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Purpose of review: Sexuality is an essential part of a healthy life. It can contribute significantly to the physical, psychological and social wellbeing of menopausal women, therefore, to their quality of life. This study is an overview of the most recent findings in the literature retrieved from searches of computerized databases. We extracted all notable information concerning definition, epidemiology, symptoms, diagnostic evaluation and management. Recent findings: The experience of sexuality in menopause is fundamentally shaped by the biological and psychological changes that occur on a substrate of modifications linked to the ageing process. Moreover, several additional factors, including effects of illness, medications and psychosocial stressors can contribute to sexual dysfunction. Patients should be educated about the causes of sexual dysfunction and available treatment. Summary: In recent years, the field of research in sexual dysfunctions has made great progress in many areas of investigation, from epidemiology to pathophysiology providing a better understanding of causes and promoting better care. However, the multifactorial nature of human sexuality still makes our ability to comprehensively treat sexual dysfunction quite difficult. An integrated approach is needed to recognize different aspects involved and to identify the proper intervention strategies for early prevention and promotion of a healthy sexuality in menopause.
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C
URRENT
O
PINION
Sexuality in menopausal women
Salvatore Caruso, Agnese M.C. Rapisarda, and Stefano Cianci
Purpose of review
Sexuality is an essential part of a healthy life. It can contribute significantly to the physical, psychological
and social wellbeing of menopausal women, therefore, to their quality of life. This study is an overview of
the most recent findings in the literature retrieved from searches of computerized databases. We extracted
all notable information concerning definition, epidemiology, symptoms, diagnostic evaluation and
management.
Recent findings
The experience of sexuality in menopause is fundamentally shaped by the biological and psychological
changes that occur on a substrate of modifications linked to the ageing process. Moreover, several
additional factors, including effects of illness, medications and psychosocial stressors can contribute to
sexual dysfunction. Patients should be educated about the causes of sexual dysfunction and available
treatment.
Summary
In recent years, the field of research in sexual dysfunctions has made great progress in many areas of
investigation, from epidemiology to pathophysiology providing a better understanding of causes and
promoting better care. However, the multifactorial nature of human sexuality still makes our ability to
comprehensively treat sexual dysfunction quite difficult. An integrated approach is needed to recognize
different aspects involved and to identify the proper intervention strategies for early prevention and
promotion of a healthy sexuality in menopause.
Keywords
climateric, menopause, sexual dysfunctions, sexuality
INTRODUCTION
The gradual extension of life span over the last 100
years continues: recent statistics suggest that life
expectancy for United States women is now 81 years
[1]. Therefore, a woman may spend on average one-
third of her life in the postmenopausal stage. Sexu-
ality is a central aspect of being human. Though
essentially it is meant for procreation, it is a source of
pleasure, a natural relaxant, it bolsters one’s self-
esteem, intimacy and a couple’s relationship [2].
Sexual health is defined as ‘a state of physical,
emotional, mental and social wellbeing related to
sexuality; not merely the absence of dysfunction or
infirmity’ [3].
The pattern of menopausal changes, symptoms
and their natural history have become increasingly
clear thanks to several longitudinal long-term
studies that have examined many aspects of
women’s biology through this time of life [4
&
].
Oestrogen deficiency is known to be the principal
pathophysiological mechanism that underlies men-
opausal symptoms and sexual dysfunctions. It has a
multitude of effects on several organs and tissues
including urogenital tissues, brain, skin, breasts,
muscles and skeleton [5
&
]. Female sexual dysfunc-
tions (FSDs), however, are complex and distinguish-
ing the effects of menopause from those related to
the ageing process is a major challenge for the
physician [6,7]. Moreover, age and type of meno-
pause, premenopausal sexuality, physical and men-
tal health, life-events, as well as relationship status
and partner availability are important confounding
factors [8
&
,9,10].
In the setting of recent studies a new conceptu-
alization and definition of FSDs that mirrors the
complexity of human sexuality is needed [11
&
].
Soliciting open discussions about sexual problems,
Department of General Surgery and Medical Surgical Specialties, Clinic
of Gynecology, Research Group of Sexology, University of Catania, Italy
Correspondence to Prof Salvatore Caruso, MD, Gynecological Clinic of
the Policlinico Universitario, Via S. Sofia 78, 95124 Catania, Italy.
Tel: +39 095 3781101; fax: +39 095 3781326;
e-mail: scaruso@unict.it
Curr Opin Psychiatry 2016, 29:323– 330
DOI:10.1097/YCO.0000000000000280
0951-7367 Copyright ß2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-psychiatry.com
REVIEW
providing an accurate and comprehensive evalu-
ation considering different cultural and social
beliefs seem to be the most critical steps for a early
recognition and an effective therapeutic manage-
ment [12
&
].
ATTITUDES ABOUT SEX IN MENOPAUSE
There is a tendency to assume that women lose
interest in sex after menopause [13]. Instead, many
midlife women declare that sex is a moderately or
extremely important element in their life [14]. How-
ever, many studies report a decline in all phases of
the sexual response, as well as higher levels of sexual
distress as a consequence of ageing and/or meno-
pause [1518].
A decrease in sexual desire and an increase in
painful intercourse were found during perimeno-
pause [17]; these changes were found to be inde-
pendent of chronological ageing and likely related
to menopausal changes. Moreover, women main-
taining sexual activity showed stability in sexual
functioning, whereas inactive women reported an
overall decline [18].
