What are the best medical options to improve female libido and sexual drive?

Best Medical Options to Improve Female Libido and Sexual Drive

For women experiencing low sexual desire, the most effective medical interventions include flibanserin for premenopausal women, DHEA (prasterone) for vaginal symptoms, and a combination of psychosocial interventions with appropriate pharmacological options based on specific symptoms.

Assessment and Diagnosis

• Before initiating treatment, identify potential contributing factors including:

  • Prescription medications that may reduce libido (hormone therapy, narcotics, beta blockers, SSRIs) 1
  • Medical conditions such as cardiovascular disease, diabetes, and obesity 1
  • Psychosocial factors including anxiety, depression, relationship issues, and body image concerns 1, 2
  • Menopausal status and associated symptoms 1, 2

• Validated screening tools can help assess sexual function:

  • For women, options include the Brief Sexual Symptom Checklist, Arizona Sexual Experiences Scale (ASEX), and Female Sexual Function Index (FSFI) 1
  • These tools help identify specific areas of dysfunction (desire, arousal, orgasm, pain) 1

Pharmacological Interventions

FDA-Approved Medications

• Flibanserin (Addyi):

  • FDA-approved for premenopausal women with acquired, generalized hypoactive sexual desire disorder 1
  • Dosage: 100 mg taken once daily at bedtime 3
  • Mechanism: Acts as a 5-HT1A agonist and 5-HT2A antagonist 3
  • Contraindicated with alcohol use and moderate/strong CYP3A4 inhibitors 3
  • Results in approximately one additional satisfying sexual event every two months 1

• Bremelanotide (Vyleesi):

  • Self-administered subcutaneous injection used as needed before sexual activity 2
  • Activates melanocortin receptors 2
  • May cause nausea and skin flushing as side effects 2

• DHEA (prasterone):

  • FDA-approved vaginal insert for dyspareunia 1
  • Shown to significantly improve sexual desire, arousal, pain, and overall sexual function 1, 2
  • Contraindicated in women with a history of breast cancer 1

Off-Label Pharmacological Options

• Testosterone therapy:

  • Can be considered for postmenopausal women with low desire 1, 2
  • Transdermal formulations preferred 4
  • Not FDA-approved for women in the US but supported by evidence 4
  • Contraindicated in women with hormone-sensitive cancers 2

• Bupropion:

  • May improve sexual desire as an off-label option 1, 2
  • Particularly useful when depression is a contributing factor 1

• Buspirone:

  • Can be considered for hypoactive sexual desire disorder 1, 2
  • May be particularly helpful when anxiety is a contributing factor 2

Non-Pharmacological Interventions

• Psychotherapy and counseling:

  • Cognitive behavioral therapy (CBT) has strong evidence for improving sexual function in women 1, 2
  • Sexual/couples counseling addresses relationship factors affecting desire 1

• Vaginal health management:

  • Lubricants and vaginal moisturizers for symptoms of vaginal dryness and pain 1
  • Topical treatments including gels, oils, and topical vitamin D or E 1
  • Lidocaine for pain with sexual activity 1

• Physical interventions:

  • Pelvic floor muscle training improves sexual pain, arousal, lubrication, orgasm, and satisfaction 1, 2
  • Vaginal dilators for pain during sexual activity 1

• Integrative approaches:

  • Yoga and meditation may help reduce anxiety and improve sexual function 1, 2
  • Regular exercise and stress management techniques 2

Treatment Algorithm

1. First-line approaches:

   • Address modifiable risk factors (medication changes, lifestyle modifications) 1
   • Vaginal moisturizers and lubricants for vaginal dryness 1
   • Psychotherapy (particularly CBT) and sexual counseling 1, 2

2. Second-line approaches (if first-line ineffective):

   • For premenopausal women with low desire: Consider flibanserin 1, 3
   • For postmenopausal women with vaginal symptoms: Consider DHEA (prasterone) 1, 2
   • For women with pain during sex: Consider topical anesthetics, pelvic floor therapy 1

3. Third-line approaches:

   • Off-label medications (bupropion, buspirone) 1, 2
   • Testosterone therapy for postmenopausal women without contraindications 1, 4

Special Considerations

• Cancer survivors:

  • Ospemifene can be considered for dyspareunia in survivors of non-hormone-sensitive cancers 1
  • Avoid hormonal treatments in survivors of hormone-sensitive cancers 1, 2

• Common pitfalls to avoid:

  • Using PDE5 inhibitors (like sildenafil) for female sexual dysfunction is not recommended due to lack of evidence for effectiveness 1
  • Prescribing hormonal treatments without considering contraindications in patients with hormone-sensitive cancers 1, 2
  • Focusing solely on pharmacological treatments without addressing psychological and relationship factors 1, 4

• Biological basis:

  • Female sexual desire involves complex interactions between hormones (estrogen, testosterone, dopamine) and neurotransmitters 5, 6
  • Both biological and psychosocial factors contribute to sexual desire and should be addressed 7, 8