Pathophysiology and Medical Management of Hypoactive Sexual Desire Disorder

Sexual Health in Menopause

“…Declining levels during peri-menopause, and extremely low levels in post-menopause, are associated with detrimental consequences on overall and sexual well-being. With regard to the central nervous system, menopause-related low sex steroid levels may result in changes in the activation of certain brain areas, representing the neurobiological correlate of menopause-related decrease in sexual arousability [12]. Functional magnetic resonance imaging (fMRI) highlighted a lower activation in post- versus pre-menopausal women in the thalamus, amygdala and anterior cingulate cortex following visual sexual stimulation [13].…”

“…Estrogen loss has been suggested to exacerbate the effects of aging on cognitive functions, contributing to brain senescence and neurodegenerative processes [14]. Moreover, estrogens stimulate several neurotransmitter systems in brain regions involved in sexual behaviour, including dopaminergic transmission [12].…”

“…Providing information on normal sexual functioning, emphasizing the role of motivation, the importance of adequate sexual stimulation and the influence of age and relationship length often facilitates positive sexual behavioural changes. Common modifiable risk factors, such as mood disorders/use of antidepressants, sedentary life-style, endocrine disorders (hyperprolactinemia, hypo/hyperthyroidism, diabetes mellitus), gynecological and urological infections or diseases should be adequately investigated and addressed [12]. Involving the partner may be helpful in order to modify negative communication patterns, to address partner’s SD or to modify partner’s pressure or demanding behaviour for sex [40].…”

“…Furthermore, although large cross-sectional studies have shown associations between specific androgens and self-reported measures of sexual function, circulating levels do not systematically reflect peripheral tissue exposure and sensitivity, which is extremely variable. Nevertheless, systemic testosterone therapy at high physiologic doses has been convincingly shown to improve desire, arousal, vaginal blood flow, orgasm frequency, and sexual satisfaction in surgically and naturally menopausal women, either alone or in combination with HRT [10,12]. Limited data also suggest a beneficial effect of systemic testosterone on vaginal epithelial health and blood flow [60].…”

Changes of androgens levels in menopausal women

“…Sexual function worsens with advancing menopause level. Declining levels of sex steroids play a major role in deterioration of sexual response [ 5 ]. What should be taken into consideration are psychological changes dependent on aging and an increase in metabolic and cardiovascular comorbidities in elderly.…”