Current Management Strategies of the Postmenopausal Patient with Sexual Health Problems

Abstract

Introduction Sexual health concerns of menopausal women include decreases in sexual interest, arousal, lubrication, and orgasm, and increases in sexual pain, all of which may be associated with distress. Aim To review a step-care progression of sexual healthcare management: identification of the sexual health problem; education of the patient and the partner; modification of reversible causes; first-line therapies consisting of devices and medications; and second-line therapies with more invasive treatments including surgery. Methods The healthcare provider is presented with a clinical diagnosis and treatment paradigm that engages mind, body, and relationship issues proceeding step-wise in a rational and cost-effective fashion. Main Outcome Measure Literature review in women's sexual health. Results Women's health, including sexual health, is a fundamental human right. Supported by evidence-based data, a step-care approach to diagnosis and management of women with sexual health problems is advised. Multidisciplinary interventions should be considered as needed. Identification of sexual health concerns engages diagnostic components of psychologic consultation, history, physical examination, and laboratory testing as appropriate. Key to clinical assessment is the detailed sexual, medical, and psychosocial history. No agreement exists on necessary laboratory tests. Patient (and partner) education improves understanding of treatment options and expectations, and promotes a trusting patient–physician partnership. Modification of reversible causes includes sex therapy, lubricants, altering medications, modifying lifestyle and physical therapy for pelvic floor disorders. First-line therapies should be administered based upon diagnosis, needs, expectations, risks, benefits, and cost, and include medical devices and drugs such as hormones, vasoactive agents, dopamine agonists, topical steroids, anti-infectious agents, and analgesic agents. Second-line therapies, such as surgery, are initiated upon failure, insufficient response, or adverse side effects associated with one or more of the first-line therapies or patient preference. Conclusions For postmenopausal women with sexual dysfunction, a rational clinical management strategy begins with treatment options that are most reversible and least invasive and costly.

Sexual dysfunction in women: What can urologists contribute?

“…They revolutionized the therapeutic armamentarium for contemporary management of men's sexual health care. My mission as a urologist working in the fi eld of female sexual dysfunction is to provide a rational and cost-effective step-care progression of sexual health care management [22]. This begins with 1) identifi cation of the sexual health problem (eg, psychologic consultation, history, physical examination; Fig.…”

“…Urologists are also familiar with the international consensus-derived diagnostic and treatment paradigms used in sexual medicine related to evidence-based research [21]. Application of these principles to manage women with sexual health issues seems natural [22]. As skilled surgeons in the pelvic and perineal region, urologists have the opportunity to develop new surgical procedures for women with sexual health problems [23,24].…”

Management of Sexual Dysfunction in Postmenopausal Breast Cancer Patients Taking Adjuvant Aromatase Inhibitor Therapy

“…Psychosexual therapy for the patient alone or with her partner may ameliorate specific psychologic or interpersonal factors such as relationship distress, extended periods of sexual abstinence, and dysfunctional communication patterns-possibly enhancing sexuality 66 .…”

“…The principles for managing symptoms in women with breast cancer follow the strategies seen in the care of postmenopausal patients with sexual health problems 66 . Multidisciplinary interventions must be considered as needed, and modification of reversible causes includes sex therapy, lubricants, altering medications, modifications in lifestyle, and physical therapy for pelvic floor disorders.…”

“…At that point, firstline therapies should be administered upon diagnosis, and after needs, expectations, risks, benefits, and costs have been clarified. More invasive second-line therapies are initiated only with failures or insufficient response 66 .…”