The overall prevalence of dysfunction in men-
opausal women is estimated between 68 and 86.5%
depending on cultural, religious, ethnic and indi-
vidual differences [19]. The most common com-
plaints are reduced sexual desire, vaginal dryness
and dyspareunia, poor arousal and orgasm as well as
impaired sexual satisfaction [20].
Despite the potentially impairing effects, a
recent study shows that overall sexual functioning
is moderately stable across 4 years from menopause,
suggesting that there is considerable variation and
hence, room for improvement [21
&
]. The main pre-
dictors of changes were desire and arousal, high-
lighting their role as possible key players in women’s
sexual health. These findings somewhat question
the role of menopausal transition as a ‘total’ and
‘enduring’ risk factor for sexual problems and focus
attention on considering FSDs in a broader context
taking into account the different aspects that may
affect sexual behaviour.
UNDERSTANDING FEMALE SEXUAL
DYSFUNCTIONS IN MENOPAUSE
FSDs are rooted in a wide range of predisposing,
precipitating and maintaining factors that can be
of different origins.
Predisposing factors comprise constitutional
and developmental influences that render a person
susceptible to dysfunction. They include preexisting
medical conditions such as congenital, hormonal,
and/or metabolic disorders and underlying psycho-
social considerations, such as body/sexual self-ima-
ge and relationship issues. Contextual predisposing
factors are centred on cultural, and religious beliefs
about sexuality, as well as the meanings attached to
menopause itself and basic socioeconomic and
social factors.
Precipitating factors include events, situations
and/or comorbidities that are more directly and
causally linked to the development of dysfunction.
Menopause itself may represent a biological
precipitating event.
Maintaining factors act to prolong or intensify
the dysfunctional state. One critical maintaining
factor is ‘diagnostic omission’: the failure to recog-
nize FSDs, consequently lack or inappropriate treat-
ment. Others are loss of intimacy and changes in
feelings towards the partner [22,23].
MENOPAUSE AND BIOLOGICAL CHANGES
The hormonal environment is the major driver of
women’s sexual functioning. Sex steroids
estrogens, progestogens and androgens exert
both organizational and trophic effects within
the genitals influencing brain responsivity and
modulating the threshold of tissue response to
stimuli [5
&
,11
&
]. The characteristic trigger of
natural menopause is a decline in ovarian func-
tion, leading to a reduction in circulating levels of
estradiol [5
&
]. The small amount of circulating
estrogens in postmenopausal women depends on
two factors: the intensity and rate of ovarian
exhaustion and the amount of adipose tissue,
which functions as an endocrine gland. A higher
body mass index is associated with increased
production of estrone, via conversion of adrenal
and residual ovarian androgens by aromatases in
adiposetissue[22].
KEY POINTS
Sexuality is an integral part of healthy life; it should not
abruptly come to an end with the onset of menopause.
Satisfaction with different aspects of sex is strongly
associated with general health and quality of life.
FSDs in menopause are rooted in a wide range of
predisposing, precipitating and maintaining factors of
different origins and menopause itself represents a
biological precipitating event.
Soliciting open discussions, providing an accurate
evaluation considering different cultural and social
beliefs seem to be the most critical steps for an early
and effective therapeutic management of FSDs.
Sexual disorders
324 www.co-psychiatry.com Volume 29 Number 6 November 2016
The precipitous drop in estrogen levels is the
most important underlying biological precipitating
factor for FSDs during menopausal transition. It
initially accounts for irregular menstruation, and
vasomotor instability, then with changes in the
vascular, muscular and urogenital systems, in mood,
sleep and cognitive functioning, influencing sexual
function both directly and indirectly [4
&
,5
&
,24,25
&
].
Typical changes in external-labia minora, labia
majora, clitoris and internal-vagina, uterus-repro-
ductive components include reduction in size, thin-
ning of skin and mucous membranes, involution of
the corpus cavernosa and loss of subcutaneous fat.
The clitoris becomes fibrous, resulting in decreased
blood flow and attenuated vasocongestion during
sexual activity. The vaginal vault becomes pale in
appearance with loss of rogation and more friability,
vaginal pH shifts from acidic to alkaline, with
changes in the vaginal flora and more vulnerability
to infections. When coital exchange is attempted
after years of estrogen loss and abstinence, the
marked shortening and narrowing of the vagina
may make sexual intercourse extremely painful or
impossible to achieve [26,27
&&
].
These changes are accompanied by significant
alterations in the urinary tract, including reductions
in intraurethral pressure, bladder size and thickness
of the mucous membranes lining the bladder and
urethra. Complaints of urinary frequency, urgency,
nocturia, dysuria, incontinence and postcoital
infection are common [28,29]. In addition, there is
significant reduction in pelvic muscle tone and resili-
ence of connective tissue support for urogenital struc-
tures, such as the uterosacral ligament, which is
associated with increased risk for pelvic prolapse [30].
Contrasting with the sharp decline in estradiol
during menopausal transition, circulating andro-
gens seem to remain stable. They tend to peak when
women are in their 20s, then gradually decline with
ageing. After menopause, peripheral conversion of
androstenedione becomes the major source of cir-
culating testosterone [31]. Serum levels of andro-
gens exceed those of estradiol, even during peak
reproductive years, suggesting that androgenic hor-
mones play important roles in maintaining sexual
integrity as well as libido and orgasm and their
importance in overall health is the subject of much
current research [32]. We are still missing, however,
a cut-off plasma level for androgens or androgen
precursors to diagnose a deficiency in clinical prac-
tice [33].
