Commentary

Treatment benefits for women with low libido are overstated


 

I was glad to see reduced libido in women addressed in Clinical Inquiries (Which treatments help women with reduced libido? J Fam Pract. 2013;62:102, 112), but after reading it, I was disappointed. The main recommendation was for the use of a transdermal testosterone patch. The authors correctly note that the FDA doesn’t recommend androgens for female sexual dysfunction, but fail to clarify that no androgen has been approved, let alone recommended, for this purpose.

The article concludes by stating that “The North American Menopause Society recommends testosterone therapy for postmenopausal women with HSDD” [hypoactive sexual desire disorder]—a statement supported by a reference to a 2007 commentary on the topic. Looking at the original source reveals that this recommendation is from 2005 and has been officially “retired” by NAMS.1

1. The North American Menopause Society. Positions statements. Available at http://staging.menopause.org/aboutmeno/consensus.aspx. Accessed April 16, 2013.

Tony Glaser, MD, PhD
Charleston, SC

As a physician with both academic and professional interest in reduced libido in women, I found 2 statements in the Clinical Inquiry that I want to bring to your attention.

1. The authors state “Sildenafil improves HSDD associated with selective serotonin reuptake inhibitors,” based on a 2008 JAMA article by Nurnberg et al.1 Careful examination of Nurnberg’s results reveals that desire measurements were not improved with sildenafil but that some improvement in global function, orgasm, and satisfaction was statistically significant. Nurnberg et al state, “Lack of a significant sildenafil treatment effect for sexual desire is consistent with reports that selective phosphodiesterase type 5 inhibitors do not directly enhance libido. …”

2. It is inaccurate to state that “The North American Menopause Society recommends testosterone therapy for postmenopausal women with HSDD.” Even when this now-retired position statement was active, it was not that strongly worded.

Jennifer E. Frank, MD, FAAFP
Neenah, Wisc

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