Aging, menopause both contribute to women's declining sexual responsivity

By Karla Gale

WESTPORT, CT (Reuters Health) – As a woman ages and progresses from perimenopause to postmenopause, her sexual functioning declines significantly, according to results of an 8-year longitudinal study conducted in Australia.

Dr. Lorraine Dennerstein and colleagues of the University of Melbourne in Victoria began their study in 1991, enrolling women who were between 45 and 55 years old and who had experienced menses in the previous 3 months.

During the ensuing 8 years, 197 of the women underwent the menopausal transition. Two other subsets served as control groups, one comprising 44 women who remained pre- or early peri-menopausal for 7 years and another that included 42 women who were postmenopausal for over 5 years.

As reported in Fertility and Sterility for September, the subjects completed the Personal Experiences Questionnaire annually, which included questions regarding feelings for one's partner, sexual responsivity, frequency of sexual activities, libido, partner problems, and vaginal dryness/dyspareunia.

All three groups exhibited declines in sexual responsivity, as assessed by questions regarding arousal, orgasm, and enjoyment during sexual activities.

During the entire transition period, women also experienced problems with their partner's sexual performance. From late perimenopause to postmenopause, libido and frequency of sexual activities decreased, while vaginal dyspareunia increased.

Dr. Sheryl Kingsberg, of Case Western Reserve University School of Medicine in Cleveland and spokesperson for the American Society for Reproductive Medicine, agrees with the conclusion of Dr. Dennerstein and her associates, that both aging and the menopausal transition affect women's sexual responsivity.

In an interview with Reuters Health, Dr. Kingsberg lauded the researchers' use of a validated, reliable measure of sexual functioning. She wanted to add, however, that a woman's sexual functioning comprises three components: physiological drive; cognitive expectations, beliefs and values; and motivation.

"The motivation component includes all the psychological, interpersonal issues that create her interest in being sexual with a partner," Dr. Kingsberg said. "She may have sexual drive, but if she has lost interest, that is going to impact the frequency [of sexual activity] and her responsivity."

Dr. Kingsberg urged physicians to "tease out" the components of a woman's sexual dysfunction. She suggested that doctors ask themselves, "Should I be looking at her hormonal status? Are there age and physical problems, or is it more an issue of what is going on in the woman's life?"

She emphasized that simply providing a medical treatment when cognitive or motivation issues may be involved, is inadequate. Both the physician and the patient will feel like failures.

"Physicians don't need to be an expert in sex therapy," she added. "The biggest help is to ask, delineate the problem, then make the appropriate referrals if that's indicated."

"By asking a patient to schedule a consultation, then to report back to the doctor, that makes the patient feel cared about, that she's in good hands, and that her problem is important," Dr. Kingsberg concluded.

Fertil Steril 2001;76:456-460.

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