Sexual function in nondepressed women using escitalopram for vasomotor symptoms: a randomized controlled trial

Abstract

Objective: To evaluate sexual function in midlife women using selective serotonin reuptake inhibitors for vasomotor symptoms. Selective serotonin reuptake inhibitors effectively treat vasomotor symptoms but adversely affect sexual function in depressed populations. Information on sexual function in nondepressed midlife women using selective serotonin reuptake inhibitors for vasomotor symptoms is lacking; any treatments that might impair function are of concern.

Methods: This was a randomized controlled trial comparing 8 weeks of escitalopram with placebo in women ages 40-62 years with 28 or more bothersome vasomotor symptoms per week. Change in Female Sexual Function Index composite score (ranges from 2 [not sexually active, no desire] to 36) and six sexual domains (desire, arousal, lubrication, orgasm, satisfaction, pain) and the Female Sexual Distress Scale, and a single-question of sexually-related personal distress from the Female Sexual Distress Scale, were compared between groups.

Results: Among all women, median composite baseline Female Sexual Function Index score was 18.1 (interquartile range 2.4-26.5, n=200) and among sexually active women was 22.8 (interquartile range 17.4-27.0, n=75) in the escitalopram group and 23.6 (interquartile range 14.9-31.0, n=70) in the placebo group. Treatment with escitalopram did not affect composite Female Sexual Function Index score at follow-up compared with placebo (P=.18 all women; P=.47 sexually active at baseline). Composite mean Female Sexual Function Index change from baseline to week 8 was 0.1 (95% confidence interval [CI] -1.5 to 1.7) for escitalopram and 2.0 (95% CI 0.2-3.8) for placebo. The Female Sexual Distress Scale results did not differ between groups (P=.73) nor did adverse reports of sexual function. At week 8, among those women sexually active at baseline, there was a small difference between groups in Female Sexual Function Index domain mean score change in lubrication (P=.02) and a marginal nonsignificant difference in orgasm (P=.07).

Conclusion: Escitalopram, when used in the treatment of vasomotor symptoms, did not worsen overall sexual function among nondepressed midlife women.

Trial registration: ClinicalTrials.gov NCT00894543.

Figure 1

Study participant sexual function data collection.

Figure 2

Distribution of baseline Female Sexual Function Index (FSFI) composite scores among (A) all women and (B) women sexually active at baseline.

Figure 3

Mean and 95% confidence intervals of responses to questions in the (A) Female Sexual Function Index (FSFI) lubrication domain and (B) FSFI orgasm domain at baseline, 4 and 8 weeks among women who were sexually active at baseline (n=73 escitalopram, n= 67 placebo). Y-axis: possible scores ranged from 0= poor to 5= maximum function. X-Axis: Sexual function items. Questions for lubrication included: “Often”= Over the past 4 weeks, how often did you become lubricated (wet) during sexual activity or intercourse?; “Difficult“= How difficult was it to become lubricated (wet) during sexual activity or intercourse?; “Often Maintain” = How often did you maintain your lubrication (wetness) until completion of sexual activity or intercourse?; and “Difficult Maintain” = How difficult was it to maintain your lubrication (wetness) until completion of sexual activity or intercourse? Changes in domain scores (weighted average of all domain item scores) from baseline to 8 weeks, comparing escitalopram to placebo, were significant for lubrication (p=0.02), but not orgasm (p=0.07).