Sexuality and the menopause

Sexual problems such as dyspareunia and decreased sexual desire are common after the menopause. Hypoactive sexual desire disorder is the diagnostic category applied to many women with loss or lack of sexual interest or desire. The principal components of assessment for sexual dysfunction in menopausal women are: a general, gynaecological, obstetric, psychiatric, psychosexual and relationship history; use of self-report questionnaires; physical examination; and hormonal evaluation. The use of low-dose vaginal estrogen tablets, rings, creams or pessaries may help to improve local genital response but does not necessarily improve sexual interest or motivation. An improvement in sexual function has been reported with tibolone and a combination of estrogen and androgen therapy, al though it remains unclear which groups of postmenopausal women with sexual problems will benefit most from such treatments. Where there is no response to estrogens or where there is premature or surgical menopause the addition of an androgen may be necessary, particularly if the free testosterone levels are low.