Testosterone Supplementation to Improve Women's Sexual Satisfaction: Complexities and Unknowns

Sexual dissatisfaction is highly prevalent among women. In large population-based studies, the prevalence of dissatisfaction ranges from 17% to 25% and is largely independent of age. Similar numbers of women report sexual activity without pleasure (1–4).

What promotes women's sexual satisfaction? Apparently, satisfaction is more than simply an absence of sexual problems. In keeping with previous studies (1, 5), a recent community-based survey that targeted women of different ethnicities and ages confirmed that only 35% of women with self-reported sexual problems were dissatisfied with their sexual lives (6). Similarly, lack of desire to engage in sex does not preclude satisfaction with sexual activities. The Study of Women Across the Nation surveyed 3250 multiethnic, middle-age women in North America. Most were satisfied with their physical sexual pleasure, yet 42% to 67.8% never or very infrequently experienced sexual desire (7).

We know enough to formulate a logical approach to treating sexual dissatisfaction in women. Psychological correlates of women's sexual satisfaction include mental health (5, 6), positive feelings for one's partner (1, 5), no past abuse (4, 6), and no sexual dysfunction in one's partner (8). The mainstays of sexual therapy for women follow from these correlates. First, address mental health and relationship issues and any sexual dysfunction in the partner. If the problem persists, move on to specific therapy, including cognitive behavioral therapy; sex therapy; psychotherapy; and, more recently, mindfulness techniques (9).

The article by Davis and colleagues (10) in this issue suggests that transdermal testosterone (a very different approach) might be used to manage sexual dissatisfaction in premenopausal women. Why testosterone? …