.

• #44 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  Treatment is patient-specific and requires a multidisciplinary team. […] A 2017 systematic review of 43 studies, including seven randomized control trials, demonstrated significant reduction in pain and improvement in sexual function with pelvic physiotherapy. […] Many clinicians address vulvar pain prior to treating pelvic muscle floor dysfunction as superficial vulvar pain, which may make pelvic physiotherapy exceedingly difficult. […] This can be treated by switching to another form of contraception and the use of vestibular and vaginal hormonal therapy in the form of estrogen or a mixture of estrogen and testosterone. […] A recent study reported that intravaginal testosterone and estradiol-releasing vaginal rings demonstrated a favourable safety profile in the short-term in women on aromatase inhibitors.

• #45 Female Sexual Dysfunction (FSD) – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/500_599/0574.html

  If a specific etiology for FSD is discovered on history, physical, and laboratory examination, the suspected etiology may be treated. If no specific etiology for FSD is discovered, basic treatment strategies are applied. These include educational interventions, enhancement of stimulation and elimination of routine (e.g., use of erotic books or videos, varying positions, use of vibrators, etc.), provision of distraction techniques (e.g., background music, encourage fantasies, etc.), encouragement of non-coital behaviors (e.g., sensate focus exercises, sensual massage), and techniques to minimize dyspareunia (e.g., change in position, topical lidocaine, lubricants, etc.). […] Female erectile devices such as the Eros clitoral stimulation device (UroMetrics, Inc., St. Paul, MN) are used to obtain greater clitoral engorgement, which increases lubrication, and enhances the ability to achieve an orgasm. However, more studies are needed to ascertain the medical necessity and long-term effects of clitoral stimulation devices as compared with established approaches such as lubricants, manual stimulation, and over-the-counter devices.

• #46 Female Sexual Dysfunction: Signs, Causes & Treatment Options

  https://my.vanderbilthealth.com/female-sexual-dysfunction/

  Treatment for female sexual dysfunction is available and worth trying. […] Possible treatment options for female sexual dysfunction can include counseling or cognitive behavioral therapy; lifestyle changes such as weight loss or smoking cessation; prescription estrogen treatment; vaginal moisturizers and lubricants; short-term testosterone therapy; and a prescription device called Eros that increases blood flow to the genitals. […] Theres also a medication called Addyi that is specifically approved by the U.S. Food and Drug Administration for low sexual desire in women. […] Another possible treatment is pelvic floor physical therapy. […] Sexual health is an important part of overall well-being, so dont brush it off. […] If you dont bring it up with your health-care provider, and they dont bring it up either, you could go for years suffering with something that could be treated.

• #47 Female Sexual Dysfunction: From Causality to Cure

  https://www.uspharmacist.com/article/female-sexual-dysfunction-from-causality-to-cure

  Female sexual dysfunction (FSD) is a highly prevalent disorder affecting women’s quality of life across the lifespan and around the world. […] A complete understanding of the continuum of FSD’s manifestations is essential for comprehending the functions of the various treatment options pharmacists can recommend to patients with this complex condition. […] Due to the diversity of causative factors associated with symptoms of FSD, modifying lifestyle, addressing physical and psychological causes, and changing behavioral habits associated with sex are preferential first steps in the treatment of FSD that could result in a reversal of symptoms if addressed appropriately. […] Significant improvements in arousal, sensation, orgasm, and overall sexual pleasure have been reported by women with physiologic arousal disorders caused by inadequate blood flow to the genitalia who utilized the Eros Clitoral Therapy Device, a nonpharmacologic clitoral-stimulation vacuum apparatus.

• #48 Overview of Sexual Function and Dysfunction in Women – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/sexual-function-and-dysfunction-in-women/overview-of-sexual-function-and-dysfunction-in-women

  Couples therapy may be helpful to improve communication or address relationship issues. Sex therapy often helps women and their partner deal with issues that affect their sexual life, such as specific sexual problems and their relationship with each other. […] Several types of physical therapy may be useful in women with genito-pelvic pain/penetration disorder. […] Vaginal lubricants and moisturizers can reduce vaginal dryness, which causes pain during intercourse.

