What is alprostadil cream?

Alprostadil cream is a prostaglandin E1 cream that has been used in the past in men for the treatment of erectile dysfunction, but is not FDA-approved for the treatment of female sexual dysfunction. However, this topical medication in the form of a compounded cream can be applied to the pelvic genital area twice a day in women and acts assumedly by relaxing arterial smooth blood vessels, causing vasodilatation and increased sensitivity and sexual arousal. NexMed pharmaceutical company is conducting advanced randomized clinical trials with this cream with the intention of making it widely available in the United States sometime in the near future under the brand name Femprox.

A similar product is under investigation by Vivus under the name of Alista. There have been some stage 2 clinical trials. In a double-blind trial, 400 women with Female Sexual Arousal Disorder (FSAD) aged 21 to 65 years were randomized to receive a 10-dose at-home treatment of500, 700, or 900 mg of alprostadil cream or a placebo cream. They were instructed to apply the cream to their clitoris and G-spot. More than 370 patients completed the study, and many showed significant improvement in sexual arousal. Possible side effects include pain to the genitals (which was decreased as the cream was washed away), lowered blood pressure, and possible temporary fainting (syncope). Alprostadil cream should be topically applied approximately 15 minutes before engaging in intercourse.

What is apomorphine?

Apomorphine is a medication that has been used sublingually for the treatment of male sexual health concerns. It is sometimes considered an alternative to the phosphodiesterase inhibitors. In a recent Journal of Sexual Medicine article, Bechara and associates published an excellent although small study titled "A Double-Blind Randomized Placebo Control Study Comparing the Objective and Subjective Changes in Female Sexual Response Using Sublingual Apomorphine." This small study attempted to show the effect of 3 mg of apomorphine with respect to subjective or objective changes in the female response cycle in those women who were diagnosed with orgasmic problems and those having difficulty reaching orgasm.

This study demonstrates that clitoral blood flow changes in peak velocity were significantly higher in the subjects who took the medication, which theoretically translates into better pelvic blood flow. This phenomenon, when considered in a broader light, would mean changes in arousal and lubrication. These areas were also significantly improved in the apomorphine group.

The researchers concluded that this medication was beneficial for women with orgasmic problems or difficulties in the domains of subjective and objective complaints. They also propose an anatomic mechanistic model of the function and result of the drug. The side effects and adverse events were low in incidence and mostly mild and also transient. Although this study had very small numbers, many sexual healthcare professionals are optimistic because the medication is provocative and warrants further rigorous study for the treatment of female sexual complaints. It is presently not available for prescription to female sexual health patients, but studies are ongoing.

How can the antidepressant bupropion (Wellbutrin) be helpful to my sexual health?

Bupropion is a nonserotonin reuptake inhibitor antidepressant dopamine agonist that has recently been touted as the medication for depression treatment with the least sexual side effects. This medication is a weak blocker of the uptake of the brain chemicals serotonin and norepinephrine and is commonly used in smoking-cessation programs. A typical trial of this medication includes a starting dose of 75 mg that can be increased gradually. Precautions and possible side effects include insomnia, nervousness, and mild to moderate increases in blood pressure as well as a risk of lowering seizure threshold.

Seagraves and Dr. Anita Clayton published a study titled "Bupropion Sustained Release for the Treatment of Hypoactive Sexual Desire in Premenopausal Women" in the Journal of Clinical Psychopharmacology. This was a landmark study that examined women with idiopathic acquired or global hypoactive sexual desire disorder in a randomized placebo controlled trial with escalating dose of bupropion. All measures indicated increased sexual responsiveness, and changes in the Sexual Function Questionnaire demonstrated increased sexual arousal, orgasmic completion, and sexual satisfaction. The researchers propose a mechanism by which the medication operates and causes positive sexual effects by acting on the dopamine and norepinephrine pathways. The concepts that this medication acted centrally or in the brain were reinforced, and it did improve sexual functioning and desire in many women.

There are minimal side effects, and most women can tolerate this medication. It has been used extensively by sexual medicine healthcare providers off-label for complaints of low desire. It is also used in breast cancer patients who suffer from lowered libido. This already FDA-approved medication (for another indication), which acts centrally, warrants further detailed study as a possible treatment for sexual desire complaints in women.

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