Is hypersexuality reported in females taking spironolactone (aldosterone antagonist)?

Hypersexuality in Females Taking Spironolactone

There are no reports of hypersexuality in females taking spironolactone; in fact, the evidence suggests spironolactone may cause decreased libido and sexual arousal problems due to its anti-androgenic effects. 1, 2

Evidence on Sexual Side Effects of Spironolactone in Women

Decreased Sexual Function

• Spironolactone has been documented to cause sexual dysfunction in women, specifically:
  • Decreased libido 2
  • Impaired lubrication 2
  • Vestibular atrophy leading to dyspareunia 1
  • Female sexual arousal disorder 1

Mechanism of Action

• Spironolactone works through multiple anti-androgenic mechanisms 3:
  • Decreases testosterone production
  • Competitively inhibits testosterone and dihydrotestosterone binding to androgen receptors
  • Inhibits 5α-reductase
  • Increases steroid hormone-binding globulin

Clinical Evidence

• A 2019 case series documented 7 women who developed vestibulodynia and sexual arousal disorder while taking spironolactone 1
  • All women showed vulvar vestibular atrophy and tenderness
  • Symptoms improved after discontinuation of spironolactone and application of topical estrogen/testosterone gel

Other Side Effects in Women

Menstrual Disturbances

• Menstrual irregularities occur in 15-30% of women taking spironolactone 3
• The risk increases significantly with higher doses (relative risk of 4.12 for women taking 200mg/day) 3
• Polymenorrhea was noted as a major side effect in women treated for hyperandrogenism 4

Other Reported Side Effects

• Diuresis (29%)
• Breast tenderness (3-5%)
• Dizziness (3-4%)
• Nausea (2-4%)
• Polyuria (1-2%) 3

Clinical Implications

Monitoring for Sexual Side Effects

• When prescribing spironolactone to women, clinicians should:
  • Inquire about changes in sexual function during follow-up visits
  • Be aware that sexual side effects may be underreported due to patient discomfort discussing these issues
  • Consider dose reduction if sexual side effects occur, as lower doses (50-75mg) may be effective for some conditions with fewer side effects 5, 4

Management of Sexual Side Effects

• If sexual side effects occur, options include:
  • Discontinuation of spironolactone
  • Dose reduction
  • Consideration of topical estrogen/testosterone preparations for vestibular symptoms 1

Conclusion

The evidence consistently shows that spironolactone's anti-androgenic properties tend to decrease rather than increase sexual function in women. There are no documented cases or studies reporting hypersexuality as a side effect of spironolactone in females. In contrast, decreased libido and sexual arousal problems are recognized adverse effects of this medication.