Abordaje clínico de las disfunciones sexuales femeninas: perspectiva orgánica

What should be really categorized as female sexual dysfunction (FSD) is under debate, although there is agreement in its relatively high prevalence. The multidimensional and contextual nature of female sexual expression is also acknowledged, and that must be kept in mind when addressing FSD. It is also recognized that it relies on a biological support which can deteriorate by several medical problems (as diseases, treatments, or scars), thus resulting in an impaired sexual function. The only drugs currently approved for the specific treatment of FSD are the hormonal preparations prescribed for menopausal symptoms. Estrogens have proved highly effective in reversing urogenital atrophy and its sexual symptoms (vaginal dryness, dyspareunia) whereas their main influence on sexual desire is likely indirect. Several estrogenic preparations to be given by either systemic or vaginal routes are available. Androgens are now regarded as having an important role for fostering sexual appetite/desire in men and women. A transdermal testosterone preparation has been recently approved by the EMEA for the treatment of oophorectomized, estrogenized women complaining of lack of sexual desire. Tibolone, a synthetic steroid with tissue selective estrogenic, progestogenic, and androgenic effects, has long been used in Europe for the treatment of menopausal symptoms. It has proved effective for relieving urogenital atrophy and improving various indices of sexual function and satisfaction. Several non-hormonal preparations, primarily used for treating male erectile dysfunction, are showing promising results in controlled studies in women with sexual difficulties, especially in arousal problems. They include the 5 phosphodiesterase inhibitor sildenafil, apomorphin SL, a melanocortin analogue, and topical prostaglandin E1 (alprostadil).