Female sexual response: the role of drugs in the management of sexual dysfunction

A large component of women's sexual desire is responsive rather than spontaneous. Therefore, women's motivation and ability to find and respond to sexual stimuli to experience sexual arousal and subsequent sexual desire is crucial, but complex. In ongoing relationships, a woman's motivation appears to be largely influenced by her emotional intimacy with her partner and her wish to enhance it. Drugs (including androgen replacement therapy) aimed at increasing women's spontaneous sexual wanting (less characteristic of women in long-term relationships) or their arousability may have a role if other psychologic factors affecting arousability are addressed in tandem. A woman's sexual arousal is composite and complex, correlating well with how mentally exciting she finds the sexual stimulus and its context and poorly with objective genital blood flow changes. Drugs aimed at increasing the latter, including phosphodiesterase inhibitors, may have a role if there is prior careful enquiry as to whether genital engorgement is present but not attended to or is physically absent. Psychophysiologic studies to date suggest the former is common in women presenting with arousal disorder.