26th Annual Meeting of the International Academy of Sex Research

Lorraine Dennerstein, AO, MBBS, PhD, FRANZCP, DPM

Disclosures

July 10, 2000

In This Article

Pharmacologic Treatment for Female Sexual Dysfunction

Researchers from the University of Texas at Austin addressed nonhormonal pharmacologic treatments for sexual problems in postmenopausal women aged 51-69 years. Dr. Cindy Meston studied 23 postmenopausal women who met DSM-IV criteria for female sexual arousal disorder (FSAD) for at least 6 months. They measured subjective arousal and physiologic arousal (using vaginal pulse amplitude) in response to erotic films after a double-blind dose of test drug.

Drugs administered included placebo, yohimbine HCl (6 mg), and the combination of L-arginine glutamate (6 g) with yohimbine HCl (6 mg). Only the latter combination proved effective, inducing a rapid and significant increase in vaginal pulse amplitude response to erotic film at 60 minutes post drug administration. These results seem promising but need replication and investigation for effectiveness when women are in real-life situations rather than in laboratories.

Yohimbine is a selective alpha2 adrenergic blocker and has both central and peripheral effects. The investigators had previously shown that clonidine, an alpha2 adrenergic agonist, had an opposite effect to yohimbine. The mechanism responsible for the combined effect of yohimbine and L-arginine glutamate was thought to be an increase in nitrous oxide released from nonadrenergic, noncholinergic vaginal nerves. L-arginine is a precursor to nitrous oxide, which releases cGMP in the genitalia, relaxing smooth muscle and increasing vasodilatation. The breakdown of cGMP is blocked by sildenafil (Viagra).

The effect of sildenafil (50 mg) on women's subjective and genital sexual arousal (vaginal pulse amplitude) in response to erotic movies was measured in an ongoing double-blind trial being conducted in Amsterdam and Seattle. Dr. Ellen Laan, of the Department of Clinical Psychology, University of Amsterdam, presented preliminary results from the Amsterdam site.

The study evaluated 2 groups of women, 1 with sexual arousal problems or FSAD and the other comprising age-matched volunteers without FSAD. There were no significant differences between sildenafil and placebo on subjective or genitally measured sexual arousal whether used in premenopausal or postmenopausal women. Postmenopausal women had lower vaginal pulse amplitude at baseline (pretreatment) than did premenopausal women, and volunteers without FSAD reported more subjective arousal than did those women with FSAD.

Thus, so far sildenafil is not showing the same beneficial effects on sexuality in women as have been observed in men. Perhaps this reflects the measures used -- for example, vaginal pulse amplitude may be less relevant for women than measures of clitoral excitement. It is also possible that in women, the powerful effects of psychosocial factors, such as feelings for the partner,[3] may override hormonal or biologic factors. Several anecdotes were reported in which women who found new partners about whom they had very positive feelings reported that their sex lives were transformed in the positive direction.

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