[Inhibition of sexual desire associated with menopause]

Physicians or gynaecologists, specifically in their general practice or in the setting of a menopause clinic, are more and more frequently confronted to sexual complaints of menopausal women. Among these, decline in sexual desire is probably the most usually reported. The first study to evaluate a potential relationship between sexual functioning and menopause was conducted by Hallström in 1977. Thereafter, a review of the literature was able to show that there is nearly a consensus regarding the role of oestrogens in that condition. They effectively relieve vaginal atrophy and resulting dyspareunia. There is less agreement, however, regarding a direct effect of oestrogens on more complex sexual behaviour and motivation. When analyzing potential influence of sex hormones, oestrogens may exert a positive effect on the quality of the sexual relationship whereas androgens can definitely increase sexual "motivation" including sexual desire. In spite of the potentially important part played by androgens as promoters of libido and in the maintenance of sexual functioning in men and women, the exact role of the hormonal treatment in relieving sexual complaints still keeps controversial. In some women whose decline of sexual desire can be reasonably attributed to menopause, androgens in non-masculinizing adequate dosages, can be effectively included in the postmenopausal hormone replacement regimen. However, aetiology of diminished sexual motivation and desire is far from univocal particularly in the human being where psychological, social and cultural influences are endowed with a prominent importance. It is accordingly conspicuous that our sexual life is not reduced to hormonal fluctuations only. A short critical review of the literature devoted to the main aspects of changes of sexual desire associated with menopause is presented.