Female Sexual Desire, Arousal, and Orgasmic Dysfunctions: A Systematic Review and Meta-Analysis of Treatment Options.
This systematic review and meta-analysis examined treatments for female sexual desire, arousal, and orgasmic (DAO) dysfunction, explicitly excluding patients with sexual pain conditions. Researchers searched six major databases through December 2024, screening 8,994 abstracts and ultimately including 36 studies (26 RCTs and 10 single-arm trials). Treatments evaluated included cognitive behavioral therapy (CBT, 10 studies), medications (24 studies), and devices (2 studies). Meta-analyses were feasible for three interventions: mindfulness-based CBT, flibanserin, and bremelanotide, all assessed using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS). The study found that mindfulness-based CBT was associated with significant improvements in total FSFI and DAO subscales; flibanserin was associated with improvements in total FSFI and the desire subscale; and bremelanotide was associated with improvements in total FSFI and both the desire and arousal subscales. All three treatments were associated with reduced sexual distress. Key limitations include the absence of direct head-to-head comparisons between CBT and pharmacotherapy, heterogeneous terminology across studies, varying outcome measures, and insufficient data to draw conclusions about most other treatments reviewed.