Natural menopause represents a good model to
understand the role of estradiol deprivation. On the
other hand, surgical menopause (following oopho-
rectomy) represents a suitable model to explore the
effects of acute estrogen and androgen deprivation
[20]. As an effect of natural menopause, a reduction
in circulating androgen levels is not seen, contrast-
ing with the sharp decline in estradiol [34]. Instead,
after iatrogenic menopause only the adrenal glands
continue to produce low levels of androgens [13].
Bilateral oophorectomy is associated with 25%
lower testosterone levels versus natural menopause
[35]. Oophorectomized women are more likely to
report high prevalence of FSD [36].
FEMALE SEXUAL DYSFUNCTIONS IN
MENOPAUSE
FSDs comprise a wide range of disorders, including
hypoactive sexual desire, reduced genital arousal,
sexual pain and inability to achieve orgasm, these
can be multidimensional in nature and often coex-
isting. Over the past decades, the classification of
FSDs has undergone intense revisions that mirror
the new understanding of their complex aetiology
[37
&&
]. The International Classification of Diseases,
10th Edition (ICD-10) [38] and the Diagnostic and
Statistical Manual of Mental Disorders fourth edi-
tion with text revision or fifth edition (DSM-IV-TR
and DSM-V) [39,40] have been the most widely used
systems. There is still no consensus on the contri-
buting role of discrete factors because of a high
overlap between desire and arousal in women has
been reported. Recently, in the DSM-V, female
sexual interest/arousal disorders were merged into
a single category [41].
Hypoactive sexual desire disorder (HSDD) was
found to be the most prevalent recent and lifelong
sexual complaint [42], affecting up to one in 10 US
women [43]. It is defined as ‘persistently or recur-
rently deficient or absent sexual fantasies and desire
for sexual activity’ accompanied by ‘marked distress
and interpersonal difficulty’ [44]. Major representa-
tive studies in the literature over the past few years
are reported in Table 1 [4247]. The vast majority of
which, such as the Women’s International Study of
Health and Sexuality (WISHeS) [45] and Prevalence
of Female Sexual Problems Associated With Distress
and Determinants of Treatment Seeking (PRESIDE)
[46] are cross-sectional surveys and do not strictly
include the requirement for the diagnosis of HSDD.
The prevalence rates obtained are thus more repre-
sentative of low desire with distress rather than
HSDD. In the PRESIDE study, the prevalence of
distressing sexual problems peaked in middle-aged
women and was considerably lower than the preva-
lence of sexual problems. This underlines the
importance of assessing related personal distress
in accurately estimating FSDs. Greater impairment
of sexual function was observed to be associated
with surgical versus natural menopause [45 47].
Sexuality in menopausal women Caruso et al.
0951-7367 Copyright ß2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-psychiatry.com 325
In many years of research, vasoactive agents,
hormone therapy and psychoactive drugs have been
investigated, and randomized placebo-controlled
trials have shown their efficacy and safety; however,
the FDA did not approve a transdermal testosterone
patch for HSDD in postmenopausal women [48
&&
].
Flibanserin, a multifunctional serotonin 1A receptor
agonist and 2A antagonist, hypothetically targeting
brain circuits that mediate motivation, interest in
and desire for sex. It soon became the candidate to
change the history of sexual medicine for women,
similar to sildenafil for men. In deed, it is the first
medication approved to treat HSDD in women, after
three large phase III trials demonstrated significant
improvements of satisfactory sexual events, level of
sexual desire and distress in comparison with
placebo [48
&&
,49
&&
].
Genitourinary syndrome of menopause (GSM) is
found to be the most important cause of genito-
pelvic pain disorders among menopausal women
[5052]. GSM can be defined as an aggregate of
signs and symptoms associated with any morbid
process, only some of which need to be present
for the diagnosis. They include genital symptoms
(dryness, burning and irritation), sexual symptoms
(lack of lubrication, discomfort or pain) and urinary
symptoms (urgency, dysuria and recurrent urinary
tract infections). The term GSM improves on
previous more restrictive terms like vulvovaginal
atrophy and atrophic vaginitis, which are not
adequate for referring to the complexity of the
condition. Most prevalent urogenital symptoms
are vaginal dryness, dyspareunia, irritation, burn-
ing, itching and dysuria [27
&&
,53]. Between 50
and 70% of postmenopausal women state that
vulvovaginal symptoms have a negative impact
on sexual life and relationship with partner. Vaginal
discomfort is considered the major cause for avoid-
ance of intimacy and loss of libido [5053,54
&
]
(Table 2). The principal treatment options in GSM
include local and systemic hormonal treatment [55].
Vaginal estriol has proven to be effective in treating
vaginal dryness, in improving vaginal maturation
index (VMI), vaginal pH and dysuria [56]. Recent
data indicate the benefits of local intravaginal dehy-
droepiandrosterone on vaginal atrophy symptoms
and sexual dysfunction [57]. New treatments have
recently appeared such as ospemifene [58
&
], a selec-
tive hormone receptor modulator as well as the use
of vaginal laser [59].
MEDICAL CONDITIONS AND USE OF
DRUGS
When a diagnosis of FSD is suspected, a complete
and detailed medical history should be obtained to
evaluate the presence of chronic diseases and use of
drugs. This is especially true in menopause because
of a cumulative impact on interest and ability to
have sexual activity [7,60]. Sexual dysfunction in
later life is often comorbid with psychiatric illness,
particularly mood and anxiety disorders, neurologic
diseases, diabetes, thyroid diseases and osteoarticu-
lar problems [6166]. Diabetes can causes vascular
and nerve dysfunction with structural and func-
tional changes in female genitalia. Disorders of
arousal, orgasm and sexual pain are the main con-
sequences of the diabetic neuropathy [65]. Thyroid
Table 1. Prevalence of HSDD/low desire disorders: review of the literature
Original articles Study population Prevalence of HSDD/low desire disorders
Burri et al. [42] 1.489 UK women; age: 18– 85 years Low desire: 21.4% of women; sexual distress: 26.6% of
women
Leiblum et al. [44] 4.517 US women; age: 20– 70 years HSDD women aged 5070 years: 9% naturally
postmenopausal; HSDD women aged 20– 49 years: 26%
for surgically postmenopausal women
Shifren et al. [45] 31.581 US women; age: 18–102 years Low desire: 38.7 (overall prevalence), 38.9% in women
aged 45– 64, 74.8% among 65 or older; personal
distress: 22.8% (overall prevalence), 25.5% in women
aged 45– 64, 12.5% among 65 or older
West et al. [46] 2.207 US women; age: 3070 years Low desire: 26.7% premenopausal women, 52.4% naturally
menopausal women, 39.7% surgically menopausal
women; HSDD: 7.7% premenopausal women, 6.6%
naturally menopausal women, 12.5% surgically
menopausal women
Dennerstein et al. [47] 2.467 European women; age: 20–70
years
HSDD (women 20– 49 years): 7% for premenopausal
women, 16% surgically menopausal women; HSDD
(women 50– 70 years): 9% naturally postmenopausal
women, 12% surgically menopausal women
HSDD, hypoactive sexual desire disorder.
Sexual disorders
326 www.co-psychiatry.com Volume 29 Number 6 November 2016
diseases are considered risk factors for women’s
sexual health. Some data suggest a possible role of
thyroid-stimulating hormone in impaired sexual
function [67].
Several studies have revealed an effect of cardi-
ovascular diseases on women’s sexual desire; arousal
and pain disorders [6870] but contrary to men
wherein the association is widely recognized, in
women it is less clear [71].
Medications often play a role in precipitating
FSDs. They can interfere through effects on the
central and peripheral nervous system or hormonal
effects [72]. Some of the most common culprits
include antihypertensives (beta-blockers and diu-
retics) [73] and many psychotropic medications,
particularly antidepressants such as serotonin
reuptake inhibitors (SSRIs) and serotonin/norepi-
nephrine reuptake inhibitors (SNRIs) [74].
CONFOUNDING FACTORS
Though certain physiologic and pathologic changes
are responsible for the aforementioned compli-
cations, there are a number of other possible factors
for deteriorating sexual function. Decreased sexual
activity may be interpreted as a biological phenom-
enon or as sexual dysfunction, or it may be the result
of adapting to changed circumstances [75]. Ageing
and menopause may bring on significant changes in
body shape and facial appearance, weight gain and
self-consciousness about other health issues. These
may lead to an extended period of grief over lost
youth and beauty, poorer self-esteem and a loss of
sexual desire. Changes related to ageing in both
women and their partners frequently exacerbate
pre-existing relationship problems that may be
marked by poor communication and mismatch of
sexual ‘scripts’ or interest. Low levels of relationship
satisfaction and increased distress have been
strongly associated with attenuated sexual desire
and low frequency of sexual activity. Partner avail-
ability can be a significant problem for ageing
women, because of divorce, partner death, chronic
illness or sexual dysfunction [76,77]. The import-
ance of sex and level of distress may also differ as a
consequence of values and attitudes towards sexu-
ality and personal experiences [78].
A HEALTHY SEXUALITY IN MENOPAUSE:
THE ROLE OF HEALTHCARE
PROFESSIONALS
A menopause consultation provides an excellent
opportunity to make a sexual health assessment as
Table 2. Prevalence of VVA symptoms/signs and effects on sexuality: review of literature
Original articles Study population
Prevalence of VVA symptoms/signs and effects
on sexuality
Kingsberg et al. [50] 10.486 US women; age: 45–75 years 3046 (38%) experiencing VVA symptoms: vaginal dryness
(55%), pain during intercourse/dyspareunia (44%), vaginal
irritation (37%); VVA symptoms had the greatest impact on
enjoyment of sex (59%)
Simon et al. [51] 1.000 American women; 1.000
American male partners; age:
55– 65 years
Effect of vaginal discomfort: avoidance of intimacy (women:
58%, men: 78%), loss of libido (women: 64%, men: 52%),
pain during sex (women: 64%, men: 59%), cessation of
sex (women and men: 30%)
Nappi et al. [52] 4.100 females; 4.100 males (from the
United Kingdom, Finland, Norway,
Sweden, Denmark, Italy, France,
Canada and the United States)
Effects of VVA: having sex less often (women: 58%, men:
61%), less satisfying sex (women: 49%, men: 28%),
putting off having sex (women: 35%, men: 14%); major
causes for intimacy avoidance: painful sex (women: 55%,
men: 61%), women’s reduced desire (women: 46%, men:
43%)
Nappi et al. [53] 3.768 women (from Italy, Germany,
Spain and the UK); age: 45– 75 years
VVA-associated symptoms: vaginal dryness (70.0%), vaginal
irritation (32.7%), pain during intercourse (29.0%), vaginal
tenderness (14.3%); VVA has a significant impact on: the
ability to be intimate (62%), enjoyment of sexual
intercourse (72%), feeling of sexual spontaneity (66%)
Palma et al. [54
&
] 913 Italian women; age: 59.3 7.4
years
Diagnosis of GSM 722 (79.1%). Symptoms: vaginal dryness
(100%), dyspareunia (77.6%), burning (56.9%), itching
(56.6%), dysuria (36.1%); signs detected by gynecologists:
mucosal dryness (99%), thinning of vaginal rugae (92.1%),
pallor of the mucosa (90.7%), mucosal fragility (71.9%),
petechiae (46.7%)
GSM, genitourinary syndrome of menopause; VVA, vulvar and vaginal atrophy.
