For treatment of ...

Desire disorder:

• Testosterone preparations: patches, gels and intranasal;
• Estrogen receptor antagonist: oral; estrogen/testosterone preparations: patches;
• Dopamine agonists: sublingual, oral, and intranasal.
  
  

Arousal disorder:

• Eros (marketed): device;
• estrogen/testosterone cream; (Estratest/Estrace, marketed but not for this indication, in testing)
• Arginmax (marketed): oral;
• Zestra (marketed): topical;
• alpha adrenergic antagonist: phentolamine: oral and suppository;
• sildenafil (Viagra, marketed but not for this indication, in testing): oral;
• arginine/yohimbine: elixir;
• dopamine agonists: oral, sublingual, and intranasal;
• melanocyte stimulating hormone analog: intranasal;
• estrogen/testosterone: patch
• transcutaneous nerve stimulation: device;
• nitroglycerine: topical;
• prostaglandins: topical.
  
  

Orgasm disorder:

Not enough is known at this time about mechanisms to warrant product testing. Some researchers are exploring the serotonin pathways given the evidence of SSRI antidepressants in suppressing orgasms. Other researchers believe orgasm disorder is subsequent to one or more of the other disorders.

Pain disorders:

• Nitroglycerine: topical;
• Amitryptiline: oral;
• Transcutaneous nerve stimulation: device;
• Desensitizing agents: topical.
  

Many products are offered commercially that contain nutritional substances and/or herbs. Since almost all drug can trace their origins to plants, it is reasonable to assume that some of these substances may be effective. However, one cannot accept the claims made for these products unless well-controlled clinical trials support those claims. Problems associated with herbals and nutriceuticals include insufficient content, mislabeled contents, inconsistent manufacturing controls, absent or insufficient assay of active ingredients, and absent or insufficient data on stability. If all of these obstacles can be overcome, then well-designed, adequately controlled clinical trials could be initiated to test the effectiveness of these preparations. The placebo effect in sexual dysfunction trials can be enormous: 30-50%. Thus, all studies must have placebo controls.

Another aspect of clinical trials is assessment of adverse events, commonly called safety testing. Many of the commercially available topical preparations that have not been clinically tested employ irritants such as menthol or orange oil to create a warming, tingling sensation in the genitalia. No data have been presented regarding the chronic safety of applying skin irritants to these sensitive tissues.

Some topicals claim to employ the nitric oxide pathway (made famous by Viagra) in their action because they have included arginine in their formulations. This is bunk. Arginine cannot permeate the skin or mucous membranes because of its high polarity. The only effect that topical arginine can have is irritation because of its pH.

Women who seek treatments for their FSD should be skeptical of claims made for any product. They should ask whether the actual promoted product has been proven in a randomized, placebo-controlled, double-blinded clinical trial. Is the product manufactured with proper controls? What are the safety issues? Are there potentially dangerous drug interactions? Are the storage conditions and shelf life adequately described?