Treatment of female sexual dysfunction in postmenopausal women—What is the evidence?

Postmenopausal women often seek medical advice because they suffer from one or more subtypes of sexual dysfunction. A variety of nonprescription, prescription and investigational products to treat female sexual dysfunction is available, but the evidence regarding the effects of these products on female sexual function is inconclusive. Individualized care is vital as each woman has specific needs that require personalized treatments.

Prior to recommending existing pharmacological treatment in women with sexual dysfunction, behavioral therapy should be sought. This therapy may help women overcome psychological barriers towards sexual activity, modify sexual behavior and subsequently improve sexual function. A secondary option is pharmacological therapy to treat underlying medical conditions. Hormone replacement therapy with estrogens improves vasomotor symptoms, vaginal dryness, dyspareunia and general well-being, yet in most women has little effect on libido. Testosterone replacement enhances sexual motivation and improves libido. Tibolone has estrogenic, progestagenic and androgenic properties and is effective in several subtypes of female sexual function. The results from clinical trials using sildenafil citrate (Viagra), dopamine agonists, peripheral nonselective alpha-blockers, phosphodiesterase type-5 inhibitors, as well as oxytocine, ginkgo biloba, caffeine and psychostimulants are inconclusive.

Future randomized, double-blind, placebo-controlled trials with appropriate target population, validated outcomes measures, bigger sample sizes and of longer duration are needed to assess treatment options in women with sexual dysfunction.