Sexuality in menopausal women Caruso et al.
0951-7367 Copyright ß2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-psychiatry.com 327
part of a general assessment. A wide number of issues
can hinder the proper management of FSDs [12
&
].
Several themes relating to healthcare professionals’
experience of discussing sexuality have emerged,
they include fear about ‘opening up a can of worms’,
lack of time, concerns about knowledge and abil-
ities, worry about causing offense, personal discom-
fort, lack of confidence, embarrassment combined
with stereotypes about the lack of sexual needs and
age-appropriate behaviours [12
&
,7982]. Additional
barriers exist for older women to access information
and professional help, making it even less likely that
adequate treatment is sought and/or received. The
importance of health professionals’ strong and
effective communication skills has been high-
lighted, as well as the need to appear interested,
empathetic and be more prepared to initiate such
conversations [81]. Management of FSDs can
include reassurance, education, sex therapy, and/
or medication as part of an optimal multidiscipli-
nary management following an accurate diagnostic
workup and taking into account the biopsychoso-
cial model [11
&
].
CONCLUSION
Great progress has been made over the past years,
clarifying the effects following natural and iatro-
genic menopause and demonstrating that meno-
pause itself and not simply increased age is the
primary driver for FSDs. A comprehensive collection
of medical and sexual history can address whether
the sexual problems began before or after the onset
of menopause. Proper knowledge of different
cultural and social beliefs helps to understand what
role menopause plays in the woman’s overall sexual
health. Giving the opportunity to talk about sexu-
ality is a fundamental part of healthcare, and early
recognition of distressed FSDs is a critical step in
effective therapeutic management. New discoveries
have led to improve the approach to FSDs but
human sexuality still remains complex by its very
nature. The multifactorial etiology, clinical con-
sequence and the indication for treatment need to
be evaluated in a multidisciplinary setting.
Acknowledgements
The authors wish to thank The Scientific Bureau of the
University of Catania for language support.
Financial support and sponsorship
None.
Conflicts of interest
There are no conflicts of interest.
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... Postmenopausal women are likely to have vulvovaginal disorders due to the cessation of ovarian estrogenic activity 1 . Approximately 50% of postmenopausal women experience vulvovaginal atrophy (VVA) with moderate or severe symptoms affecting their quality of life and sexual function [2][3][4] . ...
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Full-text available
Background: To evaluate the efficacy of daily vaginal gel containing hyaluronic acid (HA) and Biosaccharide Gum-1 (BG-1) on vulvovaginal atrophy (VVA) and on sexual function and quality of life (QoL). Methods: One hundred-four postmenopausal women with VVA were enrolled in the nonrandomized comparison cohort study. Of them, 50 women on HA/BG-1 participated in the study group and 54 women on lubricants/moisturizers on-demand as a control group. The primary endpoint was the efficacy of the vaginal gel on VVA evaluated by the Vaginal Health Index (VHI) score. Secondary endpoints included sexual behavior by the self-administered female sexual function index (FSFI) questionnaire and quality of life (QoL) by the Short Form-36 questionnaire (SF-36). Results: All symptoms of AVV improved after 12 weeks of treatment in women on HA/BG-1. The VMI, although improved at the 12-week follow-up compared to baseline, indicated a low estrogenic stimulation value. Sexual function improved significantly in women on HA/BG-1. Moreover, women reported a significant improvement in the somatic aspects of QoL. No benefits were obtained by the women in the study group. Conclusions: Treatment with HA/BG-1 could be used in postmenopausal women who complain of vaginal dryness. The amelioration of VVA-related signs could improve sexual function and QoL.
... Significant relationship has also been found between menopausal experience and women's sexuality and sexual intimacy (Caruso et al., 2016). Sexual Intimacy has been also found as a moderating factor between post-menopausal state and sexual desire. ...
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Menopause involves the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Post-menopause is defined as the period dating from the final menstrual period (FMP). Certain symptoms that are often part of post-menopause, and are collectively called 'Post-Menopausal Syndrome' include vasomotor symptoms, urogenital atrophy, osteoporosis, depression, sexual dysfunction, cognitive and sleep disturbances. The age at which menopause will take place, is influenced by genetic and environmental factors and also differs across cultures. Thus, although, this is a biological process, these changes do not occur in isolation rather is surrounded by psychological, social and cultural variables. All of which have significant impact on women's life; including their perceptions, experiences, coping and overall health. Taking this into account, the present study aims to explore the perceptions regarding self and experience of intimacy in post-menopausal women. The study compares women in the age group of 45-55 years, who are in the post-menopausal stage and women aged between 30-40 years who are in the menstruation stage. Findings suggests significant difference between the two groups.
... Furthermore, further clinical studies are required to evaluate and further analyze the psychological influence of the abdominal scar on patients' quality of life [63,64] in this context. ...
