Davis Susan R, Guay André T, Shifren Jan L, Mazer Norman A
NHMRC Centre of Clinical Research Excellence, The Jean Hailes Foundation and Monash University, Clayton, Vic, Australia.
J Sex Med. 2004 Jul;1(1):82-6. doi: 10.1111/j.1743-6109.2004.10112.x.
Various endogenous hormones, including estrogen, testosterone, progesterone and prolactin, may influence female sexual function.
To provide recommendations for the diagnosis and treatment of women with endocrinologic sexual difficulties.
The Endocrine Aspects of Female Sexual Dysfunction Committee was part of a multidisciplinary International Consultation. It included four experts from two countries and several peer reviewers.
Expert opinion was based on committee discussion, a comprehensive literature review and evidence-based grading of available publications.
The impact of hormones on female sexual function and their etiological roles in dysfunction is complex. Research data are limited as studies have been hampered by lack of precise hormonal assays and validated measures of sexual function in women. Sex steroid insufficiency is associated with urogenital atrophy and may also adversely affect central sexual thought processes. Systemic estrogen/estrogen progestin therapy alleviates climacteric symptoms but there is no evidence that this therapy specifically improves hypoactive sexual desire disorder (HSDD) in premenopausal or postmenopausal women. Exogenous testosterone has been shown in small randomized controlled trials (RCT) to improve sexual desire, arousal and sexual satisfaction in both premenopausal and postmenopausal women. However, as there is no biochemical measure that clearly identifies who to treat, use of exogenous testosterone should be considered only after other causes of HSDD have been excluded, such as depression, relationship problems and ill health. The clinical assessment of HSDD should include detailed medical, gynecologic, sexual and psychosocial history and physical examination including the external/internal genitalia. Hormonal therapy should be individualized and risks/benefits fully discussed, and all treated women should be carefully followed up and monitored for therapeutic side effects.
There is a need for prospective, multi-institutional clinical trials to define safe and effective endocrine treatments for female sexual dysfunction.
包括雌激素、睾酮、孕酮和催乳素在内的多种内源性激素可能会影响女性性功能。
为患有内分泌性性功能障碍的女性提供诊断和治疗建议。
女性性功能障碍的内分泌问题委员会是多学科国际咨询的一部分。它包括来自两个国家的四名专家和几名同行评审员。
专家意见基于委员会讨论、全面的文献综述以及对现有出版物的循证分级。
激素对女性性功能的影响及其在性功能障碍中的病因学作用很复杂。由于缺乏精确的激素检测方法和经过验证的女性性功能测量方法，研究受到了阻碍，研究数据有限。性类固醇不足与泌尿生殖系统萎缩有关，也可能对中枢性性思维过程产生不利影响。全身雌激素/雌激素孕激素疗法可缓解更年期症状，但没有证据表明这种疗法能特异性改善绝经前或绝经后女性的性欲减退障碍（HSDD）。在小型随机对照试验（RCT）中已表明，外源性睾酮可改善绝经前和绝经后女性的性欲、性唤起和性满意度。然而，由于没有明确的生化指标来确定哪些人需要治疗，只有在排除HSDD的其他原因，如抑郁、人际关系问题和健康状况不佳之后，才应考虑使用外源性睾酮。对HSDD的临床评估应包括详细的医学、妇科、性和社会心理病史以及体格检查，包括外部/内部生殖器检查。激素治疗应个体化，并充分讨论风险/益处，所有接受治疗的女性都应仔细随访并监测治疗副作用。
需要进行前瞻性、多机构的临床试验，以确定治疗女性性功能障碍安全有效的内分泌治疗方法。
