Article

Treatment options for female sexual arousal disorder: part II

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Abstract

Female sexual arousal disorder (FSAD) occurs when a woman experiences distress due to the inability to attain or maintain adequate vaginal lubrication. Many treatments are still under investigation, and at this time, there are no FDA-approved medications available for the treatment of FSAD. Treatment options include "off-label" medications, vaginal estrogen, compounded preparations, and over-the-counter products.

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... Women often complain of problems with arousal when estrogen levels decrease due to menopause, ovarian removal, or the use of hormonal contraceptives [51]. Therefore, when genital response is inhibited due to estrogen deficiency, it can be replaced using a vaginal tablet, ring, or topical cream to improve the arousal response [51]. ...
... Women often complain of problems with arousal when estrogen levels decrease due to menopause, ovarian removal, or the use of hormonal contraceptives [51]. Therefore, when genital response is inhibited due to estrogen deficiency, it can be replaced using a vaginal tablet, ring, or topical cream to improve the arousal response [51]. While the FDA has maintained that the risks of vaginal estrogens are similar to those of systemic estrogen, recent studies indicate the safest hormonal treatment for FSAD is localized estrogen [52]. ...
... A double-blind, placebo-controlled study conducted in 2003 showed that sildenafil immediately improved outcomes in patients with arousal-specific dysfunction as measured by the Female Intervention Efficacy Index [64]. Several largescale, placebo-controlled studies were conducted in about 3000 women with FSAD and found that sildenafil citrate was generally well-tolerated, but due to the high placeboresponse data, did not offer a significant benefit to women with sexual dysfunction [51]. ...
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Purpose of Review This review article discusses the controversy in the DSM-5 conceptualization and diagnostic criteria for female sexual dysfunction (FSD). An overview of recent studies on available treatments for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), and genitopelvic pain/penetration disorder (GPPD) is provided. Recent Findings Include delineation of the process of care for pre- and postmenopausal women with HSDD; release of global position statement on testosterone therapy in women; updates on efficacy and safety of vaginal estrogen for genitourinary syndrome of menopause and bremelanotide for HSDD; removal of flibanserin alcohol REMS; and development of new technology to enhance bioavailability and brain delivery of treatments. Summary The DSM-5 revision combining HSDD and FSAD into one diagnostic category is a less accurate characterization of these separate disorders and may hinder access to demonstrated effective treatments for the women with these conditions. There are a wide range of pharmacological, other physiological, and psychological treatment options available for women with FSD, which can be offered based on their specific symptoms, potential benefits/risks, and preferences.
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Resumo: A função sexual representa um componente importante da saúde e da qualidade de vida. O objetivo deste artigo foi descrever aspectos normais e patológicos da função sexual feminina e expor os métodos diagnósticos e terapêuticos, abordando a prevalência no Brasil. Para isso, foi realizada uma revisão da literatura, de artigos publicados entre 1985 e 2012, dos quais foram selecionados 56, indexados no PubMed/Medline e SciELO. Os achados indicam que as disfunções sexuais nas mulheres apresentam etiologia multifatorial e são pouco estudadas na população brasileira. A terapêutica deve ser adaptada de acordo com a necessidade da paciente e desenvolvida por uma equipe multidisciplinar. Abstract: Sexual function represents an important component of health and quality of life. The purpose of this article was to describe normal and pathological aspects of female sexual function and expose the diagnostic and therapeutic methods, addressing the prevalence in Brazil. For this, was realized a literature review, of articles published from 1985 to 2012, which 56 were selected, indexed in PubMed/Medline and SciELO. The findings indicate that female sexual dysfunctions have multifactorial etiology and are not very well studied in the Brazilian population. Therapy should be tailored according to the needs of the patient and done by a multidisciplinary team.
Article
The term off-label drug use (OLDU) is used extensively in the medical literature, continuing medical education exercises, and the media. Yet, we propose that many health care professionals have an underappreciation of its definition, prevalence, and implications. This article introduces and answers 10 questions regarding OLDU in an effort to clarify the practice's meaning, breadth of application, acceptance, and liabilities. Off-label drug use involves prescribing medications for indications, or using a dosage or dosage form, that have not been approved by the US Food and Drug Administration. Since the Food and Drug Administration does not regulate the practice of medicine, OLDU has become common. It occurs in every specialty of medicine, but it may be more common in areas of medicine in which the patient population is less likely to be included in clinical trials (eg, pediatric, pregnant, or psychiatric patients). Pharmaceutical companies are not allowed to promote their medications for an off-label use, which has lead to several large settlements for illegal marketing. To limit liability, physicians should prescribe medications only for indications that they believe are in the best interest of the patient. In addition, health care professionals should educate themselves about OLDU to weigh the risks and benefits and provide the best possible care for their patients.
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