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In the last decade, Ultra-minimally invasive surgery (UMIS) including both minilaparoscopic (MH) and percutaneous (PH) endoscopic surgery achieved widespread use around the world. Despite UMIS has been reported as safe and feasible surgical procedure, most of the available data are drawn from retrospective studies, with a limited number of cases and heterogeneous surgical procedures included in the analysis. This literature review aimed to analyze the most methodologically valid studies concerning major gynecological surgeries performed in UMIS. A literature review was performed double blind from January to April 2021. The keywords ‘minilaparoscopy’; ‘ultra minimally invasive surgery’; ‘3 mm’; ‘percutaneous’; and ‘Hysterectomy’ were selected in Pubmed, Medscape, Scopus, and Google scholar search engines. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed for the drafting of the systematic review. The systematic literature research provided 298 studies, of which 9 fell within the inclusion criteria. Two hundred ninety-six total patients were included, 148 for both PH and MH groups. Median age (48 years), BMI (24 kg/m ² ), OT (90 min), EBL (50 ml), time to discharge (1 day), self scar evaluation (10/10), and VAS (3/10) were reported. The most frequent intraoperative complication in both the PH and MH groups was surgical bleeding. The UMIS approaches were feasible and safe even for complex gynecological procedures. Operative times and complications were superimposable to the “classical” minimally invasive approaches reported in the literature. The reported results apply only to experienced surgeons.
... Sin embargo, es necesario entender que la sexualidad se encuentra multideterminada por factores biológicos, culturales, sociales, económicos, nutricionales, psicoemocionales y de género (Lugones-Botell, 2013; Rivera-Moya y Bayona-Abello, 2014); a esto, Caruso et al. (2016) agregaron otros factores como los psicológicos, los efectos de enfermedades, la ingesta de medicamentos y los estresores psicosociales. Su propuesta es educar a las mujeres sobre las causas de la disfunción sexual, así como sobre los tratamientos disponibles. ...
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La sexualidad es una de las áreas que sufre cambios importantes cuando la mujer se instala en el climaterio, estos cambios se conocen como trastornos y/o disfunciones sexuales. Material y método: en el Instituto Nacional de Perinatología se llevó a cabo un estudio con 139 mujeres en climaterio; se utilizó la encuesta de síntomas y la Historia Clínica Codificada de la Sexualidad Femenina (HCCSF) para conocer la presencia de las disfunciones y/o trastornos sexuales y los factores asociados a estos. Resultados: no se encontró relación alguna entre las variables sociodemográficas y la presencia de disfunciones sexuales; de la muestra, 124 mujeres presentaron al menos una disfunción sexual. Conclusión: aquellas mujeres que cuentan con información sexual a edades tempranas, que tienen deseo y cooperan durante la relación sexual y que además han explorado su sexualidad con más de una pareja, tienen un efecto protector para no presentar disfunciones sexuales. Por otra parte, la presencia de trastornos sexuales se asocia exclusivamente con padecimientos médicos y de salud en la mujer como en la pareja.
... The presence of myometrial lesions such as leiomyomas can lower the diagnostic accuracy of ultrasound, so special attention should be given in case of concomitant uterine lesions. To report that ultrasound is a highly reproducible diagnostic investigation and with high diagnostic sensitivity, fewer articles report the limits of TVU, 67,68 in fact, various aspects both operator and uterus-dependent can reduce the diagnostic accuracy of the method. as reported by epstein et al. 69 and Frühauf et al., 48 if on one side the high sensitivity and specificity ultrasound were confirmed, on the other one it was emphasized that the sonographer must be an expert operator. ...
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iNTrOdUcTiON: endometrial cancer (ec) is the most frequent gynecological cancer. Transvaginal ultrasound (TVU) plays a leading role in the preoperative workup and often is the first diagnostic instrumental examination. Despite expert hands' ultrasound is recommended to assess myometrial invasion in early stage ec, this method is a strictly operator-dependent examination, and varying degrees of sensitivity and specificity have been reported. The present review aims to provide an update of ultrasound imaging in the preoperative work-up for ec patients. eVideNce acQUiSiTiON: a double-blind search was performed from May to September 2020. The following keywords: "ultrasound," "transvaginal ultrasound" and "endometrial cancer" were searched in Pubmed search engines, Sco-pus, and Web of Science. The Prisma statement was followed for the selection of the articles included. eVideNce SYNTHeSiS: The initial search provided 958 studies, of which 11 were included in the analysis. non-eng-lish articles, not relevant to the purposes of this study, case reports and articles with fewer than 40 cases were excluded. CONCLUSIONS: TVU sensitivity and specificity in myometrial infiltration and cervical invasion is comparable to MRI but has lower costs, greater patient tolerability, and does not require contrast agents. an expert operator should perform the ultrasound examination in patients with suspected ec The presence of myometrial lesions, such as leiomyomas, could lower the diagnostic accuracy of ultrasound, so special attention should be paid to patients with concomitant uterine lesions. (Cite this article as: capozzi Va, rosati a, rumolo V, Ferrari F, Gullo G, Karaman e, et al. Novelties of ultrasound imaging for endometrial cancer preoperative workup.
... It often occurs in ages ranging from 45-55 years [3]. During menopause, women experience recurrent vitaminD deficiency caused by a decrease in the 7-dehydrocholesterol levels in the skin; expansion of fatty tissue in the body; decreased bioavailability of vitaminD , which is one of the fat-soluble vitamins and, decrease in the activity of 1-α-hydroxylase in the kidneys [4]. Androgen deficiency can worsen sexual function disorders which are common in postmenopausal women [5]. ...
... It often occurs in ages ranging from 45-55 years [3]. During menopause, women experience recurrent vitaminD deficiency caused by a decrease in the 7-dehydrocholesterol levels in the skin; expansion of fatty tissue in the body; decreased bioavailability of vitaminD , which is one of the fat-soluble vitamins and, decrease in the activity of 1-α-hydroxylase in the kidneys [4]. Androgen deficiency can worsen sexual function disorders which are common in postmenopausal women [5]. ...
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From a group of pre and post-menopausal women, respectively (34 and 46) were selected as test samples as well as 24 healthy women as control samples. All the test and control samples evaluated to measure the Total Vitamin level, Anti Mullerian hormone, and HMGB1 level. The study was planned to assess the relationship between Vit. D. level, AMH, and HMGB1 at the Babylon women at age < 45 years as (Pre-Menopausal) and > 45 years as Post-menopausal. The time between sample collection and measure of the studied parameters was in between (Jullay 2019-Until January 2020) in Merjan medical city, GIT, and Live Center laboratory. Pre-menopausal women show a low level of AMH in comparison with postmenopausal and control samples. postmenopausal women show a low level of HMGB1 in comparison with the premenopausal and the control samples, While the result of premenopausal show that increased level of HMGB1 in comparison with the control sample. Highly significant decrease of VitaminD level of pre-and post-menopausal women in comparison with healthy women. While no significant result of AMH level and significant increase of HMGB1 level. A significant negative correlation of Total vitaminD level with HMGB1 level at both pre and post-menopausal women, on the other hand, insignificant correlation has been found between Vit. D and other parameters.
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Background: Menopause is a unique event in women's life it usually occurs naturally, most often after age 50 when woman has not menstruated in 12 consecutive months. This study was planned to assess the relationship between Vitamin D3 level, PAI-1 and HCG in Babylon women at age <50 years as pre-menopausal and> 50 years as post-menopausal. Methods: The sample were selected from a group of pre- and post-menopausal women, 30 and 50 respectively. All the tests were evaluated to measure Vitamin D3 level, PAI-1 and HCG level. The sample was collected between July 2019 and January 2020 at Merjan medical city GIT and Liver Center, Babylon province, Iraq. Results: The result of current study revealed that there are significant differences in vitamin D3 level in various age categories within postmenopausal women (p= 0.02) also there is no significant differences in PAI-1 and HCG with in these two groups, p= 0.08 and 0.07, respectively. Also, there is significant negative correlation between vitamin D3 and PAI-1 in postmenopausal women (p. value is 0.01). Conclusion: Indeed, postmenopausal women regarded as elderly, but they have sufficient vitamin D3 and normal PAI-I levels as markers for normal non fibrosis status.
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Introduction: Endometrial cancer (EC) is the most frequent gynecological cancer. Transvaginal ultrasound (TVU) plays a leading role in the pre-operative workup and often is the first diagnostic instrumental examination. Despite expert hands' ultrasound is recommended to assess myometrial invasion in early stage EC, this method is a strictly operator-dependent examination, and varying degrees of sensitivity and specificity have been reported. The present review aims to provide an update of ultrasound imaging in the preoperative work-up for EC patients. Evidence acquisition: A double-blind search was performed from May to September 2020. The following keywords: 'ultrasound', 'transvaginal ultrasound', and 'endometrial cancer' were searched in Pubmed search engines, Scopus, and Web of Science. The Prisma statement was followed for the selection of the articles included. Evidence synthesis: The initial search provided 958 studies, of which 11 were included in the analysis. Non-English articles, not relevant to the purposes of this study, case reports, and articles with fewer than 40 cases were excluded. Conclusions: TVU sensitivity and specificity in myometrial infiltration and cervical invasion is comparable to MRI but has lower costs, greater patient tolerability, and does not require contrast agents. An expert operator should perform the ultrasound examination in patients with suspected EC The presence of myometrial lesions, such as leiomyomas, could lower the diagnostic accuracy of ultrasound, so special attention should be paid to patients with concomitant uterine lesions.
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Background: Thanks to timely diagnosis and medical advancement the number of endometrial cancer (EC) patients achieving long term survival is constantly increasing and here comes the necessity to move forward with the understanding of post-treatment sexual adjustment and with the strategies to enhance sexual functioning (SF) and quality of life (QoL) in this population. In this scenario we designed this study aiming to summarize and analyze the available scientific evidence regarding QoL and especially SF in patients affected by EC who underwent surgical and adjuvant treatment. Evidence acquisition: A preliminary research was conducted using Pubmed database with specific keywords combinations regarding SF, QoL and endometrial cancer. The main findings considered in the present review were: the study design, the number of patients included in each study, the information about pathology (histology and stage of disease), the questionnaires administered and the principal results concerning SF and QoL. Evidence synthesis: A total of thirteen studies, between 2009 and 2018, treating the aspects of SF and QoL in patients affected by EC were extracted. The principal findings of different studies were organized in the following sections: -Overall SF in EC patients (reasons for sexual inactivity); -Impact of EC on SF when compared to benign gynecological disease or healty controls-Focus on Surgery; -Minimally invasive surgery versus classical laparotomic approach and SF of EC patients; -Surgery alone versus VBT versus EBRT and SF of EC patients - Focus on RT; -The mutual correlation between sociodemographic, relational, psychological, clinical/metabolic factors and the SF of EC patients. Conclusions: Considering the w idespread diffusion of female sexual dysfunction among EC patients and the relatively good prognosis, especially in early stage disease, it undoubtedly looms the need for proactive countermeasures to maximize the sexual well-being and QoL of these patients. A wide range of intervention in a multi-modal physical and mental perspective should be considered.
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The article consist of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, the pathophysiology of female sexual dysfunction but excluding hormonal aspects. Aim: To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations accordng to the Oxford Centre for evidence based medicine (2009) "levels of evidence" wherever relevant. Conclusion: Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.
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Background: Sexual function and its subsequent satisfaction are among the most important aspects of women's life. However, this instinct could be influenced by some factors such as diseases, drug using, aging, and hormonal and physiologic changes associated with menopause, and sexual behavior. Objective: The aim of this study was to describe the prevalence rates of sexual dysfunction, and related attitudes among aged women in Jahrom, Iran. Materials and methods: This cross-sectional study was conducted on 746 postmenopausal women aged between 50 and 89 years old who had referred to obstetric and gynecologic clinic in Jahrom, from April to October 2014. Female Sexual Function Index questionnaire was used order to assess the sexual function. The cases were classified into three categories according to the attitude scores: negative (17-32), medium (33-38), and positive (39-48). One-way ANOVA test was used to determine the relationship between FSFI and attitude scores. Results: The participants' mean±SD age was 60.10±6.89 years and the total mean score of FSFI was 19.31±8.5. In addition, 81.5% of the women had sexual dysfunction (FSFI< 26.55) and only 147 women (18.5%) had normal sexual function (FSFI> 26.55). Almost 62.1% the women displayed a negative attitude towards sexuality and only 18.8% women had positive attitude. Feeling of dyspareunia (p= 0.02), lubrication (p< 0.0001), orgasm (p= 0.002) and satisfaction (p= 0.002) were significantly different between three categories of attitudes regarding sexuality, respectively. Conclusion: Our data showed that sexual disorders were highly prevalent among postmenopausal women. The most affected problems were arousal, dyspareunia, and lubrication. More than half of the women had negative attitude towards sexual function consequently this could affect their sexual function. So, it seems screening of sexual dysfunction for finding the causes in women should be the main sexual health program. Also, it would be important to emphasis the role of physicians and experts on education and counseling in this subject.
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Introduction The article consists of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, and the pathophysiology of female sexual dysfunction but excluding hormonal aspects. Aim To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations according to the Oxford Centre for evidence based medicine (2009) “levels of evidence” wherever relevant. Conclusion Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.
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Introduction: Definitions of sexual dysfunctions in women and men are critical in facilitating research and enabling clinicians to communicate accurately. Aims: To present the new set of definitions of all forms of sexual dysfunction in women and men adopted by the Fourth International Consultation on Sexual Medicine (ICSM) held in 2015. Methods: Classification systems, including the International Classification of Diseases, 10th Edition and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and systems that focus on only specific types of sexual dysfunctions (eg, the International Society for Sexual Medicine definition for premature ejaculation) were reviewed. Main Outcome Measures: Evidence-based definitions were retained, gaps in definitions were identified, and outdated definitions were updated or discarded. Where evidence was insufficient or absent, expert opinion was used. Some definitions were self-evident and termed clinical principles. Results: The evidence to support the various classification systems was carefully evaluated. A more comprehensive analysis of this evidence can be found in two other articles in this journal that consider the incidence and prevalence and the risk factors for sexual dysfunction in men and women. These data were used to shape the definitions for sexual dysfunction that have been recommended by the 2015 ICSM. Conclusion: The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions. As more research and clinical studies are conducted, there likely will be modifications of at least some definitions.
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Introduction: This article presents a review of previous research concerning risk factors for sexual dysfunction in women and men. Aim: The aim is to evaluate past research studies to determine the contribution of all risk factors to the development and maintenance of sexual dysfunction among women and men. Methods: Studies were organized under a biopsychosocial framework, with the bulk of studies of women and men having investigated the role of biological factors. Main Outcome Measures: The outcome measures were the data on factors for sexual dysfunction. Results: Many more studies investigated risk factors for sexual dysfunction in men than in women. For women and men, diabetes, heart disease, urinary tract disorders, and chronic illness were significant risk factors for sexual dysfunction. Depression and anxiety and the medications used to treat these disorders also were risk factors for sexual dysfunction in women and men. In addition, substance abuse was associated with sexual dysfunction. Many other social and cultural factors were related to sexual dysfunction in women and men. Conclusion: Psychosocial factors are clearly risk factors for sexual dysfunction. Women and men with sexual dysfunction should be offered psychosocial evaluation and treatment, if available, in addition to medical evaluation and treatment. The impact of social and cultural factors on sexual function requires substantially more research. The evidence that erectile dysfunction is a harbinger of other forms of cardiovascular disease is strong enough to recommend that clinical evaluation for occult cardiovascular disease should be undertaken in men who do not have known cardiovascular disease but who develop organic erectile dysfunction, especially in men younger than 70 years.
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In 2015, the approval of flibanserin opened a debate about diagnosis and treatment of female sexual dysfunction. Designing clinical trials with suitable end points is difficult, but some studies indicate correlations between hormone levels and low desire. New research demonstrates opportunities for a better understanding of this multifaceted condition.
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We studied sexual dysfunction (SD) prevalence and lack of sexual activity in 117 women undergoing coronary angiography. SD was consistent with a low (≤26.55) Female Sexual Function Index questionnaire (FSFI) score. The mean age was 61.8 years (range: 40-75 years). SD prevalence was 76.1% (n = 89), and 41 (35.0%) women reported a lack of sexual activity. Regression analyses showed that only age was independently associated with SD (odds ratio 1.088; 95% confidence interval 1.024-1.157;p = .006) and lack of sexual activity (odds ratio 1.144; 95% confidence interval 1.064-1.230; p < .0001), regardless of cardiovascular risk factors, inflammatory biomarkers blood levels, and the number of stenotic coronary arteries.