sildenafil-citrate and tibolone

'Female sexual dysfunction' (FSD) is an umbrella term comprising a range of common disorders, including hypoactive sexual desire, reduced subjective and/or physical genital arousal (poor sensation, vasocongestion, lubrication), sexual pain and inability to achieve orgasm/satisfaction, which are multidimensional by nature and often coexisting. Psychological and contextual factors have a significant influence on organic components of sexual response and behavior and a tailored medical approach to sexual symptoms is inevitably limited.. The paper reports the most recent advances in pharmacotherapy for women taking into account the biopsychosocial model. Hormone therapy, including estrogens, testosterone, tibolone and dehydroepiandrosterone, are discussed in term of efficacy and safety in postmenopausal women both for female sexual interest/arousal disorder (FSIAD) and genito-pelvic pain/penetration disorder. Ospemifene, a selective estrogen receptor modulator, approved to treat dyspareunia at menopause, is also discussed. Data on psychoactive agents for treatment of FSIAD in premenopausal women are discussed, including the potential use of on-demand combined hormonal (testosterone) and non-hormonal (buspirone or sildenafil) treatments to address possible neurophysiological profiles of women.. We are still waiting for an approved pharmacotherapy for FSD. This is not the result of gender inequality in sexual medicine, but it reflects the need of balancing benefits and risks in order to provide effective and safe treatments to women of any age.

Topics: Buspirone; Clinical Trials, Phase III as Topic; Estrogens; Female; Humans; Menopause; Norpregnenes; Piperazines; Purines; Selective Estrogen Receptor Modulators; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfonamides; Tamoxifen; Testosterone

The frequency of female sexual dysfunction increases with age, and the menopause has a negative influence on sexual life. Pharmacological treatment options of female sexual dysfunctions in the menopause include hormone therapy and sildenafil. Few randomised controlled studies have been done, and there is evidence suggesting that systemic hormone therapy, such as estrogen, estrogen/progesterone, estrogen/testosterone and tibolone, has a positive impact on sexual dysfunction in the menopause. There is evidence that local estrogen relieves vaginal dryness and dyspareunia. The recent discoveries of the side effects of hormone therapy necessitate careful evaluation of the indication for hormone therapy, and the duration of treatment is recommended to be as short as possible. The long-term side effects of testosterone in women have not yet been fully investigated. Sildenafil has shown a positive effect on female sexual dysfunction only in a limited group of women: those with arousal problems without desire problems. This result demands a focus on new pharmaceutical products, and at present the effect of testosterone and selective estrogen receptor modulators on female sexual dysfunction is being investigated.

Topics: Adult; Androgens; Estrogen Receptor Modulators; Estrogen Replacement Therapy; Female; Humans; Incidence; Libido; Menopause; Middle Aged; Norpregnenes; Phosphodiesterase Inhibitors; Piperazines; Postmenopause; Purines; Risk Factors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Testosterone

The frequency of female sexual dysfunction increases with age, and the menopausal transition has a negative effect on the sexuality. Pharmacological treatment options for female sexual dysfunction during the peri- and post-menopause include hormone therapy or sildenafil. A limited number of randomized, controlled trials have been conducted and evidence suggests that systemic hormone therapy with estrogen, estrogen/progesterone, estrogen/testosterone and tibolone have a positive impact on sexual dysfunction during the peri- and postmenopause. Further, there is evidence that treatment with local estrogen relieves vaginal dryness and dyspareunia. Recent knowledge on side effects related to hormone therapy necessitates careful evaluation of the indication for hormone therapy and the duration of postmenopausal hormone therapy should be as short as possible. Long-term side effects of testosterone have not yet been fully investigated. A positive effect of sildenafil has been observed in a limited group of women; those with arousal problems but with no desire problems. The results suggest an intensified focus on new pharmaceutical products for the treatment of female sexual dysfunction in the postmenopause. For the time being the effect of testosterone therapy and tibolone on female sexual dysfunction is being investigated. Sexual dysfunction in women (Female Sexual Dysfunction, FSD) is multi-factorial and influenced by physiological, psychological, social and emotional factors. FSD is defined in four diagnostic groups: desire-, arousal-, orgasm- and pain problems. Recently, it has been suggested that the woman herself should assess the dysfunction as distressful to be diagnosed as having a sexual dysfunction [1]. There are only a limited number of well-conducted population surveys on the prevalence of FSD. Further, relatively few randomized, controlled trials of pharmacological treatment of FSD have been carried out.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Androgen Antagonists; Estradiol; Estrogen Replacement Therapy; Estrogens; Female; Humans; Menopause; Middle Aged; Norpregnenes; Perimenopause; Piperazines; Purines; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone; Vagina

This systematic review includes all randomized and placebo-controlled trials (RCTs) of treatment for female sexual dysfunction (FSD) in postmenopausal women published since 1990.. Electronic database and manual bibliography searches were conducted to identify all relevant publications.. Only six RCTs have been done to assess the effects of different therapies on sexual function in postmenopausal women: one with sildenafil citrate (Viagra), three with hormone replacement therapy, and two with tibolone.. In women with FSD, many treatments that are used in practice are not supported by adequate evidence. Although an improvement of sexual function was reported with tibolone and the combination of estrogen-androgen therapy, it still remains unclear which groups of postmenopausal women with FSD would benefit most from these therapies. The adverse effects of testosterone replacement therapy should be assessed against the effects of placebo in RCTs with larger sample sizes and longer duration.

Topics: Adult; Androgens; Controlled Clinical Trials as Topic; Drug Therapy, Combination; Estrogen Replacement Therapy; Estrogens; Female; Humans; MEDLINE; Middle Aged; Norpregnenes; Piperazines; Placebos; Postmenopause; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones