Treatment of female sexual dysfunction is gradually evolving as more clinical and basic science studies are dedicated to evaluating the problem. At the present time therapeutic options are limited Aside from hormone replacement therapy which at the present time is the only FDA approved treatment of FSD, medical management of female sexual dysfunction remains in early experimental phases. Studies are in progress accessing the effects of vasoactive substances on the female sexual response. We will present some of the currents conventional treatments and some unconventional (off label) therapies we use at our center.

This treatment is indicated in menopausal women (either spontaneous or surgical). Aside from reliving hot flashes, preventing osteoporosis, and lowering risk of heart disease in post-menopausal women, estrogen replacement restores clitoral and vaginal lubrication and sensation to levels close to those of pre-menopausal women. Estrogens also have protective effects, which result in increased blood flow to the vagina and clitoris. This helps to maintain female sexual response over time. Without treatment the following symptomatic complaints are common loss of desire, decreased frequency of sexual activity, painful intercourse, diminished sexual responsiveness, difficulty achieving orgasm, and decreased genital sensation.

Dehydroepiandrosterone is a male hormone produced by the adrenal gland and ovaries and converted to testosterone and estrogen. DHEA, which depletes with age, can be purchased over the counter in supplement form. In one small study published in the New England Journal of Medicine (Sept. 30, 1999), women who took 50 mg of DHEA daily noticed a significant increase in sexual interest. Other preliminary findings report encouraging results. However, we recommend the use of DHEA only after evaluating blood levels then replacing DHEA according to these blood levels.

Testosterone is considered a crucial hormone for a healthy sex drive in women as well as men. Studies show that a dramatic drop in sex drive accompanies testosterone deficiency in women and sexual responsiveness.1 One group of researchers also found that sexual gratification in women directly correlated with their testosterone levels.2
A more recent preliminary study from a team of Dutch researchers finds that testosterone may also have specific physiological effects on vaginal arousal. Women who were given testosterone supplements showed markedly higher degrees of genital sensations and arousal in response to visual stimulus, compared to those given a placebo.3 Testosterone appears to stimulate neurons in the brain that activate the nervous system - which plays a major role in female sexual response. This treatment is often used in combination with estrogen in menopausal women, for symptoms of inhibited desire, dyspareunia, or lack of vaginal lubrication.. Potential benefits of this therapy include increased clitoral sensitivity, increased vaginal lubrication, increased libido, and heightened arousal. In our center we use testosterone in various delivery forms, which are custom compounded for us. We use testosterone in Sublingual or transdermal forms using minimal possible dose to raise serum testosterone levels to the upper quintile of normal range. When used at this physiologic doses side effects are keep at bay. *

This medication, commonly known as Viagra, serves to increase relaxation of clitoral and vaginal smooth muscle and blood flow to the genital area. Sildenafil may prove useful alone or possibly in combination with other vasoactive substances for treatment of female sexual arousal disorder. Several studies are already published demonstrating efficacy of sildenafil for treatment of female sexual dysfunction secondary to use of Antidepressants (SSRI) drugs, in the post-menopausal population and on to some degree in the pre-menopausal population with arousal disorder.

At the Center for Clinical Age Management we have been very successful with the use to topical Alprostadil in a liposomal gel for the treatment of female sexual aroual disorder. This prostaglandin at time used alone and at times combined with phentolamine, DHT or VIP.