Sexual Health
Sexual Function in Postmenopausal Women
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Although sexuality remains an important part of emotional and physical intimacy that most women desire to experience throughout their lives, the prevalence of sexual dysfunction among all women is estimated to be between 25% and 63%; and the problem is even more common in postmenopausal women with rates between 68% and 86.5%.
Increasing recognition of this problem and future research in this field may change perceptions about sexuality, dismiss taboo and incorrect thoughts on sexual dysfunction, and lead to more women receiving helpful treatment.
Postmenopausal women experience significant declines in sexual responsiveness, frequency of sexual activities and libido, with significant increases in dyspareunia (painful intercourse). Sexual dysfunction significantly impacts a woman’s self-esteem and causes emotional distress, often leading to relationship problems.
Female Sexual Dysfunction (FSD) is a multicausal and multidimensional problem. Lack of sexual interest can be affected by medications, family situations, work-related issues, and psychologic factors. FSD is also related to a partner’s function: when erectile failure of a male partner is improved, a woman’s desire and satisfaction improve. More than 70% of patients with FSD are depressed, and the FSD may worsen when these patients are treated with medications such as selective serotonin reuptake inhibitors (SSRIs).
Selection of medications should take into account sexual side effects. Common disorders related to sexual dysfunction and increasing age include cardiovascular disease, diabetes, lower urinary tract symptoms, and depression; and breast cancer, hysterectomy, oophorectomy (removal of ovaries), obesity, bariatric surgery, osteoarthritis, clinical depression, and smoking are all linked to female sexual dysfunction. Treating those disorders or modifying lifestyle-related risk factors (e.g., obesity) may help reduce sexual dysfunction.
The biologic processes involved in sexual response center around estrogen and testosterone. Low estrogen levels lead to vaginal dryness and chronic estrogen deprivation causes the labia to become less responsive to touch, ultimately leading to discomfort during intercourse and loss of sexual interest. The bladder often becomes thin and atrophies with diminished estrogen, potentially leading to urinary incontinence, urinary frequency, painful urination, and cystitis after intercourse. Libido changes in menopause also may be attributed more to falling testosterone levels.
Estrogen preparations are currently the only FDA-approved medication for the treatment of sexual dysfunction. Small doses of estrogen vaginal cream can adequately improve lubrication and decrease pain with intercourse; however, response to estrogen is quite individual. Therefore, we customize hormone therapy in the best dose and dosage form for each patient. Drug efficacy may be affected by the route of estrogen administration. Transdermal and intravaginal routes of estrogen administration for patients with sexual dysfunction have become the most common and successful treatments for these patients. Testosterone therapy has also been shown to improve sexual dysfunction. Other hormones, such as progesterone, can be used alone or combined with estrogen repalacement therapy to enhance the positive effects or to diminish the negative effects when dealing with FSD.
References
Obstet Gynecol. 2012; 5(1): 16–27.