• #49 Female Sexual Dysfunction Treatment & Management: Approach Considerations, Medical Care, Consultations

  https://emedicine.medscape.com/article/2500107-treatment

  Nonestrogen lubricants and moisturizers may also be helpful for patients with genitopelvic pain/penetration disorder. […] Fractional CO2 laser treatment has also been proposed as a therapy for sexual pain related to vaginal atrophy, but adequate studies have not been completed and this modality is not FDA-approved. […] Surgical care may be appropriate occasionally for patients with deep dyspareunia associated with a distinct pelvic diagnosis, for example adenomyosis, endometriosis, or adhesive disease. […] Inhibition of orgasm is another common adverse effect of SSRIs. […] Although phosphodiesterase 5 inhibitors such as sildenafil have been effective for treating arousal and orgasmic difficulties in men, there is little evidence for an effect in women. […] Patients with relationship stagnation, infidelity, or other relationship problems, and/or survivors of abuse may benefit from psychological counseling referral.

• #50 Female Sexual Dysfunction (FSD) – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/500_599/0574.html

  The authors concluded that future treatment targets include pharmacologic modulation of emotional learning circuits, restoration of normal tactile sensation, growth factor therapy, gene therapy, stem cell-based therapies, and regenerative medicine. […] The authors concluded that further research is needed; in particular, high-quality, large-scale studies of women with common endocrinopathies, to determine the impact of these prevalent disorders on female sexual function. […] The authors concluded that the findings suggested that HA has a profile of efficacy, safety, and tolerability comparable with vaginal estrogens for the treatment of symptoms of vaginal atrophy; it was a possible alternative for women who could not use hormonal treatment. […] The authors concluded that despite the promising initial results of PRP injections, the level of current evidence is low due to methodological issues in the available studies. […] The authors concluded that randomized clinical trials regarding the use of visnadine for the female SD were scarce and methodologically limited.

• #51 Behavioral Therapies for Treating Female Sexual Dysfunctions: A State-of-the-Art Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9144766/

  In the case of female sexual interest/arousal disorder, CBT aims to increase rewards in order to increase motivation for sexual activities. Three controlled trials support CBT for addressing the symptomatology of this disorder. In addition, CBT has been found to be efficacious improving factors associated with the disorder, such as marital functioning. […] Regarding genito-pelvic pain/penetration disorder, CBT aims to achieve pain control in sexual contexts. CBT may help increase the frequency of sexual intercourse, decrease the fear of coitus, and enhance successful non-coital penetration, in comparison with no treatment. In addition, CBT for genito-pelvic pain/penetration disorder appears effective in reducing anxious symptomatology and improving marital harmony. […] Mindfulness has been understood as an awareness that emerges through paying attention, on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment by moment. Mindfulness-based approaches have begun to be used in clinical practice, either as an adjunct to other therapies (usually CBT) or as a stand-alone therapy. An approach with arguably the most evidence to date is mindfulness-based cognitive therapy (MBCT). MBCT is a treatment program that includes education related to cognitive modeling, training in decentering, and promotion of abilities or tendencies to perceive cognitions and feelings as mental events, not necessarily as reality. In addition, mindfulness may promote acceptance, compassion, and better management of ruminative and intrusive thoughts.

• #52 Female Sexual Interest/Arousal Disorder and Female Orgasmic Disorder

  https://www.exxcellence.org/list-of-pearls/female-sexual-interestarousal-disorder-and-female-orgasmic-disorder/?categoryName=&searchTerms=&featured=False&bookmarked=False&sortColumn=date&sortDirection=Descending

  Female Sexual Interest/Arousal Disorder (FSIAD), previously termed hypoactive sexual desire disorder and female sexual arousal disorder, is a condition where a woman has low or no interest in sex and/or difficulty becoming aroused, causing distress for at least six months. Symptoms include less sexual desire, fewer sexual thoughts, little interest in starting sex, and reduced pleasure during intimacy. […] Treatment of interest/arousal disorders focuses on identifying and treating contributing factors, as well as medical interventions. […] Psychologic disorders and interpersonal concerns should be managed with a combination of individual, couples, and sex therapy, including sensate focus. […] There are two medications FDA approved for interest/arousal disorders in premenopausal women.

• #53 Female Orgasmic Disorder – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/female-orgasmic-disorder

  Female orgasmic disorder involves orgasm that is absent, infrequent, markedly diminished in intensity, or markedly delayed in response to stimulation despite normal levels of subjective arousal. […] Treatment of Female Orgasmic Disorder includes self-stimulation, sex therapy, and psychological therapies. Data support encouraging self-stimulation (masturbation). First-line treatment of female orgasmic disorders is directed masturbation, which involves a series of prescribed exercises. […] Sex therapy for women, with or without their partners, can often help them with concerns about sexual performance and feelings. Other psychological therapies, including cognitive-behavioral therapy and psychotherapy, may help women identify and manage fear of vulnerability and issues of trust with a partner.

