• Estrogen Replacement Therapy: This treatment is indicated in menopausal women (either spontaneous or surgical). Aside from reliving hot flashes, preventing osteoporosis, and lowering risk of heart disease, estrogen replacement results in improved clitoral sensitivity, increased libido, and decreased pain during intercourse. Local or topical estrogen application relieves symptoms of vaginal dryness, burning, and urinary frequency and urgency. In menopausal women, or oophorectomized women, complaints of vaginal irritation, pain or dryness, can be relieved with topical estrogen cream. A vaginal estradiol ring (Estring) is now available that delivers low-dose estrogen locally, which may benefit breast cancer patients and other women unable to take oral or transdermal estrogen25.
• Methyl Testosterone: This treatment is often used in combination with estrogen in menopausal women, for symptoms of inhibited desire, dyspareunia, or lack of vaginal lubrication. There are conflicting reports regarding the benefit of methyl testosterone and/or testosterone cream for treatment of inhibited desire and/or vaginismus in pre-menopausal women. Potential benefits of this therapy include increased clitoral sensitivity, increased vaginal lubrication, increased libido, and heightened arousal. Potential side effects of testosterone administration, either topical or oral, include weight gain, clitoral enlargement, increased facial hair, and high cholesterol
• Sildenafil: This medication, commonly known as Viagra, serves to increase relaxation of clitoral and vaginal smooth muscle and blood flow to the genital area7. Sildenafil may prove useful alone or possibly in combination with other vasoactive substances for treatment of female sexual arousal disorder. Clinical studies evaluating safety and efficacy of this medication in women with sexual arousal disorder are in progress. Several studies are already published demonstrating efficacy of sildenafil for treatment of female sexual dysfunction secondary to SSRI use.20,23 Another study was recently published describing subjective effects of sildenafil in a population of post-menopausal women.26
• L-arginine: This amino acid functions as a precursor to the formation of nitric oxide, which mediates relaxation of vascular and non-vascular smooth muscle. L-arginine has not been used in clinical trials in women; however preliminary studies in men appear promising. The standard dose is 1500mg/day.
• Phentolamine (Vasomax): Currently available in an oral preparation, this drug causes vascular smooth muscle relaxation and increases blood flow to the genital area. This drug has been studied in male patients for the treatment of erectile dysfunction. A pilot study in menopausal women with sexual dysfunction demonstrated enhanced vaginal blood flow and improved subjective arousal with the medication.
• Apomorphine: Initially designed as an anti-parkinsonian agent, this short acting medication facilitates erectile responses in both normal males and males with psychogenic erectile dysfunction, as well as males with medical impotence. Data from pilot studies in men suggests that dopamine may be involved in the mediation of sexual desire as well as arousal. The physiologic effects of this drug have not been tested in women with sexual dysfunction, but it may prove useful either alone or in combination with vasoactive medications. It will be delivered sublingually.

The ideal approach to female sexual dysfunction is a collaborative effort between therapists and physicians. This should include a complete medical, and psychosocial evaluation, as well as inclusion of the partner or spouse in the evaluation and treatment process. Although there are significant anatomic and embryologic parallels between men and women, the multifaceted nature of female sexual dysfunction is clearly distinct from that of the male.

The context in which a woman experiences her sexuality is equally if not more important than the physiologic outcome she experiences, and these issues need to be determined prior to beginning medical therapies or attempting to determine treatment efficacies. Whether Viagra or other vasoactive agents are demonstrated to be predictably effective in women remains to be seen. At very least, discussions such as this will hopefully lead to heightened interest and awareness as well as more clinical and basic science research in this area.