Results are promising but long-term safety remains uncertain
Hypoactive sexual desire disorder (HSDD; loss of desire that causes personal distress)1 is common, with proposed prevalences ranging between 8% and 50% (wide variation is due to differences among populations surveyed and questionnaires used).2,3 Women with HSDD have been observed to experience poor sexual self-image, feelings of unattractiveness, fear of disappointing their partners, depression, anxiety and diminished quality of life.4,5 The effect of HSDD on quality of life has been reported as similar in magnitude to the effect of other common chronic conditions, such as diabetes and back pain.5 Furthermore, both men and women reporting a discrepancy between their own and their partner’s sexual desire have lower relationship satisfaction,6 and individuals in sexually inactive marriages report less marital happiness.7 Thus, HSDD merits recognition and intervention. In many cases, counselling and general sex education are helpful. However, the proportion of postmenopausal women who continue to experience HSDD despite good clinical care are left with few options, as there are no approved therapies presently available for this condition.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: APA, 1994.
- 2. Laumann E, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 531-544.
- 3. Hayes RD, Dennerstein L, Bennett CM, Fairley CK. What is the “true” prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact? J Sex Med 2008; 5: 777-787.
- 4. Potter JE. A 60-year-old woman with sexual difficulties. JAMA 2007; 297: 620-633.
- 5. Biddle AK, West SL, D’Aloisio AA, et al. Hypoactive sexual desire disorder in postmenopausal women: quality of life and health burden. Value Health 2009 Jan 12 [Epub ahead of print].
- 6. Davies S, Katz J, Jackson JL. Sexual desire discrepancies: effects on sexual and relationship satisfaction in heterosexual dating couples. Arch Sex Behav 1999; 28: 553-567.
- 7. Brezsnyak M, Whisman MA. Sexual desire and relationship functioning: the effects of marital satisfaction and power. J Sex Marital Ther 2004; 30: 199-217.
- 8. Davis SR, Moreau M, Kroll R, et al. Testosterone for low libido in menopausal women not taking estrogen. N Engl J Med 2008; 359: 2005-2017.
- 9. Schover LR. Androgen therapy for loss of desire in women: is the benefit worth the breast cancer risk? Fertil Steril 2008; 90: 129-140.
- 10. Goldstat R, Briganti E, Tran J, et al. Transdermal testosterone therapy improves mood, well-being and sexual function in premenopausal women. Menopause 2003; 10: 390-398.
- 11. Davis SR, Papalia MA, Norman RJ, et al. Safety and efficacy of a testosterone metered-dose transdermal spray for treatment of decreased sexual satisfaction in premenopausal women: a randomized trial. Ann Intern Med 2008; 148: 569-577.
- 12. Tamimi RM, Hankinson SE, Chen WY, et al. Combined estrogen and testosterone use and risk of breast cancer in postmenopausal women. Arch Intern Med 2006; 166: 1483-1489.
- 13. Jick SS, Hagberg KW, Kaye JA, Jick H. Postmenopausal estrogen-containing hormone therapy and the risk of breast cancer. Obstet Gynecol 2009; 113: 74-80.
- 14. Dimitrakakis C, Jones R, Liu A, Bondy CA. Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy. Menopause 2004; 11: 531-535.
- 15. Davis SR, Wolfe R, Farrugia H, et al. The incidence of invasive breast cancer among women prescribed testosterone for low libido. J Sex Med 2009 Apr 24 [Epub ahead of print].
I was the principal investigator for APHRODITE. I have been a consultant to Acrux Australia, Procter and Gamble Pharmaceuticals, Novartis Oncology and AstraZeneca. I have received unrestricted research grants from Procter and Gamble Pharmaceuticals, Bayer Schering, Novartis Oncology and AstraZeneca. I have received honoraria from Organon and Bayer Schering.