• #54 Female Orgasmic Disorder Treatment & Management: Approach Considerations, Psychotherapy, Pharmacotherapy

  https://emedicine.medscape.com/article/2185837-treatment

  In general, the initial goal of therapy for female orgasmic disorder (FOD) is to enable the patient to reach orgasm as desired under any circumstance. Evidence about the effectiveness of psychoanalytically or psychodynamically oriented therapies in attaining this goal is inconclusive. Of the variety of treatment approaches that have been tested, the most consistent support emerges for directed masturbation, sensate focus, and psychotherapy. […] At present, no medication has been specifically approved by the US Food and Drug Administration (FDA) for the treatment of FOD. In addition, very little information is available about pharmacotherapy specifically targeting disorders of orgasm in women, and it is unclear to what extent pharmacologic data about the treatment of sexual conditions in other female populations (eg, female sexual interest/arousal disorder, premenopausal and postmenopausal problems, and antidepressant-induced sexual disorders) is relevant for this population.

• #55 Female Orgasmic Disorder – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/female-sexual-function-and-dysfunction/female-orgasmic-disorder

  Currently, no data suggest that any medication is efficacious in the treatment of female orgasmic disorder. […] Treat with directed masturbation, usually as first-line therapy. Recommend sex therapy and other psychological therapies to help women identify and manage factors that contribute to orgasmic disorder.

• #56 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Bupropion (Wellbutrin) in higher dosages (150 mg twice daily) has been shown to be effective as an adjunct for antidepressant-induced sexual dysfunction in women. […] Sildenafil (Viagra) may benefit women with sexual dysfunction induced by selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor use. […] Female genital sexual pain disorders are complex and most effectively managed with a comprehensive, multidisciplinary approach that addresses contributing biopsychosocial factors. […] Group cognitive behavior therapy has been shown to effectively treat low sexual desire. […] Mindfulness-based interventions have been shown to effectively treat low sexual desire and arousal, and acquired anorgasmia. […] Directed masturbation is recommended for lifelong anorgasmia.

• #57 Sexual Dysfunction in Women: A Practical Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0815/p281.html

  Local vaginal estrogen therapy is recommended and preferred over systemic estrogen therapy for treatment of genitourinary syndrome of menopause and related dyspareunia when vaginal dryness is the primary concern. […] Ospemifene (Osphena) is modestly effective for treatment of dyspareunia. […] Transdermal testosterone, with or without concomitant estrogen therapy, has been shown to be effective for short-term treatment of low sexual desire or arousal in natural and surgically induced menopause. […] Although female sexual dysfunction often requires multidisciplinary treatment, even the initial visit can be beneficial. […] The unique predisposing, precipitating, and maintaining factors for a woman’s sexual dysfunction will determine the treatment plan. […] Strategies for managing antidepressant-induced dysfunction include reducing the dose if possible, switching to an antidepressant with fewer sexual adverse effects, or adding bupropion (Wellbutrin) as an adjunct.

• #58 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  Treatment is patient-specific and requires a multidisciplinary team. […] A 2017 systematic review of 43 studies, including seven randomized control trials, demonstrated significant reduction in pain and improvement in sexual function with pelvic physiotherapy. […] Many clinicians address vulvar pain prior to treating pelvic muscle floor dysfunction as superficial vulvar pain, which may make pelvic physiotherapy exceedingly difficult. […] This can be treated by switching to another form of contraception and the use of vestibular and vaginal hormonal therapy in the form of estrogen or a mixture of estrogen and testosterone. […] A recent study reported that intravaginal testosterone and estradiol-releasing vaginal rings demonstrated a favourable safety profile in the short-term in women on aromatase inhibitors.

• #59 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  There are a number of non-hormonal treatments that have demonstrated success in the treatment of vulvodynia. […] Refractory and severe cases of vulvodynia can ultimately be managed surgically with the resection of vestibular tissues with posterior vaginal advancement flap (vestibulectomy). […] A multidisciplinary approach to low desire is important. […] There are a number of medical treatments with evidence to support their use in patients with low desire. […] The Endocrine Society recommends a trial of testosterone therapy for 36 months in postmenopausal women with low androgen levels that are comfortable with off-label use and close monitoring. […] The management of comorbid conditions, such as diabetes and hypertension, should be optimized. […] The medical treatment of orgasmic problems is challenging, although there have been reports of success with mindfulness, yoga, the use of sex toys, and sex therapy. […] There is a strong basis for the evidenced-based evaluation and management of FSD. […] A common and multidisciplinary approach to FSD promotes better communication and outcome.

