076 Lumping, Splitting, and Treating: Therapies are Needed for Women with Overlapping Sexual Dysfunctions

Phase-specific diagnoses, e.g., Hypoactive Sexual Desire Disorder (HSDD), are the norm in sexual medicine. Epidemiologic surveys (and clinical trials) show the value of this structure for understanding (and treating) pre-menopausal sexual dysfunction. Surveys suggest, however, that most post-menopausal women have sexual dysfunction in >1 phase, e.g., in desire and arousal. We sought to evaluate the evidence for mixed or global sexual dysfunction in women, and their associated comorbidities, and to determine the scope and varieties of such problems and how such women can best be treated. Conduct a literature review of epidemiologic surveys and clinical trials to quantitate overlap in sexual dysfunctions and render conclusions about treatments. Overlap of sexual dysfunctions in women is low to moderate in the pre-menopause but is high in the post-menopause. The available data suggest that post-menopausal clinical trials of women diagnosed with Hypoactive Sexual Desire Disorder actually entered patients with mixed or global sexual dysfunction, and that benefits were pan-phasic rather than concentrated on desire. Whether local/vaginal products for vaginal dryness/involutional changes treat all phases of sexual dysfunction, specifically decreased sexual desire via “intracrinology,” is under study. Women treated for breast or gynecologic cancer are also likely to have mixed or global sexual dysfunction. Treatment options are limited, but mindfulness training and other psychotherapies have some support. Most women taking an antidepressant incur mixed sexual dysfunction. Various strategies may help, such as adding (or switching to) a serotonin (5-HT) 1A receptor agonist (e.g. buspirone, flibanserin), a 5-HT2A receptor antagonist (e.g. flibanserin, trazodone) or a norepinephrine-dopamine reuptake inhibitor (e.g. bupropion). Elimination of hormonal contraception in premenopausal women and the addition of hormonal therapies (systemic/transvaginal; estrogens/androgens) in postmenopausal women may be necessary.