Maria Sophocles, MD: The Lone Female Sexual Dysfunction Therapy


Flibanserin, a once-daily oral drug, is the only marketed therapy for female sexual dysfunction. Are more options needed?

Male sexual dysfunction therapies to have gone through and receive US Food and Drug Administration (FDA) marketing approval significantly outpace those to have been indicated for women—if not just because there is just one drug indicated for female sexual dysfunction.

In an interview with MD Magazine®, Maria Sophocles, MD, medical director of Women's Healthcare of Princeton, detailed the proven benefits and patient stipulations of flibanserin, a once-daily drug she would hope more physicians would advise for female patients in need of sexual therapy.

MD Mag: What is women’s lone option for sexual dysfunction therapy?

Sophocles: So, the only FDA-approved therapy for sexual dysfunction is a once-daily, oral, mixed serotonin agonist and antagonist. It's a little bit confusing how it works, but just remember that sexual function is not only mediated by sex steroid hormones estrogen and testosterone, but also by neurotransmitters dopamine, norepinephrine, and serotonin. Dopamine and norepinephrine tend to promote sexual desire and interest, whereas serotonin tends to reduce it.

So, we know that the prefrontal cortex of the brain has circuits connecting it to the limbic system where pleasure is mediated. And we know that if we can affect the downstream release of norepinephrine and open dopamine and inhibit serotonin, we can hopefully theoretically augment the desire and the interest in sex for women.

This medication is called flibanserin. It was FDA-approved a few years ago, and it has some drawbacks really, but in general it's well tolerated. Getting approval can be tricky, and physicians have to screen for patients who have regular and excessive alcohol use. It can lower blood pressure, and has been shown to lower blood pressure in women who consume large amounts of alcohol on a regular basis.

But I have had patients who have had wonderful response from it. And again: once-a-day pill, easy to use, works by affecting downstream release in the brain of norepinephrine and dopamine.

Hopefully other physicians will give it a try if they uncover female sexual dysfunction, because it doesn't involve a lot of risk, it doesn't involve a lot of education on the patient's part. It's simply a once-a-day pill.

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