A Systematic Review of Randomized Controlled Trials Investigating the Efficacy and Safety of Testosterone Therapy for Female Sexual Dysfunction in Postmenopausal Women

Channa N. Jayasena; Fatima M. Alkaabi; Curtis S. Liebers; Thomas Handley; Stephen Franks; Waljit S. Dhillo


Clin Endocrinol. 2019;90(3):391-414. 

In This Article

The Diagnosis and Prevalence of Sexual Dysfunction in Menopausal Women

A number of previous studies have investigated the prevalence of sexual dysfunction in menopausal women using structured questionnaires. A prospective observational community-based study of Australian born women aged 45-55 observed that the prevalence of sexual dysfunction using the McCoy Female Sexuality Questionnaire rose from 42% at early menopause to 88% at late menopause defined by hormone testing.[30] Furthermore, cross-sectional studies using the Female Sexual Function Index (FSFI) in postmenopausal, sexually active Malaysian and Thai women suggest that the prevalence of sexual dysfunction is 89.0% and 82%, respectively.[31,32] The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a strict set of diagnostic criteria for sexual dysfunction. The previous edition (DSM-4) classified reduced libido in men or women as a form of hypoactive sexual desire disorder (HSDD). However, the newer DSM-5 classification has split HSDD into gender-specific diagnoses; female sexual interest/arousal disorder is defined as symptoms including absent or significantly reduced interest in sexual activity, sexual thoughts or fantasies, and reduced initiation of sexual activity absent arousal from external sexual/erotic cues.[33] These symptoms need to have persisted for a minimum duration of 6 months, be significant enough to cause distress to the individual, and not be attributable to other mental or physical health conditions. The Women's International Study of Health and Sexuality (WISHeS) analysed the prevalence of sexual symptoms associated with distress in over 3500 women aged 20-70 years in the United States; the prevalence of HSDD was reported as 12%-19% in the United States and 6%-13% in Europe.[34] Therefore, the prevalence of HSDD defined using strict DSM-5 criteria is much lower than the prevalence of sexual dysfunction estimated using the structured questionnaire tools. However, there has been criticism of the DSM-V criteria among experts (McCabe 2016). An alternative classification system for female sexual dysfunction has been produced by the International Society of Sexual Medicine (McCabe 2016) and is summarized in Table 1.[35]