Kadın cinsel fonksiyon bozukluklarında kanıta dayalı tedavi seçenekleri

Kadın cinsel fonksiyon bozukluğu; “istek, uyarılma, orgazm ve çözülme dönemlerinden oluşan cinsel yanıt döngüsünün bozulması ve/veya cinsel ilişki sırasında ağrı duyulması” olarak tanımlanmaktadır. Diagnostic and Statistical Manual of Mental Disorders V’te cinsel istek/uyarılma bozukluğu, kadın orgazm bozukluğu ve genitopelvik ağrı/penetrasyon bozukluğu şeklinde sınıflandırılmaktadır. Tedavide bu alanları hedef alacak şekilde planlanmaktadır. Kanıta dayalı tedaviler, tedaviye karar verirken en iyi kanıtların, dikkatli, açık ve akıllıca kullanılması esasına dayanan uygulamalardır. Bu kapsamda günümüzde kadın cinsel fonksiyon bozukluklarında kanıta dayalı tedaviler son derece sınırlıdır. Hipoaktif cinsel istek bozukluğunda FDA onaylı tek ilaç flibanserindir. Postmenopozal genito-üriner sendroma bağlı disparoni için FDA onaylı birkaç ürün vardır. Kadınlarda cinsel uyarılma ve/veya orgazm bozuklukları için onaylanmış farmasötik bir ürün yoktur. Halen kadın cinsel işlev bozukluğunu hedef alan tedavilerin çoğu ilaçların endikasyon dışı kullanımları şeklindedir.

Evidence-based therapy options for female sexual dysfunction

Female sexual dysfunction is defined as disruption of the sexual response cycle consisting of desire, arousal, orgasm and resolution and/or pain during sexual intercourse. Female sexual dysfunction is classified as female sexual interest or arousal disorder, female orgasmic disorder and genitopelvic pain or penetration disorder in DSM V. The treatment is planned to target these areas. Evidence-based therapies are based on the careful, clear and wise use of the best evidence when deciding treatment. In this context, evidence based therapies in female sexual dysfunction are extremely limited. The only FDA approved drug in hypoactive sexual desire disorder is flibanserin. There are several FDA approved products for the dyspareunia associated with postmenopausal genito-urinary syndrome. There is no pharmaceutical product approved for sexual arousal and/or orgasmic disorders in women. Most of the treatments currently targeting female sexual dysfunction are off-label use.

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