AB52. What’s new in treatment of female sexual dysfunction?

Abstract: For recent a decade, field of female sexual dysfunction for classification, it’s pathophysiology and treatment has been focused. However, the treatment of female sexual dysfunction especially many potential drugs, has been not approved by their government control since their safety or efficacy. Although these present states, many drugs for enhancing sexual desire or genital blood flow have been tried with clinical improvement presenting in placebo-controlled studies.

Generally many treatments converged into improvement of arousal phase by increasing genital blood flow as discovered in a lot of experimental studies. Pentolamine, PGE1, phosphodiesterase type 5 inhibitors and apomorphine which were developing for men’s sexual dysfunction, were studied with inconsistent efficacy. Bremelanotide, melanocortin analogue by Palatin, and Flibanserin, 5HT1A agonist by Boehringer Ingelheim were reported promising results for increasing sexual desire and sexual arousal significantly. For sexual arousal disorder, another intra-vaginal alpha adrenergic blocker like Vasomax (Zonagen) and Rec 2615 (Recordati) in estronized women, and new transdermal PGE1, Alista (Vivus) or Femprox (NexMed), as additional drugs was suggested. Vasoactive intestinal polypeptide analogue, Avitadil (Senetek), also was tried with increasing genital blood flow. Dopamine agonist and Nitric oxide donor can be used for sexual arousal disorder.

For general sexual desire disorder there is no specific drugs except sex therapy. But women with low sexual drive and low serum testosterone would be significantly improved with androgen replacement therapy through oral, transvaginal (Columbia) or transdermal route. Now there is some of commercial transdermal androgen such as Intrinsa by Proctor & Gamble. Or drugs enhancing sexual arousal can be administered. There is no suitable therapy except sex therapy for all orgasmic disorder. Many investigators have demonstrated not effective results with vasoactive drugs. Vacuum suction device for clitoris, EROS, can be applied for improving orgasm.

Since sexual pain disorder is occurred by anatomical problems rather than functional, surgical treatments are sometimes effective. In case of hypertonic pelvic floor muscle, relaxants like PGE1 and nitroglycerin could be applied. Pain from dried vagina without atrophy will be solved by vaginal lubricants. Other drugs under developing can categorize phosphodiesterase type 4 inhibitors (Pfizer), Inhibitor for enzyme degrading VIP (NEP inhibitors; Solvay), selective D3 or D4 agonists (Abott) and Human growth factor. Even though many drugs would be suggested for female sexual dysfunction, psychodynamic encourage, behavior therapy and increasing intimacy should be combined with medical treatment.

Keywords: Female sexual dysfunction; treatment; Rec 2615