Treatment Options for Female Sexual Dysfunction

Sexual problems are common in women, but it is a topic seldom discussed openly with health care providers. In the U.S., 40 percent of women between the ages of 45-64 have sexual concerns, but only 12 percent of them actually report sexual dysfunction problems to their doctors.

Sexual dysfunction has many causes and multiple factors that can contribute to it. The majority of women with sexual complaints have issues that impact more than one phase of the normal sexual response (desire, arousal and orgasm). Fortunately, there are several compounded options that may be used by these patients.

OXYTOCIN -One option is oxytocin, which is usually referred to as “the love hormone.” It has been researched, studied and effectively used for many medical conditions, including lactation, uterine contractions during labor, social bonding and behavior management in autism, and even wound healing. There are many clinical references available to support the compounded use of the chemical. In the Behnia study, 30 pre- and post-menopausal women with sexual dysfunction were treated with intranasal oxytocin versus placebo. They were given 24 units of intranasal oxytocin 35 minutes prior to sexual activity. The group receiving oxytocin reported increased intensity of orgasm and sexual contentment compared to the placebo group. Both groups reported improved sexual function. In the group of women who also reported depression, the oxytocin group reported improved symptoms versus the placebo group.

The main study also reported similar results. Over the course of eight weeks, intranasal oxytocin (32 IU) or placebo was self-administered by women within 50 minutes of sexual intercourse. Intranasal oxytocin improved sexual function and symptoms of depression in women over time.

Pavilion Compounding Pharmacy has several formulas with oxytocin. Please note that oxytocin is destroyed in the gastrointestinal tract, so topicals and nasal sprays are the best routes of administration. For example:

• Oxytocin 12 Units/0.1mL Nasal Spray• Oxytocin 40 Units/mL Nasal Spray

• Oxytocin 20 Units/Gm Vaginal Cream • Oxytocin 40 Units/Gm Vaginal Cream

DHEA- Another option is dehydroepiandrosterone (DHEA). Anna Cabeca, DO, FACOG, ABAARM, presented on this topic at PCCA’s HRT Symposium in Savannah, Georgia in July 2016.

Citing a published study, she said that “DHEA applied daily, at doses at which serum steroids remain well within normal postmenopausal values, exerts relatively potent, beneficial effects on all four aspects of sexual dysfunction.” She also said that vaginal application of DHEA leads to vaginal maturation without affecting the endometrium while improving well-being and libido with no significant side effects.

Pavilion Compounding Pharmacy has several formulas for vaginal delivery of DHEA. For example:

• Dehydroepiandrosterone 13 mg Base MBK Vaginal Suppository •Dehydroepiandrosterone 6.5 mg Base MBK Vaginal Suppository •Dehydroepiandrosterone 3.25 mg Base MBK Vaginal Suppository •Dehydroepiandrosterone 13 mg/Gm Vaginal Gel Mucolox/Versabase

For more compounding ideas related to patients experiencing female sexual dysfunction and low libido, please contact us and one of our pharmacists will be happy to review.

For questions, please contact our pharmacists at 404-350-5780 or by e-mail staff@pavilionrx.com

REFERENCES

1 Shifren, J.L., Monz, B.U., Russo, P.A., Segreti, A., & Johannes, C.B. (2008). Sexual problems and distress in United States women: prevalence and correlates. Obstetrics & Gynecology, 112(5), 970-978. doi:10.1097/AOG.0b013e3181898cdb

2 Behnia, B., Heinrichs, M., Bergmann, W., Jung, S., Germann, J., Schedlowski, M., . . . Kruger, T.H. (2014). Differential effects of intranasal oxytocin on sexual experiences and partner interactions in couples. Hormones and Behavior, 65(3), 308-318. doi:10.1016/j. yhbeh.2014.01.009

3 Muin, D.A., Woltz, M., Marculescu, R., Sheikh Rezaei, S., Salama, M., Fuchs, C., . . . Bayerle-Eder, M. (2015). Effect of long-term intranasal oxytocin on sexual dysfunction in premenopausal and postmenopausal women: a randomized trial. Fertility and Sterility, 104(3), 715-723. doi:10.1016/j.fertnstert.2015.06.010

4 Cabeca, A. (2016). Vaginal health, sexual health & relationships [PowerPoint Slides]. PCCA HRT Symposium, Savannah, Georgia.

5 Consultant’s Corner By Jane H. Jones, RPh, PCCA Pharmacy Consultant September 2016 Apothagram