From the Guidelines
Aging women experiencing decreased libido, arousal, orgasm, and genital sensation should be treated with vaginal estrogen as the most effective option for vaginal dryness, as well as considering other treatments such as pelvic physical therapy, vaginal dilators, and topical prescription medications like ospemifene and flibanserin. The treatment of sexual dysfunction in aging women is multifaceted and requires a comprehensive approach. According to the NCCN guidelines 1, vaginal estrogen is the most effective treatment for vaginal dryness leading to sexual dysfunction and has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals.
Some key points to consider in the treatment of sexual dysfunction in aging women include:
- Pelvic physical therapy, which can help alleviate pelvic dysfunction and improve sexual pain, arousal, lubrication, orgasm, and satisfaction 1
- Vaginal dilators, which can be used to increase vaginal depth and accommodation and may allow a survivor to discover what hurts and what does not in a nonsexual setting 1
- Topical prescription medications like ospemifene, which has been studied in several large trials of individuals with postmenopausal vulvar and vaginal atrophy and was found to effectively treat vaginal dryness and dyspareunia 1
- Flibanserin, an FDA-approved medication used to treat acquired, generalized hypoactive sexual desire disorder, which has been shown to be an option for survivors 1
It's also important to note that psychological interventions, such as sex therapy, cognitive behavioral therapy, and mindfulness-based approaches, are equally important in addressing the complex interplay between hormonal changes, psychological factors, and relationship dynamics that contribute to female sexual dysfunction during aging 1. Lifestyle modifications, such as regular exercise, stress management, and open communication with partners, can also significantly improve sexual function and satisfaction.
In terms of specific treatment options, the NCCN guidelines 1 recommend re-evaluating patients at regular intervals and discussing available drugs, such as androgens, bupropion, buspirone, flibanserin, and bremelanotide, as well as topical vaginal therapies, vaginal dilators, ospemifene, DHEA, pelvic physical therapy, and topical anesthetics. The American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline 1 also recommends assessing for signs and symptoms of sexual dysfunction or problems with sexual intimacy and offering nonhormonal, water-based lubricants and moisturizers for vaginal dryness.
From the FDA Drug Label
1.1 The Treatment of Moderate to Severe Dyspareunia, a Symptom of Vulvar and Vaginal Atrophy, Due to Menopause. 1.2 The Treatment of Moderate to Severe Vaginal Dryness, a Symptom of Vulvar and Vaginal Atrophy, Due to Menopause.
The treatment options for aging women experiencing decreased libido, arousal, orgasm, and genital sensation may include ospemifene (PV), as it is indicated for the treatment of moderate to severe dyspareunia and vaginal dryness, symptoms of vulvar and vaginal atrophy, due to menopause 2. However, it is essential to note that decreased libido is not explicitly mentioned as an indication in the provided drug label.
- Dyspareunia and vaginal dryness are addressed, which may be related to but do not directly encompass decreased libido, arousal, orgasm, and genital sensation.
- The use of ospemifene (PV) should be considered under the guidance of a healthcare provider, weighing the potential benefits against the risks, especially considering the warnings and precautions outlined in the label, such as cardiovascular disorders and malignant neoplasms.
From the Research
Treatment Options for Decreased Libido, Arousal, Orgasm, and Genital Sensation in Aging Women
- Education and lifestyle changes can help optimize sexual function in postmenopausal women 3
- Counseling and therapy, such as psychotherapy or sex therapy, can address psychological, relational, and sociocultural factors impacting a woman's sexual function 4, 5
- Medications, including hormonal supplements and testosterone, can improve sexual functioning in naturally and surgically menopausal women 4, 5
- Mechanical devices and pelvic floor exercises can also be effective in treating female sexual dysfunction 3
- Hormone therapy (HT) can be an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause, which can impact sexual function 6
Addressing Physiological and Psychological Factors
- A comprehensive approach, addressing both physiological and psychological factors, is instrumental in evaluating and treating female patients with sexual complaints 4
- Physiological factors, such as postmenopausal vaginal symptoms, erectile dysfunction in male partners, fatigue, and bodily pain, can contribute to low libido in older women 7
- Psychological factors, such as life stressors, body image concerns, and emotional intimacy with partners, can also impact sexual function in aging women 4, 7
Classification and Evaluation of Female Sexual Dysfunction
- A classification system for female sexual dysfunction includes four categories: hypoactive sexual desire disorder, sexual arousal disorder, orgasmic disorder, and sexual pain disorders 4
- Evaluation of women with sexual complaints should include a detailed psychological, social, and medical history, as well as a thorough physical examination, including a hormonal profile 4