Sexual dysfunction: treat or refer

Sexual dysfunction is common in postmenopausal women, but because this problem may be caused by several factors, the primary need for these patients is an initial assessment and accurate diagnosis by the primary care provider. Listening to the patient and clarifying her concerns are important for defining the nature of the problem, its severity and duration, and her motivation for treatment. A complete physical evaluation, including a pelvic examination and measurement of postmenopausal hormone levels, may provide important information for structuring a treatment plan to address the patient's concerns. Providing postmenopausal women with reassuring reading materials and focusing on their specific concerns about sexual dysfunction will help reduce anxiety, as will physician suggestions keyed to the patient's individual needs. Alleviation of some menopause-related sexual function difficulties with prescription medications may be warranted, and referral to a specialist for further treatment and counseling may often be the best course of action for a primary care provider. Sexual problems in postmenopausal women are usually amenable to fairly simple interventions that are within the competence of primary care professionals. This paper provides the primary care provider with a perspective on the appropriateness of treatment compared with referral for women experiencing postmenopausal sexual dysfunction.