From the Guidelines
Female sexual arousal disorder should be treated with a combination of approaches, including addressing underlying causes, psychological therapy, and hormonal treatments, with flibanserin (Addyi) 100mg daily being a viable option for premenopausal women with hypoactive sexual desire, as supported by the most recent guidelines from the National Comprehensive Cancer Network (NCCN) 1.
Treatment Approaches
- Addressing underlying causes, such as reviewing medications that may affect arousal, treating hormonal imbalances, or managing chronic health conditions
- Psychological therapy, particularly cognitive-behavioral therapy or sex therapy with a qualified therapist, for 8-12 weekly sessions to address anxiety, relationship issues, or past trauma
- Hormonal treatments, such as local estrogen therapy (e.g., Vagifem tablets or Estring) for vaginal dryness, and systemic hormone therapy for postmenopausal women
- Lifestyle modifications, including stress reduction, regular exercise, limiting alcohol consumption, and improving communication with partners
Medication Options
- Flibanserin (Addyi) 100mg daily, FDA-approved for premenopausal women with hypoactive sexual desire
- Bremelanotide, an option for premenopausal individuals with low sexual desire, as it has been shown to increase sexual desire and reduce distress related to low sexual desire 1
- Bupropion (Wellbutrin) 150-300mg daily, which may improve arousal without the sexual side effects of other antidepressants
- Vaginal estrogen (pills, rings, or creams) for treating vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal women
Additional Considerations
- Pelvic floor muscle training may improve sexual pain, arousal, lubrication, orgasm, and satisfaction
- Vaginal dilators may be recommended for vaginismus, sexual aversion disorder, vaginal scarring, or vaginal stenosis from pelvic surgery or radiation
- Referrals for psychotherapy, sexual/couples counseling, or gynecologic care should be given as appropriate, and ongoing partner communication should be encouraged The NCCN guidelines also note that the evidence base for interventions to treat female sexual dysfunction in survivors is weak, and high-quality studies are needed 1. However, based on the available evidence and consensus among the NCCN Survivorship Panel, the recommended treatment approaches and medication options can help improve symptoms and quality of life for women with female sexual arousal disorder.
From the FDA Drug Label
ADDYI is indicated for the treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD), as characterized by low sexual desire that causes marked distress or interpersonal difficulty and is NOT due to: • A co-existing medical or psychiatric condition, • Problems within the relationship, or • The effects of a medication or other drug substance.
The patient is a female with sexual arousal disorder. Fibanserin (ADDYI) is indicated for the treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD). However, the term "sexual arousal disorder" is not explicitly mentioned in the label.
- The label does mention hypoactive sexual desire disorder (HSDD), which is characterized by low sexual desire.
- It is essential to note that HSDD and sexual arousal disorder are related but distinct conditions. Given the information provided, fibanserin (ADDYI) may be considered for the treatment of HSDD in premenopausal women, but it is crucial to determine if the patient's condition aligns with the indicated use of the medication 2.
From the Research
Female Sexual Arousal Disorder
- Female sexual arousal disorder (FSAD) is a common and distressing sexual dysfunction in women, with definitions and terminology currently being debated 3.
- The prevalence of FSAD varies and increases with age, especially at the time of menopause, while distress decreases with age 3.
- Arousal disorders are often comorbid with other sexual problems and are of biopsychosocial etiology 3.
Treatment Options
- Cognitive-behavioral therapy (CBT) and mindfulness-based therapy (MBT) have been shown to be effective in treating female sexual interest/arousal disorder (SIAD) 4, 5, 6.
- Online interventions, such as eSense, have been developed to increase access to evidence-based treatment for SIAD, and have been found to be feasible and usable 4, 7.
- Pharmacological approaches, such as flibanserin, have also been approved for the treatment of low sexual desire in women, but have significant side effects and are contraindicated with alcohol 5.
Efficacy of Treatments
- Studies have shown that CBT and MBT can lead to significant improvements in sexual desire, arousal, and satisfaction, as well as reductions in sexual distress 4, 7, 6.
- Online interventions, such as eSense, have been found to be effective in improving sexual function and reducing distress, with participants reporting high levels of satisfaction and engagement 4, 7.
- Further research is needed to advance treatment development for female sexual dysfunctions and to promote female sexual health 6.