LESLIE SCHOVER, PH.D., AND ANDREA BRADFORD, PH.D.
Women frequently ask physicians or sex therapists for a pill to increase sexual desire. Low sexual desire is the most common sexual problem in women and one of the top sexual complaints among cancer survivors.
So far, the promise of a quick fix for low desire remains unfulfilled. In this post we discuss some medications touted as "performance enhancers."
Viagra for women: why not?
Drugs to treat men's erection problems work by increasing blood flow to the penis. Sexual arousal in women also involves increased genital blood flow.
However, in clinical trials, erectile dysfunction drugs (e.g., Viagra and Cialis) offered no more relief than a placebo to women who lacked physical excitement during sex. Since most women in these studies also had little interest in sex, better blood flow would be unlikely to help.
Recently, drug developers have turned their attention to sexual desire problems.
Often touted as the "libido hormone," testosterone is prescribed for an increasing number of women with low desire. Testosterone levels in women's bloodstreams are very low, so much so that we are unsure where the "normal" range begins. Large studies have not found a clear link between women's testosterone levels and sexual desire.
Clinical trials of Intrinsa®, a testosterone patch for women, showed at best a modest effect on women's sexual desire. In 2005, the U.S. Food and Drug Administration voted not to approve the patch.
Also, several studies have linked higher testosterone levels to a higher risk of breast cancer.
Estrogen Estrogen does not act directly on sexual desire, but it can relieve vaginal dryness and pain that cause some women to avoid sex.
The risks of estrogen replacement after menopause in cancer survivors are controversial. Studies have linked estrogen use after menopause to breast cancer, but some scientists believe the dangers have been exaggerated. Long-term safety studies will eventually answer these questions.
Low-dose vaginal estrogen in the form of a ring, patch or cream works well to manage dryness and pain. Vaginal estrogen may have fewer health risks than estrogen pills or patches that result in higher estrogen levels in the bloodstream. So-called "bioidentical" hormones are no safer than other forms.
Herbal and nutritional supplements
The promise of a "natural" treatment for sexual problems is appealing, but supplements like Gingko biloba, ginseng and yohimbine have not worked in clinical trials.
A recent fad is to give women DHEA, a hormone that is changed by the body into testosterone after menopause. DHEA in pill form does not improve women's sexual function. A new, vaginal form needs further research.
DHEA is available over the counter as a nutritional supplement, but safety remains a concern, especially for cancer survivors. Over-the-counter product quality can also be very inconsistent.
Placebo (sugar pill)
We're joking, right? Not entirely. Studies have shown that a placebo can improve sexual function in a large percentage of women.
Clearly, many cancer treatments do physical damage that can affect women's sexual function. However, placebo research suggests that a woman's expectations of help can positively influence her sex life.
Loss of desire for sex after cancer treatment is a complex problem, often with more than one cause. Sexual counseling can help many women or couples to overcome problems after cancer. In our next post, we will discuss strategies for reviving your sex life without medication.