Sex Differences in the Treatment of Sexual Dysfunction
Purpose of Review
Sex differences in the treatment of sexual dysfunction are partly due to neurobiological differences, as well as, the central and peripheral physiological effects of hormones and neurotransmitter actions on reproductive systems in men and women. Differences in epidemiology of complaints and diagnostic considerations, variance in medical comorbidities, and interference from related medications also contribute to the need for different strategies for treatments of sexual dysfunction according to gender.
Flibanserin and ospemifene are new medication treatment options that may help some women with symptoms of sexual dysfunction.
Various therapies are available to address sexual dysfunction and sex differences are relevant to consider, in terms of diagnosis, effectiveness of treatments, and side effect profiles that may help determine indication, safety, and outcomes for specific treatments.
KeywordsSexual dysfunction Sex differences Treatment options Pharmacotherapy Neurobiology
Compliance with Ethical Standards
Conflict of Interest
Veronica Harsh declares no conflict of interest. Anita H. Clayton reports grants from Auspex Pharmaceuticals, Genomind, Inc., Trimel Biopharma, grants and personal fees from Forest (now Actavis), Palatin Technologies, Pfizer, Inc., and Takeda, and personal fees from Arbor Scientia, Lundbeck, Naurex, Ostuka, Roche, S1 Biopharmaceuticals, Sprout, a division of Valeant. Dr. Clayton also owns shares in S1 Biopharmaceuticals and Euthmyics. Dr. Clayton has a patent Changes in Sexual Functioning Questionniare with royalties paid, a patent Guilford Publications with royalties paid, and a patent Ballantine Books/Random House with royalties paid and International Consultation for Sexual Medicine—Vice Chair: travel/accommodations/meeting expenses World Health Organization ICD-11 Advisory Meeting on Sexual Dysfunctions and Sexual Pain Disorders—Board Member/Presenter: travel/accommodations/meeting expenses.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 9.• Chen LW, Yin HL. A literature review of antithrombotic and anticoagulating agents on sexual function. Andrologia. 2017;6:e12784. This article reviews available literature about the impact on sexual function including vasculogenic priapism, erectile dysfunction, and impact on libido with some agents in men (no findings of effects contributing to sexual dysfunction in women), and the relative risk of sexual dysfunction among therapies. CrossRefGoogle Scholar
- 10.• Kiguradze T, Temps WH, Yarnold PR, Cashy J, Brannigan RE, Nardone B, et al. Persistent erectile dysfunction in men exposed to the 5α-reductase inhibitors, finasteride, or dutasteride. PeerJ. 2017;5:e3020. This recent study assessed the risk of persistent erectile dysfunction with longer duration of use of 5α-reductase inhibitors. CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Dennerstein L, Gotts G, Brown JB, Morse CA, Farley TM, Pinol A. The relationship between the menstrual cycle and female sexual interest in women with PMS complaints and volunteers. Psychoneuroendocrinology. 1994;19(3):293–304. https://doi.org/10.1016/0306-4530(94)90067-1.CrossRefPubMedGoogle Scholar
- 14.Clayton AH, Goldfischer ER, Goldstein I, Derogatis L, Lewis-D’Agostino DJ, Pyke R. Validation of the decreased sexual desire screener (DSDS): a brief diagnostic instrument for generalized acquired female hypoactive sexual desire disorder (HSDD). J Sex Med. 2009 Mar;6(3):730–8. https://doi.org/10.1111/j.1743-6109.2008.01153.x.CrossRefPubMedGoogle Scholar
- 17.Jacobsen PL, Mahableshwarkar AR, Chen Y, Chrones L, Clayton AH. Effect of vortioxetine versus escitalopram on sexual functioning in adults with well-treated major depressive disorder experiencing SSRI-induced sexual dysfunction. J Sex Med. 2015;12(10):2036–48.Google Scholar
- 21.Caruso S, Rugolo S, Agnello C, Intelisano G, Di Mari L, Cianci A. Sildenafil improves sexual functioning in premenopausal women with type 1 diabetes who are affected by sexual arousal disorder: a double-blind, crossover, placebo-controlled pilot study. Fertil Steril. 2006;85(5):1496–501. https://doi.org/10.1016/j.fertnstert.2005.10.043.CrossRefPubMedGoogle Scholar
- 28.Braunstein GD, Sundwall DA, Katz M, Shifren JL, Buster JE, Simon JA. Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial. Arch Intern Med. 2005;165(14):1582–9. https://doi.org/10.1001/archinte.165.14.1582.CrossRefPubMedGoogle Scholar
- 31.FDA Briefing Document: http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/drugs/drugsafetyandriskmanagementadvisorycommittee/ucm449090.pdf.Google Scholar
- 32.• Joffe HV, Chang C, Sewell C, Easley O, Nguyen C, Dunn S, et al. FDA approval of flibanserin—treating hypoactive sexual desire disorder. NEJM. 2016;374(2):101–4. This perspective explains the consideration of data and associated concerns involved in the decision-making process that resulted in the eventual FDA approval of flibanserin—following two prior rejections—for the treatment of hypoactive sexual desire disorder in premenopausal women. CrossRefPubMedGoogle Scholar
- 33.Portman DJ, Bachmann GA, Simon JA, the Ospemifene Study Group. Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy. Menopause. 2013;20(6):623–30. https://doi.org/10.1097/gme.0b013e318279ba64.CrossRefPubMedGoogle Scholar
- 34.Portman D, Palacios S, Nappi RE, Mueck AO. Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: a randomised, placebo-controlled, phase III trial. Maturitas. 2014;78(2):91–8. https://doi.org/10.1016/j.maturitas.2014.02.015.CrossRefPubMedGoogle Scholar
- 35.Segraves RT, Clayton A, Croft H, Wolf A, Warnock J. Buproprion sustained release for the treatment of hypoactive sexual desire disorder in premenopausal women. J Clin Psychopharmacol. 2004;24(3):339–42. https://doi.org/10.1097/01.jcp.0000125686.20338.c1.CrossRefPubMedGoogle Scholar