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.
Why this grade: The review synthesizes 26 RCTs in human patients using validated outcome measures, but conclusions are limited by heterogeneous terminology, the absence of direct comparative trials between treatment modalities, and insufficient data for most individual therapies beyond the three meta-analyzed.
Objective To conduct a systematic review and meta-analysis of treatments for female sexual desire, arousal, and orgasmic dysfunction in patients without sexual pain conditions. Data source MEDLINE, Embase, Web of Science, Cochrane Library, PsycINFO, and ClinicalTrials.gov. Methods of study selection Following the initial search in December 2024, a total of 8994 abstracts were screened, 278 full-text articles were reviewed, and 36 studies met criteria for data abstraction including a patient population with female sexual dysfunction (FSD) of desire, arousal, and/or orgasm (DAO) and outcome measures including the Female Sexual Function Index (FSFI), its DAO subscales, and the Female Sexual Distress Scale (FSDS). Studies including patients with sexual pain conditions were excluded. Two reviewers independently conducted each phase. Tabulation, integration, and results Of the 36 studies, 26 were RCTs and 10 were single-arm trials. Ten studies evaluated cognitive behavioral therapy (CBT), 24 investigated medication therapy, and 2 investigated devices. Meta-analyses were conducted for mindfulness-based CBT, flibanserin, and bremelanotide. Mindfulness-based CBT significantly improved total FSFI and subscales of desire, arousal, and orgasm. Conversely, flibanserin improved total FSFI and desire while bremelanotide improved total FSFI and its desire and arousal subscales. No studies directly compared CBT to pharmacotherapy. Conclusion In this systematic review of treatments of females with sexual DAO dysfunctions without pain, we found that CBT improves DAO; flibanserin improves desire; and bremelanotide improves both desire and arousal; and all 3 treatments reduce distress. Our findings align with previous literature and expand upon it to include multiple treatment modalities. This broader perspective offers a starting point for clinicians, including gynecologists, who frequently serve as the first point of care for FSD. Conclusions regarding most other treatments could not be drawn due to limited numbers of studies of FSD excluding pain, heterogeneous terminology for DAO disorders, and varying outcome measures across studies.
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