Female Sexual Dysfunction  Medication

Updated: Jun 25, 2019
  • Author: Brett Worly, MD, FACOG; Chief Editor: Christine Isaacs, MD  more...
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Medication

Medication Summary

The goal of pharmacotherapy is to treat sexual pain associated with vulvovaginal atrophy. The agents listed below are FDA-approved for the treatment of this condition. [2, 17, 4, 25, 13, 19, 14, 24, 10]

Drugs indicated for hypoactive sexual desire disorder (HSDD) have also been approved by the FDA (eg, flibanserin, bremelanotide). [20, 21, 22]

 

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Estrogen Derivatives

Class Summary

Hormones are indicated for management of atrophic vaginitis resulting from diminished levels of circulating estrogens.

Conjugated estrogens, vaginal (Premarin)

Indicated for use in women experiencing vaginal changes secondary to a deficiency of estrogen.and moderate to severe painful intercourse caused by these changes.

Estradiol vaginal (Vagifem, Estrace, Estring, Yuvafem)

Vulvar and vaginal atrophy caused by estrogen loss, which results in vaginal dryness, burning, and itching, is a major source of painful intercourse for postmenopausal women. Topical estrogen reduce pH levels and mature the vaginal, which improves vaginal epithelial integrity, reduces sensitivity and improves elasticity of the vaginal tissues.

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Selective Estrogen Receptor Modulators

Class Summary

Agents in this class may aid in reversing genital atrophy.

Ospemifene (Osphena)

Selective estrogen receptor modulators activate estrogen pathways on the endometrium. Activation of these pathways improve vaginal changes associated with the decrease in natural estrogen production, which in turn improves vaginal maturation and decreases vaginal pH.

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Vaginal Preparations, Other

Class Summary

Agents in this class immprove elasticity and pH levels in vaginal tissue, which can in turn make sexual intercourse less painful.

Prasterone, intravaginal (Intrarosa)

Reduces moderate to severe painful intercourse due to menopause.  Its mechanism of action is poorly understood.

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Mixed 5HT1A agonist/5-HT2A antagonist

Class Summary

Agents in this class may improve sexual desire.

Flibanserin (Addyi)

Although the drug has known mixed agonist/antagonist effects on postsynaptic serotonergic receptors, its mechanism of action on the hypoactive sexual desire disorder is unknown,

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Melanocortin Receptor Agonists

Class Summary

Melanocortin receptor agonists with high affinity for the type-4 receptor have potential to modulate brain pathways involved in sexual response.

Bremelanotide (Vyleesi)

Melanocortin receptor (MCR) agonist that nonselectively activates several receptor subtypes with the following order of potency: MC1R, MC4R, MC3R, MC5R, MC2R. It is indicated for acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women.

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