Sexual dysfunction in women

There is no specific guidance for monitoring improvements in sexual response. Shorter follow-up periods early in treatment, to identify and challenge difficulties in executing recommendations (e.g., patient's failure to understand instructions, anxiety over doing "homework" on her sexuality, difficulty in making sexual life a priority), are advised. Patients often find change most difficult early in treatment but then, as anxiety lessens, there are fewer barriers to completing assigned exercises in later stages of treatment.

Frequent follow-up is recommended for any investigational drug therapy (e.g., 3-monthly). Repeat prescriptions should only be prescribed at scheduled follow-up visits.

Should investigational testosterone be prescribed, in addition to baseline clinical and laboratory screening, guidelines recommend follow-up every 6 months, including measurement of total testosterone levels and clinical evaluation for signs of androgen excess.[89]American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 213: female sexual dysfunction. Jul 2019 [internet publication]. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/07/female-sexual-dysfunction [160]Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4660-66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821450 http://www.ncbi.nlm.nih.gov/pubmed/31498871?tool=bestpractice.com The physician should ask about the presence of acne or any androgenising effects, and keep the patient informed on current data about risks and usage in any countries where testosterone is approved. Hematocrit, lipids, weight, blood glucose, and mammograms should also be checked.

Blood levels (using mass spectrometry methods) can confirm lack of significant systemic absorption of vaginal estradiol, and of estrogen and testosterone from vaginal dehydroepiandrosterone.