Female Sexual Dysfunction – FSD – Viable Treatment Alternatives – Part I

Treatments for postmenopausal sexual dysfunction involves a multidisciplinary strategy that mostly requires pharmacotherapy alongside proper counselling and/or spouse treatment to adeptly manage sexual dysfunction.

In spite of the dearth of a pharmacological ‘gold standard treatment’ for sexual dysfunction, several agents have been discovered to be beneficial. The usage of compounded pharmacy preparations is not advisable due to the non-availability of information regarding their safety, efficiency or bioavailability.

Oestrogen

Concentrating on oestrogen paucity and essentially treating atrophic vaginitis with vaginal oestrogen is the chief treatment for sexual problems related to hormonal changes at the menopause.

A latest, randomised controlled clinical trial spanning over six months evaluated the effects of oral oestradiol, vaginal oestradiol and drospirione and tibolone on sexual functioning in post-menopausal women. The greatest improvement in scoring and arousal was accomplished with oral oestradiol. The maximum lubrication was attained with oral and vaginal oestradiol. Tibolone exhibited the best improvement in orgasm. Both vaginal and oral oestradiol had the utmost improvement on pain.

Treating vaginal and vasomotor signs of menopause enhances quality of life and improved sexual function. Systemic oestrogen when added to vaginal preparations could have additional advantages however; it has the added risks and advantages related to Hormone Replacement Therapy (HRT).

Tibolone

The tissue-specific oestrogen, progesterone and androgen properties of tibolone have been proven effective in raising libido and regularity of sexual activities.

A latest evaluation between oestradiol and tibolone in preliminary postmenopausal women revealed that oestradiol had the maximum scoring for improvement noted in arousal, lubrication and pain. Tibolone had the highest scoring for orgasm.

It is additionally believed that tibolone lowers SHBG or sex hormone-binding globulin that aids in additional release of free testosterone. This is known to have a significant effect on elderly women when the testosterone is the least.

An advanced study revealed that though both the treatments were shown to improve sexual function, tibolone was found to be better. Tibolone has been linked to heightened chances of stroke and probably breast cancer. Hence, women must be sufficiently counselled as to the risks and advantages of this form of medication.

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