Hypoactive sexual desire disorder in postmenopausal women

Abstract

Decreases in sex hormone levels with menopause may bring about a number of consequences in women's general health and sexual well-being, especially when levels decline suddenly and prematurely, as in surgical menopause. In addition to the well-established role of estrogens in preserving the biological basis of sexual response, there is emerging evidence that androgens are significant independent determinants affecting sexual desire, activity and satisfaction, as well as mood, energy and other components of women's health. Hypoactive sexual desire disorder (HSDD), a persistent absence of sexual fantasies or thoughts and/or desire for and receptivity to sexual activity that causes personal distress, is experienced by some postmenopausal women. Even though conventional hormone therapy with estrogens or estrogens and progestogens may be effective for vaginal atrophy, increasing vaginal lubrication and reducing dyspareunia, it has not been shown to consistently increase sexual desire or activity and many women with sexual dysfunction remain unresponsive. Several recent, large, phase III studies have shown that the addition of transdermal testosterone to conventional hormone therapy can be helpful in surgically menopausal women presenting with HSDD. After 24 weeks of treatment in these studies, testosterone-treated women experienced significantly greater increases in satisfying sexual activity and sexual desire, and greater decreases in distress, than placebo-treated women. Accurate clinical assessment and individualized management of sexual symptoms are fundamentally important for all menopausal women with HSDD or other sexual problems.

Menopause and Sexuality

“…HSDD correlates with low feelings of physical and emotional satisfaction, poor self-image, and unhappiness [25]. Research suggests multiple psychological reasons why women choose to engage in sexual activity, including wanting to feel close to a partner, expression of love, and wanting to feel feminine[26].…”

“…The role of hormone therapy in consistently increasing sexual desire or activity has not been established [25]. Sexual activity analysis from the Women’s Health Initiative found no statistically significant correlation between use of hormone therapy and the continuation of sexual activity, further supporting that estrogen therapy does not increase libido [46].…”

Management of hypoactive sexual desire disorder in women: current and emerging therapies

“…Therefore, even though psychorelational issues and sociocultural factors should always be ruled out, there is no doubt that biological aspects, including sex hormone deficiency, as well as other medical conditions and medications which may cause a neuroendocrine imbalance, play a major role in the clinical manifestation of sexual problems that induce personal distress and, therefore, may require intervention 26,27. Indeed, the iatrogenic removal of both ovaries, which may occur well before the age of natural menopause, is characterized by the effects of acute estrogen and even androgen deprivation in several domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction) and has been significantly associated with HSDD and severity of other menopausal symptoms such as vaginal dryness 28–30. Following bilateral oophorectomy, both premenopausally and postmenopausally, there is a sudden 50% fall in circulating testosterone (T) levels which have been associated with the so-called androgen-insufficiency syndrome; an increasingly accepted clinical entity comprising specific symptoms such as low sexual desire, persistent and inexplicable fatigue, blunted motivation and a general reduced sense of well-being 31.…”

LEI (Lack of tEstosterone Impact) survey in a clinical sample with surgical menopause

“…Surgical menopause has long been significantly associated with the occurrence of sexual symptoms, mainly vaginal dryness and the decline or loss of libido/sexual desire 1,2 . A number of observational studies, both cross-sectional and longitudinal, have suggested that bilateral oophorectomy has a greater negative impact on sexual functioning than hysterectomy alone [3][4][5] .…”