Fast Five Quiz: Female Sexual Interest/Arousal Disorder/Hypoactive Sexual Desire Disorder

Christine Isaacs, MD


April 03, 2019

Medications prescribed to treat FSIAD/HSDD include intravaginal estrogen- and non-estrogen-containing preparations, flibanserin, and testosterone cream. Intravaginal estrogen and non-estrogen preparations decrease the vaginal pH, improve vaginal wall integrity and elasticity, and decrease vaginal sensitivity.

Flibanserin increases sexual arousal by decreasing serotonin levels and increasing dopamine and norepinephrine levels. Flibanserin is FDA-approved for the treatment of HSDD in premenopausal patients. While flibanserin is an effective therapy to treat HSDD in this patient population, there are serious risks associated with this drug. Upon the approval of flibanserin in 2015, the FDA issued a black box warning about the increased risk for severe hypotension and syncope when flibanserin is taken in combination with CYP3A4 inhibitors or alcohol, and in patients with hepatic impairment.

Although testosterone cream has been shown to increase sexual desire in patients with FSIAD/HSDD, its use for FSIAD/HSDD is off-label in the United States and Europe. Currently, Western Australia is the only country to have approved a testosterone replacement product specifically for women.

Sildenafil is currently only approved to treat erectile dysfunction. High-dose SSRI therapy and furosemide are neither effective nor appropriate therapies for FSIAD/HSDD.

For more on pharmacologic management of FSIAD/HSDD, read here.


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