Female Sexual Dysfunction and Use of Hormone Therapy in Postmenopausal Women

ABSTRACT

Sexual dysfunction is a common problem for women of all ages and remains an important aspect of women's health following menopause. For postmenopausal women, the evaluation and management of sexual dysfunction differs from that of younger women because the etiology is often linked to the diminished levels of sex hormones. Female sexual function is highly complex and deeply influenced by nonhormonal factors such as emotional intimacy and culture. Our understanding of this important area of women's health remains inadequate, and much more research needs to be performed before definitive conclusions can be made. Existing data allow for some preliminary observations. It appears that lack of estrogen may lead to sexual dysfunction primarily by causing vaginal atrophy and dyspareunia. These symptoms may be treated by systemic or local estrogen therapy. Conversely, androgen deficiency appears to be most strongly linked to diminished sexual desire. Growing evidence indicates that administration of androgens may be beneficial in such situations. Other agents that use sex hormone receptors, such as selective estrogen receptor modulators and tibolone, also may affect sexual function.

KEYWORDS

Female sexual dysfunction - postmenopausal - hormone therapy - androgens

REFERENCES

• 1 Laumann E O, Paik A, Rosen R C. Sexual dysfunction in the United States: prevalence and predictors.  JAMA. 1999;  281 537-544
• 2 Masters W, Johnson V. Human Sexual Response Boston; Little, Brown 1966
• 3 Basson R. Human sex-response cycles.  J Sex Marital Ther. 2001;  27 33-43
• 4 Basson R, Berman J, Burnett A et al.. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.  J Urol. 2000;  163 888-893
• 5 Dennerstein L, Dudley E, Burger H. Are changes in sexual functioning during midlife due to aging or menopause?.  Fertil Steril. 2001;  76 456-460
• 6 Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition.  Fertil Steril. 2002;  77(suppl 4) S42-S48
• 7 Morrell M, Dixen J, Carter C, Davidson J. The influence of age and cycling status on sexual arousability in women.  Am J Obstet Gynecol. 1984;  148 66-71
• 8 Myers L S, Morokoff P J. Physiological and subjective sexual arousal in pre- and postmenopausal women and postmenopausal women taking replacement therapy.  Psychophysiology. 1986;  23 283-292
• 9 Modelska M, Cummings S. Female sexual dysfunction in postmenopausal women: Systematic review of placebo-controlled trials.  Am J Obstet Gynecol. 2003;  188 286-293
• 10 Sherwin B B. The impact of different doses of estrogen and progestin on mood and sexual behavior in postmenopausal women.  J Clin Endocrinol Metab. 1991;  72 336-343
• 11 Sherwin B B, Gelfand M M, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause.  Psychosom Med. 1985;  47 339-351
• 12 Dennerstein L, Burrows G D, Wood C, Hyman G. Hormones and sexuality: effect of estrogen and progestogen.  Obstet Gynecol. 1980;  56 316-322
• 13 Pinkerton J V, Shifren J L, La Valleur J, Rosen A, Roesinger M, Siddhanti S. Influence of raloxifene on the efficacy of an estradiol-releasing ring for treating vaginal atrophy in postmenopausal women.  Menopause. 2003;  10 45-52
• 14 Natale V, Albertazzi P, Zini M, Di Micco R. Exploration of cyclical changes in memory and mood in postmenopausal women taking sequential combined oestrogen and progestogen preparations.  BJOG. 2001;  108 286-290
• 15 Hays J, Ockene J K, Brunner R L et al.. Effects of estrogen plus progestin on health-related quality of life.  N Engl J Med. 2003;  348 1839-1854
• 16 Lobo R A, Rosen R C, Yang H M, Block B, Van Der Hoop R G. Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire.  Fertil Steril. 2003;  79 1341-1352
• 17 Davis S R. When to suspect androgen deficiency other than at menopause.  Fertil Steril. 2002;  77 S68-S71
• 18 Guay A T. Screening for androgen deficiency in women: methodological and interpretive issues.  Fertil Steril. 2002;  77 S83-S88
• 19 Goldstat R, Briganti E, Tran J, Wolfe R, Davis S R. Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women.  Menopause. 2003;  10 390-398
• 20 Sarrel P, Dobay B, Wiita B. Estrogen and estrogen-androgen replacement in postmenopausal women dissatisfied with estrogen-only therapy. Sexual behavior and neuroendocrine responses.  J Reprod Med. 1998;  43 847-856
• 21 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;  343 682-688
• 22 Gracia C, Sammel M D, Freeman E W, Liu L, Hollander L, Nelson D B. Predictors of decreased libido in women during the late reproductive years.  Menopause. 2004;  11 144-150
• 23 Spark R F. Dehydroepiandrosterone: a springboard hormone for female sexuality.  Fertil Steril. 2002;  77 S19-S25
• 24 Arlt W, Callies F, van Vlijmen J C et al.. Dehydroepiandrosterone replacement in women with adrenal insufficiency.  N Engl J Med. 1999;  341 1013-1020
• 25 Barnhart K T, Freeman E, Grisso J A et al.. The effect of dehydroepiandrosterone supplementation to symptomatic perimenopausal women on serum endocrine profiles, lipid parameters, and health-related quality of life.  J Clin Endocrinol Metab. 1999;  84 3896-3902
• 26 Hackbert L, Heiman J R. Acute dehydroepiandrosterone (DHEA) effects on sexual arousal in postmenopausal women.  J Womens Health Gend Based Med. 2002;  11 155-162
• 27 Day R, Ganz P A, Costantino J P, Cronin W M, Wickerham D L, Fisher B. Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study.  J Clin Oncol. 1999;  17 2659-2669
• 28 Fallowfield L, Fleissig A, Edwards R et al.. Tamoxifen for the prevention of breast cancer: psychosocial impact on women participating in two randomized controlled trials.  J Clin Oncol. 2001;  19 1885-1892
• 29 Shiota A, Igarashi T, Kurose T, Ohno M, Hando T. Reciprocal effects of tamoxifen on hormonal cytology in postmenopausal women.  Acta Cytol. 2002;  46 499-506
• 30 Modugno F, Ness R B, Ewing S, Cauley J A. Effect of raloxifene on sexual function in older postmenopausal women with osteoporosis.  Obstet Gynecol. 2003;  101 353-361
• 31 Strickler R, Stovall D W, Merritt D, Shen W, Wong M, Silfen S L. Raloxifene and estrogen effects on quality of life in healthy postmenopausal women: a placebo-controlled randomized trial.  Obstet Gynecol. 2000;  96 359-365
• 32 Voss S, Quail D, Dawson A et al.. A randomised, double-blind trial comparing raloxifene HCl and continuous combined hormone replacement therapy in postmenopausal women: effects on compliance and quality of life.  BJOG. 2002;  109 874-885
• 33 Laan E, van Lunsen R H, Everaerd W. The effects of tibolone on vaginal blood flow, sexual desire and arousability in postmenopausal women.  Climacteric. 2001;  4 28-41
• 34 Castelo-Branco C, Vicente J J, Figueras F et al.. Comparative effects of estrogens plus androgens and tibolone on bone, lipid pattern and sexuality in postmenopausal women.  Maturitas. 2000;  34 161-168
• 35 Kaplan H S. The New Sex Therapy: Active Treatment of Sexual Dysfunctions. New York; Brunner/Mazel 1974
• 36 Basson R. Female sexual response: the role of drugs in the management of sexual dysfunction.  Obstet Gynecol. 2001;  98 350-353