• #60 Female Sexual Dysfunction | Treatment | MedStar Health

  https://www.medstarhealth.org/services/female-sexual-dysfunction

  Female sexual dysfunction (FSD) affects 43% of US women and includes disorders of desire, arousal, orgasm, and pain. […] Treatment requires an individualized approach and may include individual or couples counselling, physical therapy, medication or hormonal therapy, and treatment of underlying medical and psychiatric conditions.

• #61 Overview of sexual dysfunction in females: Management – UpToDate

  https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-females-management

  Female sexual dysfunction is multifactorial, often with several different etiologies contributing to the problem. Nonetheless, careful evaluation and use of available therapies can improve sexual function for many patients. […] Complete the evaluation and diagnosis — Evaluate the patient for the range of sexual issues and physical, psychological, and relationship factors associated with their concerns before starting treatment. Most patients with sexual concerns have clinical issues that impact more than one aspect of sexual function. The problem may involve more than one phase of the normal sexual response cycle (desire, arousal, orgasm), sexual pain, or a general decrease in sexual satisfaction. As an example, if a patient complains of decreased libido, a full evaluation may also reveal issues with arousal or pain.

• #62 Sexual Dysfunction: Disorders, Causes, Types & Treatment

  https://my.clevelandclinic.org/health/diseases/9121-sexual-dysfunction

  Sex therapy: Sex therapists can help people experiencing sexual problems that their primary care provider cant address. […] Psychotherapy: Therapy with a trained counselor can help you address sexual trauma from the past, feelings of anxiety, fear, guilt and poor body image. All of these factors may affect sexual function. […] Education and communication: Education about sex and sexual behaviors and responses may help you overcome anxieties about sexual function. Open dialogue with your partner(s) about your needs and concerns also helps overcome many barriers to a healthy sex life. […] Sexual dysfunction is a challenging condition. Most causes of sexual dysfunction are treatable with counseling, education and improved communication between partners.

• #63 Female sexual dysfunction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556

  More research is needed, but therapies that may help improve sex include: […] Talk to your healthcare professional before trying any herbal or topical oil products. […] Don’t be shy talking about sex with your healthcare professional. […] Or lifestyle changes, therapy or a mix of treatments might help. […] Make a list of questions to make the most of your appointment time. […] Be sure to ask all the questions you have. […] Talk with your partner. Be honest about the problem you have. Think about other ways to be close to each other. Make time to be intimate.

• #64 Overview of Sexual Function and Dysfunction in Women – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/sexual-function-and-dysfunction-in-women/overview-of-sexual-function-and-dysfunction-in-women

  Just becoming aware of what is required for a healthy sexual response may be enough to help women change their thinking and behavior. However, more than one treatment is often required because many women have more than one type of sexual dysfunction. Sometimes a multidisciplinary team, including primary care physicians, gynecologists, pain specialists, psychotherapists, sex therapists, and/or physical therapists, is needed. […] Estrogen therapy can be used to treat sexual dysfunction in women with genitourinary syndrome of menopause. […] Prasterone (a synthetic form of dehydroepiandrosterone [DHEA]) inserted as a suppository into the vagina, can also relieve vaginal dryness and make sex less painful for postmenopausal women. […] Psychological therapies may help women with sexual problems.

• #65 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  The evaluation and treatment of male sexual dysfunction has developed considerably since the release of sildenafil (Viagra) as a treatment for erectile dysfunction in 1998. […] Unfortunately, despite robust clinical and academic interest in male sexual dysfunction, women with sexual complaints have been largely overlooked. […] Fortunately, over the past decade there has been an increase in the clinical and academic interest in female sexual function. […] There are now U.S. FDA-approved therapies for both low desire and sexual pain that will possibly be available in Canada in the future. […] This review provides a practical, evidence-based guide to the evaluation and management of FSD that is adaptable for clinical practice in Canada. […] A symptom-based approach is the most effective means to organize the initial medical evaluation and treatment of women with sexual complaints to encourage collaboration and communication between healthcare providers.

• #66 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  There are a number of non-hormonal treatments that have demonstrated success in the treatment of vulvodynia. […] Refractory and severe cases of vulvodynia can ultimately be managed surgically with the resection of vestibular tissues with posterior vaginal advancement flap (vestibulectomy). […] A multidisciplinary approach to low desire is important. […] There are a number of medical treatments with evidence to support their use in patients with low desire. […] The Endocrine Society recommends a trial of testosterone therapy for 36 months in postmenopausal women with low androgen levels that are comfortable with off-label use and close monitoring. […] The management of comorbid conditions, such as diabetes and hypertension, should be optimized. […] The medical treatment of orgasmic problems is challenging, although there have been reports of success with mindfulness, yoga, the use of sex toys, and sex therapy. […] There is a strong basis for the evidenced-based evaluation and management of FSD. […] A common and multidisciplinary approach to FSD promotes better communication and outcome.

