Daily Apomorphine May Be Useful for Women With Sexual Arousal Disorder

May 20, 2004

Yael Waknine

May 20, 2004 — Daily sublingual (SL) apomorphine may improve the sexual life of premenopausal women with sexual arousal disorder and recurrent hypoactive sexual disorder, according to results of a study published in the May issue of Urology.

"Generalized female sexual arousal disorder includes a lack of mental excitement and a physical lack of genital congestion," write Salvatore Caruso, MD, and colleagues, from the Group for Sexual Research of the European Federation of Sexology at the University of Catania in Catania, Italy.

According to the authors, hypoactive sexual disorder is associated with recurrent deficiency of sexual fantasies/thoughts and/or receptivity to sexual activity. "The coexistence of sexual arousal and sexual desire, which develops during a sexual experience, explains the frequent comorbidity of arousal and desire disorders," the authors note.

The potential role of vascular mechanisms in the pathophysiology of these disorders led investigators to postulate that the central and peripheral pharmacologic actions of apomorphine SL could have beneficial clinical effects in women affected by both sexual arousal and desire disorders.

Fifty-five premenopausal women with recurring deficiency of sexual fantasies and/or thoughts, and in whom sexual stimulation did not result in lubrication for at least six months were included in the study. The Personal Experiences Questionnaire (PEQ) was used to measure sexuality at baseline and during each treatment period.

Fifty women completed the first phase of the study, an "as required" open-label dose-escalation regimen of 2 and 3 mg of apomorphine. PEQ scores at one month indicated beneficial changes from baseline in six women receiving the 3-mg dose of apomorphine ( P < .05).

During the second phase of the study, the 44 remaining nonresponders were randomized to one of six sequences of three 2-week, double-blind, crossover study periods with daily 2 or 3 mg of apomorphine SL, washout, and placebo.

Daily intake of apomorphine improved both arousal and desire with both the 2- and 3-mg doses compared with placebo ( P < .05). The daily 3-mg dose was more effective than the daily 2-mg dose ( P < .05), benefiting all facets of sexual activity and resulting in increased desire, enjoyment, arousal, orgasm, frequency of intercourse, and satisfaction with frequency of intercourse compared with placebo ( P < .001).

"[W]e observed an increase in sexual desire during the daily treatment with apomorphine SL," the authors write. "[I]t could have been an indirect effect of treatment, depending on the improvement of other aspects of the sexual experience, such as arousal, intercourse satisfaction, and/or orgasmic function."

Mild to moderate adverse events occurred mainly with 3 mg of apomorphine, including nausea, vomiting, dizziness, and headache. Subjective acceptance of apomorphine treatment was considered good — 69% of women reported satisfaction with the treatment and were willing to continue it after the study.

"We believe that additional studies in this field are needed to establish which subgroups of premenopausal women with sexual dysfunction could be expected to benefit from [apomorphine SL] use," the authors write, adding that further studies may explore the efficacy of the drug in postmenopausal women as well.

The authors reported no pertinent financial interest in this study.

Urology. 2004;63:955-959

Reviewed by Gary D. Vogin, MD

Yael Waknine is a freelance writer for Medscape.

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