Antidepressants
Neither the SSRIs nor an atypical antidepressant had an effect on sexual function. Three RCTs (two with a low and one with a moderate risk of bias) in women after breast cancer reported no difference after 4-12 weeks of treatment with bupropion 300 mg/d, fluoxetine 20 mg/d, or paroxetine 10-20 mg/d on sexual function compared with placebo.14, 15, 29 [ES25]
Two RCTs (one with a low and one with a moderate risk of bias) reported no significant differences in sexual functioning for the SNRI venlafaxine compared with clonidine,20, 22 while another RCT (with a moderate risk of bias) reported an increased difficulty achieving orgasm for venlafaxine (75mg/d) compared with gabapentin (300mg/d or 900mg/d).24 [ES25]
In a population of peri- and postmenopausal women, one RCT in a systematic review found that the SSRI escitalopram (10-20 mg/d for 8 weeks) had no statistically significant effect on libido compared to placebo.18 [ES57]
Vaginal gel
One RCT (with a low risk of bias) in women after breast cancer found that 12 weeks treatment with a vaginal pH-balanced gel was associated with a statistically significant improvement in a range of vaginal symptoms, compared with placebo.80 [ES27]
Topical lidocaine
One RCT (with a low risk of bias) in women after breast cancer found that 8 weeks with topical lidocaine treatment (4% solution for 3 minutes) was associated with a statistically significant improvement in vulvovaginal symptoms including dyspareunia, compared to placebo.81 [ES27]