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Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis

Weinberger, James M., BS; Houman, Justin, MD; Caron, Ashley T., BS; Patel, Devin N., MD; Baskin, Avi S., MD; Ackerman, A. Lenore, MD, PhD; Eilber, Karyn S., MD; Anger, Jennifer T., MD, MPH

doi: 10.1097/AOG.0000000000002733
Sexualty: Review: PDF Only

OBJECTIVE: To quantify the placebo effect of various pharmacologic modalities including neuromodulators, hormonal agents, and onabotulinum toxin A for female sexual dysfunction.

DATA SOURCES: Using Meta-analyses Of Observational Studies in Epidemiology guidelines, we conducted a systematic review of PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Review databases.

METHODS OF STUDY SELECTION: Eleven search terms, “female sexual dysfunction” “treatment” in combination with “hypoactive sexual desire,” “arousal disorder,” “sexual pain disorder,” “genitourinary syndrome of menopause,” “orgasmic disorder,” “vulvovaginal atrophy,” “vaginismus,” “vaginal atrophy,” “vulvodynia,” and “vestibulitis,” were used. Studies were included if their design was randomized, included a placebo arm, and used the Female Sexual Function Index as an outcome measure.

TABULATION, INTEGRATION, AND RESULTS: The placebo effect on the Female Sexual Function Index was compared with each respective study's treatment effect using inverse-variance weighting in a random-effects analysis model. Six hundred five relevant articles were retrieved. Twenty-four randomized controlled trials included a placebo arm. Of these, eight studies used the Female Sexual Function Index. Across these studies, 1,723 women with clinical pretreatment female sexual dysfunction received placebo. Two thousand two hundred thirty-six women were in the treatment arm of the respective studies and received various pharmacologic interventions including flibanserin, bupropion, onabotulinum toxin A, intravaginal prasterone, intranasal oxytocin, ospemifene, and bremelanotide. Women receiving placebo improved 3.62 (95% CI 3.29–3.94) on the Female Sexual Function Index. The treatment arm had a corresponding increase of 5.35 (95% CI 4.13–6.57).

CONCLUSION: This meta-analysis of Level I evidence demonstrates that 67.7% of the treatment effect for female sexual dysfunction is accounted for by placebo. Our findings suggest that the current treatments for female sexual dysfunction are, overall, minimally superior to placebo, which emphasizes the ongoing need for more efficacious treatment for female sexual dysfunction.

Evidence indicates that 67.7% of the treatment effect for female sexual dysfunction can be accounted for by placebo.

David Geffen School of Medicine at UCLA, and the Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.

Corresponding author: James M. Weinberger, BS, Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, 99 N La Cienega Boulevard, Suite 307, Beverly Hills, CA 90211; email: JMWeinberger@mednet.ucla.edu.

Financial Disclosure Dr. Eilber is an investigator for Astellas and Boston Scientific. She is also a consultant for Allergan. Dr. Anger is an expert witness and investigator for Boston Scientific. The other authors did not report any potential conflicts of interest.

Presented at the American Urological Association meeting, May 12–16, 2017, Boston, MA.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received February 5, 2018. Received in revised form May 1, 2018. Accepted May 10, 2018.

Received February 05, 2018

Received in revised form May 01, 2018

Accepted May 10, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.