Medications
Because a woman's sexuality encompasses physical, emotional, and psychological factors, the causes of sexual problems are often complex and interrelated. Medications may be used in treating certain conditions that contribute to sexual problems.
Medication Choices
Estrogen. If you only have vaginal dryness and irritation (and not other symptoms such as hot flashes), you can use a limited amount of estrogen in a cream, tablet, or ring in the vagina. The daily estrogen makes your tissue less thin and sensitive and more moist. Many women find that using a cream or tablet twice a week is enough. This may increase vaginal tone and lubrication, which will decrease vulvar dryness, irritation, and shrinkage (atrophy).
If you also have other menopausal symptoms that affect physical and mental well-being, talk to your doctor about taking daily (systemic) estrogen therapy. Estrogen can increase the blood flow in the vagina, as well as reduce hot flashes and other symptoms of menopause. Estrogen therapy or estrogen-progestin therapy can be oral (pills), vaginal, or transdermal (with a patch). In a small number of women, hormone therapy causes heart disease, breast cancer, ovarian cancer, dangerous blood clots, stroke, and dementia. Talk to your doctor about whether this therapy is right for you.
Testosterone. This hormone may play a part in a woman's sex drive and satisfaction. The ovaries make testosterone throughout a woman's lifetime. Women have the most testosterone in early adulthood. Testosterone levels drop by half between the early 20s and the early 40s.
In women who have their ovaries removed (oophorectomy), testosterone drops by 50%.10 If you have had an oophorectomy, your doctor may suggest trying testosterone therapy. But the U.S. Food and Drug Administration (FDA) has not approved any testosterone therapy for women.
What To Think About
The methyltestosterone-estrogen formula called Estratest is not approved by the FDA. The company that makes it markets it for moderate to severe menopausal symptoms. It is also prescribed to some menopausal women to improve sexual desire and response. But Estratest is made with methyltestosterone, which the body uses differently than testosterone. It does not directly raise the amount of testosterone in your body. And taking a testosterone by mouth does put you at risk for problems with your liver and possibly your heart. Using a patch or cream does not.
At this time, there is no testosterone pill, patch, or cream approved for women—those made for men have too high a dose for women. Side effects of too much testosterone include acne, facial hair, and loss of hair and a deepening of the voice, which may be permanent.
No studies have looked at the benefits and risks of taking testosterone for longer than 6 months. The long-term effects of testosterone therapy in women are not known.10
Sildenafil (Viagra) is used to treat erectile dysfunction in men. The maker of this medicine has decided not to market it for improving women's sexual desire and arousal. This was based on research showing that sildenafil was not effective for most women. The maker has commented that women's sexuality is a complex mix of physical, emotional, and relationship factors, and it is not as simple to treat with a medicine as male erectile dysfunction is.11
Currently no medications are approved by the FDA to treat female sexual problems, although several paths are being studied, including stimulation of certain molecules (receptors) in the brain and increasing blood flow to the genitals. It is still too early in the process to know whether any of these medications will prove to be effective and safe treatment options.12
