Reproductive Aging, Sexuality and Symptoms

ABSTRACT

Female sexual dysfunction (FSD) affects ~50% of postmenopausal women. Unfortunately, it often goes undiagnosed because both patients and health-care providers may be reluctant to bring it up at an annual office visit. FSD encompasses both physical and emotional components, all of which are often intermingled. Exhaustion, anxiety, stress, interpersonal relationship issues, hormonal changes and their sequelae on vaginal tissue, medication side effects, and medical problems all play a potential role. This review discusses some of the common etiologies and diagnostic and management options.

KEYWORDS

Hypoactive sexual desire disorder - female sexual dysfunction - dyspareunia - vaginismus - gonadal insufficiency

REFERENCES

• 1 Masters W H, Johnson V E. Human Sexual Response. Boston, MA; Bass, Little Brown 1966
• 2 Kaplan H S. The New Sex Therapy. Vol 2. New York, NY; Brunner/Mazel 1979
• 3 Laumann E O, Paik A, Rosen R C. Sexual dysfunction in the United States: prevalence and predictors.  JAMA. 1999;  281(6) 537-544
• 4 Laumann E O, Glasser D B, Neves R C, Moreira Jr E D. GSSAB Investigators' Group . A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America.  Int J Impot Res. 2009;  21(3) 171-178
• 5 Addis I B, Van Den Eeden S K, Wassel-Fyr C L, Vittinghoff E, Brown J S, Thom D H. Reproductive Risk Factors for Incontinence Study at Kaiser Study Group . Sexual activity and function in middle-aged and older women.  Obstet Gynecol. 2006;  107(4) 755-764
• 6 Bancroft J, Loftus J, Long J S. Distress about sex: a national survey of women in heterosexual relationships.  Arch Sex Behav. 2003;  32(3) 193-208
• 7 Shifren J L, Monz B U, Russo P A, Segreti A, Johannes C B. Sexual problems and distress in United States women: prevalence and correlates.  Obstet Gynecol. 2008;  112(5) 970-978
• 8 Witting K, Santtila P, Varjonen M et al. Female sexual dysfunction, sexual distress, and compatibility with partner.  J Sex Med. 2008;  5(11) 2587-2599
• 9 Bachmann G A, Leiblum S R, Grill J. Brief sexual inquiry in gynecologic practice.  Obstet Gynecol. 1989;  73(3 Pt 1) 425-427
• 10 Bachmann G. Female sexuality and sexual dysfunction: are we stuck on the learning curve?.  J Sex Med. 2006;  3(4) 639-645
• 11 Harsh V, McGarvey E L, Clayton A H. Physician attitudes regarding hypoactive sexual desire disorder in a primary care clinic: a pilot study.  J Sex Med. 2008;  5(3) 640-645
• 12 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC; American Psychiatric Publishing 2000
• 13 Moreira Jr E D, Hartmann U, Glasser D B, Gingell C. GSSAB Investigators Group . A population survey of sexual activity, sexual dysfunction and associated help-seeking behavior in middle-aged and older adults in Germany.  Eur J Med Res. 2005;  10(10) 434-443
• 14 West S L, D'Aloisio A A, Agans R P, Kalsbeek W D, Borisov N N, Thorp J M. Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women.  Arch Intern Med. 2008;  168(13) 1441-1449
• 15 Leiblum S R, Koochaki P E, Rodenberg C A, Barton I P, Rosen R C. Hypoactive sexual desire disorder in postmenopausal women: US results from the Women's International Study of Health and Sexuality (WISHeS).  Menopause. 2006;  13(1) 46-56
• 16 Phillips N A. Female sexual dysfunction: evaluation and treatment.  Am Fam Physician. 2000;  62(1) 127-136, 141–142
• 17 Bancroft J. The endocrinology of sexual arousal.  J Endocrinol. 2005;  186(3) 411-427
• 18 Davis S R, Burger H G. The role of androgen therapy.  Best Pract Res Clin Endocrinol Metab. 2003;  17(1) 165-175
