Fast Five Quiz: Sexual Dysfunction

Bradley Schwartz, DO; Michel E. Rivlin, MD

Disclosures

August 12, 2019

In general, the initial goal of therapy for female orgasmic disorder is to enable the patient to reach orgasm as desired under any circumstance. Evidence about the effectiveness of psychoanalytically or psychodynamically oriented therapies in attaining this goal is inconclusive. One meta-analysis, however, found good evidence for benefit in female orgasmic disorder.

At present, no medication has been specifically approved by the FDA for the treatment of female orgasmic disorder. In addition, very little information is available about pharmacotherapy specifically targeting disorders of orgasm in women, and it is unclear to what extent pharmacologic data on the treatment of sexual conditions in other female populations (eg, female sexual interest/arousal disorder, premenopausal and postmenopausal problems, and antidepressant-induced sexual disorders) are relevant for this population.

Bupropion has emerged as an alternative treatment for female orgasmic disorder, mostly because case reports and case series indicate that bupropion might improve low libido secondary to depression or antidepressant-induced sexual dysfunction. In the case of SSRI-treated depression with persistent low libido levels, either using bupropion as an augmenter or switching to bupropion can raise the libido above predepression levels.

In a 4-month, double-blind, multiple-site, escalating-dose, randomized, placebo-controlled trial of idiopathic, acquired, and global hypoactive sexual desire disorder, sustained-release bupropion was superior to placebo. Further research with double-blind, randomized, placebo-controlled study designs is indicated to study the direct effectiveness of bupropion in managing female orgasmic disorder.

Recently, the FDA approved bremelanotide for use in premenopausal women with hypoactive sexual desire disorder (HSDD). Bremelanotide and flibanserin are the only FDA-approved treatments for HSDD in premenopausal women.

Certain medications, including some antidepressants, antipsychotics, antihistamines, and blood pressure medications, may inhibit orgasm in women.

Read more about female orgasmic disorder.

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