Female-Centered Medical Approach: Estrogens, Flibanserin,

Local Estrogen Therapy and Dehydroepiandrosterone in Vaginal Health

Medical intervention in women’s sexual health encompasses the therapeutic management of conditions associated with menopausal genitourinary syndrome and vulvovaginal atrophy.

The administration of local estrogen therapy via microdoses represents an ideal strategy for restoring the trophism and vascularization of genital tissues.

This route of administration includes clinical formulations such as creams, tablets, vaginal suppositories, and sustained-release rings.

By acting strictly locally, vaginal estrogen therapy minimizes systemic risks while optimizing blood flow, increasing epithelial thickness, and improving the lubrication response.

As a direct clinical consequence, it reduces dyspareunia, pelvic pain, and the incidence of recurrent urinary tract infections.

Additionally, intravaginal dehydroepiandrosterone acts as an effective local steroid precursor that is metabolized intracrinologically into estrogens and androgens, promoting cellular regeneration and significantly reducing discomfort during penetration.

Pharmacological Treatment of Hypoactive Sexual Desire: Flibanserin and Bremelanotide

The management of hypoactive sexual desire disorder in premenopausal women includes specific pharmacological options that modulate neurotransmitters in the central nervous system.

Flibanserin is a drug taken orally once daily, with a recommended dose of 100 milligrams at bedtime.

Its mechanism combines agonism at 5-HT1A serotonergic receptors and antagonism at 5-HT2A receptors, which reduces serotonergic inhibition and increases the release of dopamine and norepinephrine.

This neurochemical rebalancing stimulates erotic motivation; however, it requires clinical monitoring due to the risk of hypotension and syncope, effects that are intensified by concomitant alcohol consumption.

For its part, bremelanotide offers an on-demand administration option via a 1.75-milligram subcutaneous injection, administered 45 minutes before the anticipated erotic encounter.

As a melanocortin receptor agonist, it promotes the central release of dopamine, enhancing arousal and desire without requiring a continuous dosing regimen.

Both pharmacological treatments expand the therapeutic options for patients with desire dysfunction.

Clinical Use of Vaginal Lubricants and Moisturizers

As a non-hormonal supportive alternative, vaginal lubricants and moisturizers play a key role in the symptomatic management of dryness and pain during intercourse.

Moisturizers applied periodically maintain tissue moisture and restore mucosal trophism, while lubricants are used as needed during sexual intercourse to minimize mechanical friction.

It is essential to recommend water-based or silicone-based formulations, as they ensure full compatibility with mucous membranes and do not compromise synthetic prophylactic barrier methods.