Female Sexual Dysfunction Management

Introduction to Female Sexual Dysfunction

Sexual dysfunction is often characterized by problems related to desire, arousal, orgasm, and pain 1

Identify prescription medications that may contribute to sexual dysfunction, particularly hormone therapy, narcotics, beta blockers, and SSRIs 2
Evaluate traditional risk factors such as cardiovascular disease, diabetes, obesity, smoking, and alcohol use 2
Consider menopausal status and symptoms, as vaginal dryness and other menopausal changes can significantly impact sexual function 1
Assess for psychological factors including anxiety, depression, body image concerns, and relationship issues 2

DHEA (prasterone) can be considered for improving sexual desire and function, with typical dosing of 10-50mg daily 3
DHEA has shown significant improvements in sexual desire, arousal, pain, and overall sexual function 3, 4
Other medications that may be considered for low desire include androgens 4, bupropion 4, buspirone 4, and bremelanotide 1

Vaginal moisturizers and lubricants can be used for vaginal dryness and sexual pain 1, 5, 6
Topical treatments such as vaginal gels, oils, topical vitamin D or E, and topical anesthetics can be used for vaginal health 5, 6
Vaginal dilators can be used for pain with sexual activity or vaginal stenosis 1, 5
Pelvic physical therapy (pelvic floor muscle training) can improve sexual pain, arousal, lubrication, orgasm, and satisfaction 1, 5, 3
Cognitive behavioral therapy (CBT) has shown effectiveness for improving sexual function, particularly in cancer survivors 1, 5
Integrative therapies including yoga and meditation may help alleviate anxiety and improve sexual function 1, 5
Lifestyle modifications such as regular exercise 5, stress management 2, adequate sleep 5, and healthy diet 2 can enhance sexual wellbeing
Sexual aids such as vibrators or clitoral stimulatory devices may help with orgasmic difficulties 1, 7

For cancer survivors, treatment should be guided by cancer type and treatments received, with caution regarding hormone therapies for survivors of hormone-sensitive cancers 1, 4
Using hormonal treatments without considering contraindications in patients with hormone-sensitive cancers should be avoided 4, 3

The National Comprehensive Cancer Network recommends identifying potential contributing factors to low sexual desire, including prescription medications, medical conditions, and psychosocial factors, in women experiencing low sexual desire 8, 9
Validated screening tools, such as the Brief Sexual Symptom Checklist, Arizona Sexual Experiences Scale (ASEX), and Female Sexual Function Index (FSFI), can help assess sexual function in women 9
The National Comprehensive Cancer Network suggests that menopausal status and associated symptoms should be considered when assessing female sexual dysfunction 8

The National Comprehensive Cancer Network recommends flibanserin as a treatment option for premenopausal women with acquired, generalized hypoactive sexual desire disorder, which results in approximately one additional satisfying sexual event every two months 10
DHEA (prasterone) is FDA-approved for vaginal symptoms and has been shown to significantly improve sexual desire, arousal, pain, and overall sexual function in women 10
The American College of Obstetricians and Gynecologists supports the use of testosterone therapy for postmenopausal women with low desire, although it is not FDA-approved for this indication 11

Cognitive behavioral therapy (CBT) has strong evidence for improving sexual function in women, according to the National Comprehensive Cancer Network 8
The National Comprehensive Cancer Network recommends vaginal moisturizers and lubricants for symptoms of vaginal dryness and pain, as well as psychotherapy and sexual counseling 8, 11, 12
Pelvic floor muscle training can improve sexual pain, arousal, lubrication, orgasm, and satisfaction in women, as suggested by the National Comprehensive Cancer Network 8, 12

The National Comprehensive Cancer Network recommends avoiding hormonal treatments in survivors of hormone-sensitive cancers, and considering ospemifene for dyspareunia in survivors of non-hormone-sensitive cancers 10
The American Society of Clinical Oncology advises against using PDE5 inhibitors for female sexual dysfunction due to lack of evidence for effectiveness, and recommends considering contraindications in patients with hormone-sensitive cancers 10, 12