AFJOG

REVIEW Table 1: Medical conditions that can impact sexual function References 3,18 Desire/Arousal Coronary artery disease Diabetes Mellitus Hypertension Hypothyroidism Maligancies and treatment Neurmuscular disorders, spinal cord injuries, multiple sclerosis Parkinsons Urinary incontince Orgasm Hypothyroidism Maligancies and treatment Neurmuscular disorders, spinal cord injuries, multiple sclerosis Pain Arthritis Urinary incontinence Maligancies and treatment Dermatological conditions, lichen sclerosis, vulvar eczema Gynaecological conditions (eg, sexual transmitted infections, endometriosis, pelvic organ prolapse) Neurmuscular disorders, spinal cord injuries, multiple sclerosis Table 2: Medications associated with female sexual dysfunction References 15 Desire/Arousal Anticholinergics Hormonal Preparations Antiandrogens Hormonal contraceptives Tamoxifen Antihistamines Cardiovascular and antihypertensives Antilipids Betablockers Clonidine Digoxin Spironolactone Monoamine oxidase inhibitors Trazadone Venlofaxine Psychotropics Antipsychotics Barbiturates Benzodiazapine Lithium Selective serotonin reuptake inhibitors Other Aromatase Inhibitors Chemotherapeutic agents Orgasmic disorder Amphetamines and related anorectic medications Hormonal Preparations Antiandrogens Cardiovascular and antihypertensives Clonidine Digoxin Narcotics Psychotropics Antipsychotics Barbiturates Lithium Selective serotonin reuptake inhibitors Tricyclic antidepressants Various assessment tools have been developed to evaluate different aspects of sexual function in women. One commonly used tool is the Female Sexual Function Index (FSFI), which measures sexual function across six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. 16 The FSFI has been shown to have good psychometric properties and is useful for assessing female sexual dysfunction. 17 In addition to self-report measures, clinical interviews and medical examinations are important components of the assessment process. These allow healthcare providers to gather detailed information about a woman's sexual history, identify any underlying medical conditions or medications that may contribute to sexual dysfunction, and assess for any psychological factors that may be influencing sexual function. 18 MANAGEMENT OF FEMALE SEXUAL DYSFUNCTIONS The management of FSD requires a comprehensive and individualized approach that addresses both the physical and psychological aspects of sexual function. Treatment options may vary depending on the specific type of FSD and its underlying causes. The potential use of central nervous system medications to treat FSD arises from laboratory and clinical studies suggesting the role of some neurotransmitters in the activation and/or deactivation of brain areas affecting sexual response. 14 For sexual desire disorders such as HSDD, pharmacological interventions such as Flibanserin, a novel non-hormonal therapy, initially developed as an antidepressant medication has been shown to be effective in premenopausal and postmenopausal women. 19,20 Extensive clinical research demonstrated statistically and clinically significant improvement in the number of satisfying sexual events, level of sexual desire, and decrease of distress compared with placebo after 24 weeks and up to 52 weeks in open-label extensions. 21–23 Unfortunately, Flibanserin has not been registered for use in South Africa. The antidepressant bupropion, a compound with dopamine and norepinephrine reuptake inhibition and no direct serotoninergic effect, has shown a mild to moderate pro-sexual effect. Research indicate that bupropion has significant effects on increasing measures of sexual arousal, orgasm completion, and sexual satisfaction and can be considered as a treatment option for HSDD as well as FSAD. 19,24 Testosterone has been explored as a potential treatment for FSD, particularly in HSDD and FSAD. The use of testosterone in managing FSD has been a topic of debate and investigation. Several studies have examined the effect of testosterone therapy on female sexual function, but the evidence is still limited and controversial. Some studies suggest that testosterone therapy, particularly transdermal testosterone, may have a positive effect on sexual desire in postmenopausal women with FSD. 25 Testosterone has been used for decades in women to treat FSD, and it is frequently prescribed off-label for the treatment of low libido in postmenopausal women. 26 The Brazillian Society of Endocrinology and Metabolism suggests that testosterone may have positive effects on sexual desire, although the effect size is small. 27 The safety and long- African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 2 | 2023 | 12