• #67 A discussion about treatment options for women’s sexual dysfunction

  https://www.contemporaryobgyn.net/view/a-discussion-about-treatment-options-for-women-s-sexual-dysfunction

  I think what’s most important right now is that we have really seen the durability of the first FDA-approved treatment for women with hypoactive sexual desire disorder (HSDD) or low libido. […] there are only 2 FDA-approved treatments for female sexual dysfunction in the world (bremelanotide and flibanserin). […] So it’s 27 for men and 2 for women, so we continue to need to even the score and I continue to look forward to doing that for my patients and my partners in care in the future.

• #68 Female sexual disorders: Treatment options in the pipeline

  https://www.managedhealthcareexecutive.com/view/female-sexual-disorders-treatment-options-pipeline

  Femprox is an alprostadil-based cream intended for treatment of FSAD. […] Apomorphine is a dopamine agonist that has been used as a subcutaneous (SQ) injection for treatment of Parkinson disease and researched in oral form for treatment of arousal disorder. […] Bremelanotide is a melanocortin receptor 4 agonist (MCR4 agonist) for treatment of HSDD and FSAD. […] Intravaginal dehydroepiandrosterone (DHEA) is currently under investigation for treatment of vulvovaginal atrophic changes. […] Ospemifene is a novel estrogen agonist and antagonist that has been studied as an oral agent for treatment of vulvovaginal atrophy (VVA) and, therefore, would be effective for VVA-related sexual pain. […] Viveve (Sunnyvale, Calif.) has developed a monopolar radiofrequency (RF) thermal therapy to improve laxity of the vaginal introitus and sexual satisfaction in women after vaginal deliveries.

• #69 Female sexual disorders: Treatment options in the pipeline

  https://www.managedhealthcareexecutive.com/view/female-sexual-disorders-treatment-options-pipeline

  Only 2 FDA-approved treatments currently exist for female sexual disorders, but a wide range of oral, topical, and SQ formulations are being investigated. The etiologies of female sexual disorders are multifactorial, and a variety of treatment options are necessary to individualize treatment. Development of effective therapies is 1 important step for improving the sexual health of women.

• #70 A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/

  There are a number of non-hormonal treatments that have demonstrated success in the treatment of vulvodynia. […] Refractory and severe cases of vulvodynia can ultimately be managed surgically with the resection of vestibular tissues with posterior vaginal advancement flap (vestibulectomy). […] A multidisciplinary approach to low desire is important. […] There are a number of medical treatments with evidence to support their use in patients with low desire. […] The Endocrine Society recommends a trial of testosterone therapy for 36 months in postmenopausal women with low androgen levels that are comfortable with off-label use and close monitoring. […] The management of comorbid conditions, such as diabetes and hypertension, should be optimized. […] The medical treatment of orgasmic problems is challenging, although there have been reports of success with mindfulness, yoga, the use of sex toys, and sex therapy. […] There is a strong basis for the evidenced-based evaluation and management of FSD. […] A common and multidisciplinary approach to FSD promotes better communication and outcome.

• #71 Female sexual dysfunction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556

  More research is needed, but therapies that may help improve sex include: […] Talk to your healthcare professional before trying any herbal or topical oil products. […] Don’t be shy talking about sex with your healthcare professional. […] Or lifestyle changes, therapy or a mix of treatments might help. […] Make a list of questions to make the most of your appointment time. […] Be sure to ask all the questions you have. […] Talk with your partner. Be honest about the problem you have. Think about other ways to be close to each other. Make time to be intimate.

• #72 Overview of Sexual Function and Dysfunction in Women – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/sexual-function-and-dysfunction-in-women/overview-of-sexual-function-and-dysfunction-in-women

  Just becoming aware of what is required for a healthy sexual response may be enough to help women change their thinking and behavior. However, more than one treatment is often required because many women have more than one type of sexual dysfunction. Sometimes a multidisciplinary team, including primary care physicians, gynecologists, pain specialists, psychotherapists, sex therapists, and/or physical therapists, is needed. […] Estrogen therapy can be used to treat sexual dysfunction in women with genitourinary syndrome of menopause. […] Prasterone (a synthetic form of dehydroepiandrosterone [DHEA]) inserted as a suppository into the vagina, can also relieve vaginal dryness and make sex less painful for postmenopausal women. […] Psychological therapies may help women with sexual problems.

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