Restoring sexual function: Which medications show benefit?
When trying centrally acting or topical agents, also address patients’ psychopathologies.
Some evidence suggests that bupropion—which has noradrenergic and dopaminergic agonist properties—increases orgasm completion and other measures of sexual responsiveness in women with hypoactive sexual desire disorders.25
The investigational compound bremelanotide—a synthetic version of melanocytes stimulating hormone—is administered intranasally and appears to acutely influence libido in women.26 Trials have been delayed because of this agent’s effects on blood pressure.
Herbal compounds. Some herbal compounds are being sold for low-desire complaints. Web sites for 2 herbal compounds, Ziti and Alibi, cite unpublished double-blind studies attesting to their efficacy. Because these studies are unpublished, one cannot evaluate their methodologies.
One double-blind study of the herbal compound ArginMax—which contains ginseng, ginkgo, damiana, L-arginine, and multivitamins—suggests efficacy in a small group of women with poorly specified sexual problems.27 Zestra, a topical herbal compound, has been evaluated in large multisite studies and found to be effective in increasing female sexual responsiveness.28
Other approaches. Some clinicians advocate using the testosterone precursor dehydroepiandrosterone (DHEA) for low sexual desire, although evidence does not support its efficacy.29
A battery-operated device is FDA -approved for treating sexual dysfunction in women. The clitoral vacuum increases vaginal engorgement and various indices of sexual responsiveness. This device’s target population is not clearly defined.30
When medication side effects are causing hypoactive sexual desire, consider substituting another drug or using antidotes such as buspirone or bupropion. Unfortunately, however, most sexual desire problems are idiopathic.
Testosterone therapy has been shown to improve libido, although it is not FDA-approved for this indication. Considerable off-label use occurs, but long-term safety is unknown.
Related resource
- Medline Plus. Sexual problems overview. www.nlm.nih.gov/medlineplus/ency/article/001951.htm.
- Bupropion • Wellbutrin
- Buspirone • BuSpar
- Cabergoline • Dostinex
- Clomipramine • Anafranil
- Fluoxetine • Prozac
- Lorazepam • Ativan
- Paroxetine • Paxil
- Phentolamine • Regitine
- Prostaglandin E1 • Liprostin
- Sertraline • Zoloft
- Sildenafil • Viagr
- Tadalafil • Cialis
- Vardenafil • Levitra
Dr. Segraves receives grant/research support from Pfizer, Boehringer Ingelheim, AstraZeneca, Bristol-Myers Squibb, and Novartis and is a consultant to Eli Lilly and Company, GlaxoSmithKline, Boehringer Ingelheim, and Bristol-Myers Squibb.