• 19 Avis N E, Zhao X, Johannes C B, Ory M, Brockwell S, Greendale G A. Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Women's Health Across the Nation (SWAN).  Menopause. 2005;  12(4) 385-398
• 20 Channon L D, Ballinger S E. Some aspects of sexuality and vaginal symptoms during menopause and their relation to anxiety and depression.  Br J Med Psychol. 1986;  59(Pt 2) 173-180
• 21 Adashi E Y. The climacteric ovary as a functional gonadotropin-driven androgen-producing gland.  Fertil Steril. 1994;  62(1) 20-27
• 22 Judd H L, Judd G E, Lucas W E, Yen S S. Endocrine function of the postmenopausal ovary: concentration of androgens and estrogens in ovarian and peripheral vein blood.  J Clin Endocrinol Metab. 1974;  39(6) 1020-1024
• 23 Longcope C, Hunter R, Franzc C. Steroid secretion by the postmenopausal ovary.  Am J Obstet Gynecol. 1989;  138 564-568
• 24 Judd H L, Lucas W E, Yen S S. Effect of oophorectomy on circulating testosterone and androstenedione levels in patients with endometrial cancer.  Am J Obstet Gynecol. 1974;  118(6) 793-798
• 25 Sarrel P M. Sexual dysfunction: treat or refer.  Obstet Gynecol. 2005;  106(4) 834-839
• 26 North American Menopause Society . The role of testosterone therapy in postmenopausal women: position statement of the North American Menopause Society.  Menopause. 2005;  12(5) 497-511
• 27 Danielsson I, Sjöberg I, Ostman C. Acupuncture for the treatment of vulvar vestibulitis: a pilot study.  Acta Obstet Gynecol Scand. 2001;  80(5) 437-441
• 28 Bergeron S, Brown C, Lord M J, Oala M, Binik Y M, Khalifé S. Physical therapy for vulvar vestibulitis syndrome: a retrospective study.  J Sex Marital Ther. 2002;  28(3) 183-192
• 29 Pukall C, Kandyba K, Amsel R, Khalifé S, Binik Y. Effectiveness of hypnosis for the treatment of vulvar vestibulitis syndrome: a preliminary investigation.  J Sex Med. 2007;  4(2) 417-425
• 30 Munday P E. Response to treatment in dysaesthetic vulvodynia.  J Obstet Gynaecol. 2001;  21(6) 610-613
• 31 Shifren J L, Braunstein G D, Simon J A et al.. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.  N Engl J Med. 2000;  343(10) 682-688
• 32 Valadares A L, Pinto-Neto A M, Conde D M, Sousa M H, Osis M J, Costa-Paiva L. A population-based study of dyspareunia in a cohort of middle-aged Brazilian women.  Menopause. 2008;  15(6) 1184-1190
• 33 Bergeron S, Binik Y M, Khalifé S et al. A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis.  Pain. 2001;  91(3) 297-306
• 34 Nusbaum M R, Singh A R, Pyles A A. Sexual healthcare needs of women aged 65 and older.  J Am Geriatr Soc. 2004;  52(1) 117-122
• 35 Bergeron S, Khalifé S, Glazer H I, Binik Y M. Surgical and behavioral treatments for vestibulodynia: two-and-one-half year follow-up and predictors of outcome.  Obstet Gynecol. 2008;  111(1) 159-166
• 36 Haefner H K, Collins M E, Davis G D et al.. The vulvodynia guideline.  J Low Genit Tract Dis. 2005;  9(1) 40-51
• 37 Ben David B, Friedman M. Gabapentin therapy for vulvodynia.  Anesth Anal. 1999;  89 1459-1460
• 38 Haefner H K. Critique of new gynecologic surgical procedures: surgery for vulvar vestibulitis.  Clin Obstet Gynecol. 2000;  43(3) 689-700
• 39 Gutmann J N. Exploring sexual dysfunction in the menopausal woman.  Semin Reprod Med. 2005;  3 8-11
• 40 Kingsberg S A. Taking a sexual history.  Obstet Gynecol Clin North Am. 2006;  33(4) 535-547
• 41 Tomlinson J. ABC of sexual health: taking a sexual history.  BMJ. 1998;  317(7172) 1573-1576
• 42 Nusbaum M R, Singh A R, Pyles A A. Sexual healthcare needs of women aged 65 and older.  J Am Geriatr Soc. 2004;  52(1) 117-122