Efficacy of pharmacological and non-pharmacological interventions on low sexual interest/arousal of peri- and post-menopausal women: a meta-analysis

ABSTRACT

The aim of our study was to investigate the therapeutic efficacy of pharmacological and non-pharmacological interventions on low sexual interest/arousal of peri- and post-menopausal women. In this systematic review and meta-analysis, randomized clinical trials (RCTs) that published up to 22 June 2016 were retrieved from several online electronic databases, including Cochrane Library, PubMed, Ovid, Scopus, Medline, CINHAL, and EBSCO. Fifty-seven studies were included in the meta-analysis. The results showed that both pharmacological interventions (mean difference (MD) = –0.86, 95% confidence interval (CI) = –1.49 to –0.90, p = 0.0001) and non-pharmacological interventions (MD = –0.92, 95% CI = –1.35 to –0.49, p = 0.0001) had statistically significant effects on improving sexual interest/arousal. Among pharmacological interventions, hormone therapy with dehydroepiandrosterone, testosterone, tibolone and estrogen in combination with progesterone, estrogen in combination with testosterone as well as estrogen in combination with progesterone and testosterone were found to be effective. Non-hormonal medications including flibanserin and sildenafil as well as herbal medicines were also shown to be effective. However, due to high heterogeneity of the findings and scarcity of the studies in certain domains, there is uncertainty of their true effect. So, further well-designed RCTs with larger samples are required to ascertain the long-term effects of studies.

KEYWORDS:

• Low sexual interest/arousal
• menopausal women
• pharmacological intervention
• non-pharmacological intervention
• meta-analysis

Acknowledgment

This study is a part of Z. Javadivala's PhD dissertation. We would like to thank the Vice-Chancellor of Research and the Research Centre of Psychiatry and Behavioral Science of Tabriz University of Medical Sciences for the financial support. As well as the authors would like to thank Zahrar Fathifar, the Medical Librarian for his collaboration on finding full text of the papers.

All authors read and approved the final manuscript. Z. Javadivala, M. Asghari Jafarabadi, E. Merghati-Khoei, and H. Allahverdipour designed the review, performed the searches, appraised and selected the trials, extracted the data, contacted authors for additional data, carried out the analysis and interpretation of the data, and drafted this report. M. Mirghafourvand, K. Kouzekanani and H. Nadrian worked on the completion of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Zeinab Javadivala

Zeinab Javadivala is Ph.D Student in Health Education, Department of Health Education and Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz Iran.

Effat Merghati-Khoei

Effat Merghati-Khoei is PhD in Sexology, Associate Professor, The Iranian National Center for Addiction Studies (INCAS), Institution for Risk Behavior Reduction, Brain & Spinal Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran . Mohammad Asghari-Jafarabadi is PhD in Biostatistics, Associate Professor, Department of Epidemiology and Biostatistics School of Health, Tabriz University of Medical Sciences, Tabriz Iran.

Hamid Allahverdipour

Hamid Allahverdipour is PhD in Health Education, Professor, Clinical Psychiatry Research Center, Department of Health Education and Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz Iran.

Mojgan Mirghafourvand

Mojgan Mirghafourvand is PhD in Reproductive Health, Associate Professor, Department of Reproductive Health, School of Nursing & Midwifery Tabriz University of Medical Sciences, Tabriz, Iran.

Haidar Nadrian

Haidar Nadrian is PhD in Health Education & Promotion, Assistant Professor, Social Determinants of Health Research Center, Department of Health, School of Health, Tabriz University of Medical Sciences, Tabriz Iran.

Kamiar Kouzekanani

Kamiar Kouzekanani is PhD in Quantitative Research Methodology, Professor, College of Education & Human Development at Texas A&M University-Corpus Christi (TAMU-CC).