Bupropion for sexual dysfunction can be helpful when the patient’s concerns are arousal and orgasm. Bupropion is not indicated for sexual desire problems that do not include issues with arousal and orgasm.
Bupropion sustained-release 150 – 400 mg per day has been studied for the treatment of Hypoactive Sexual Desire Disorder (HSDD)
Start at lower dose
Follow up at 2-4 weeks
Most patients do not have trouble tolerating the medication
Bupropion, a norepinephrine-dopamine reuptake inhibitor, is commonly used and has been approved for depression and smoking cessation. Following multiple studies, it is also used off-label for the treatment of HSDD. While dopamine is often associated with addiction and craving, it is also effective in aiding the access of pleasurable response. Data from studies in individuals who are not depressed indicate that the drug is useful in the setting of orgasmic dysfunction, separate from antidepressive properties it may have.
If after a month, the patient experiences little to limited improvement in orgasmic capability, either in ease of producing an orgasm or quality of orgasm, dose can be raised up to 400 milligrams
Blood pressure should be monitored before prescription and after a month as bupropion can raise blood pressure
Safety data for bupropion specifically for HSDD are not available but common side effects seen when used for depression include
Your Patient’s Orgasm Has Disappeared – Next Steps
Secondary anorgasmia describes a situation in which a woman used to achieve orgasm and over time her response has weakened or dissipated. If you identify this concern, or a patient reports this problem
Take the time to ascertain that the patient is indeed describing secondary anorgasmia
Assess if the problem is secondary to medications
In those situations where a patient is able to achieve orgasm in some way, but they are concerned because they are unable to achieve orgasm using penile/vaginal stimulation alone, psychoeducation is needed to assure them that they are perfectly normal as this is the case with 70% of women
Secondary anorgasmia is fundamentally much easier to treat than primary anorgasmia and can often be resolved with medication or behavioral treatment fairly effectively. Various treatment options can be offered and discussed with the patient.
Secondary anorgasmia can describe a situation in which one of the following scenarios is occurring:
It takes a woman significantly more time than it previously did to achieve orgasm
Orgasms are weak or almost non-discernable
A woman cannot reach orgasm at all
Assess whether the secondary anorgasmia is due to side effects of medications
Selective serotonin re-uptake inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) often cause secondary anorgasmia in women
Oral contraceptives can also affect a woman’s ability to achieve orgasm
Treatment options include:
Bupropion HCl, particularly if anorgasmia is caused by antidepressants
150 mg daily, increase if needed, increase to twice daily dosage up to 300 mg
Can take up to 2 weeks for results
May take 3-6 months for results
If secondary anorgasmia determined to be due to medication side effects, consider modification:
Discontinuation of oral contraceptives
Reduction of SSRI, if possible and under the guidance of the prescribing physician
Introduction of strong vibrator
While some authors suggest introduction of phosphodiesterase type 5 (PDE5) inhibitors, which is commonly used in men for erectile dysfunction, ACOG states that more research is required to determine efficacy before a recommendation for use in women can be made
Education is important in those cases where, due to medication or age, more direct or higher levels of stimulation are needed so that the patient understand that this is not uncommon
Generally, referral to a psychotherapist may not be required as this is rarely a purely psychological issue
Referral to a sex therapist if patient interaction does not allow time for discussion, or to benefit from expertise to discuss vibrator use
Treatment Options for the Patient with Sexual Arousal Concerns
Arousal problems occur when women do not experience the usual sexual response to the introduction of sexual stimulation.
Obtain a history to better understand the problem
Ascertain that the problem is arousal, rather than desire/libido
Clarify woman’s arousal response by asking about lubrication, mental interest, tingling or swelling normally experienced by the patient
Consider treatment with medications, but benefit may also be gained by simultaneous referral to a sex therapist
Women describe problems with sexual arousal in a variety of ways: an inability to “quiet the laundry list” in their brains, or a marked absence of the swelling and tingling often felt with sexual arousal. Absent too may be the lubrication that women have experienced in the past. Often they will describe it as “nothing happening down there.” Once the possibility of the problem being desire rather than arousal has been excluded (see differential diagnosis desire/arousal) there are a number of treatments that can be effective.
Assess whether the problems with arousal is due to side effects of medications and if that is the case, consider whether those medications should be reduced or discontinued under the guidance of the prescribing physician
SSRIs and SNRIs can often cause arousal problems in women
Oral contraceptive pills can also affect a woman’s ability to become aroused. Sometimes women will describe the feeling as “being covered in a slipcover”
Treatment options include:
Bupropion xl 150 mg daily, increase if needed, to twice daily up to 300 mg per day
Introduction of strong vibrator
While some advocate for the use of PDE5 (phosphodiesterase type 5) inhibitors, used for male erectile dysfunction, ACOG does not recommend use of these drugs without further study
Education is needed in those cases where, due to medication or age, more direct or higher levels of stimulation are needed and perfectly natural
Consider referral to a sex therapist to recommend or discuss practical solutions to increasing mental and physical stimulation
A sex therapist may help the patient to take more time and can suggest use of erotica, fantasy or vibrators
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan