Predictors of decreased libido in women during the late reproductive years

Disorders of Sexual Desire and Arousal

Desire and arousal disorders are very common. These disorders can cause significant distress to a patient. A successful approach depends on an accurate diagnosis, which is dependent on history. Laboratory evaluation is usually not helpful, whereas psychosexual therapy is helpful in many cases. Although there is some evidence that drug therapy is helpful in some cases, no drug has been approved for the treatment of these disorders.

Antidepressants and sexual dysfunction

OBJECTIVE

Many patients with depression suffer from sexual dysfunction and sexual dysfunction is a recognized side-effect of antidepressants. The aim of this review was to examine the prevalence of psychosexual dysfunction associated with antidepressants, and to review treatment options which are specific to the affected component of sexual functioning and antidepressants.

METHOD

Comprehensive literature review using Medline and Cochrane databases.

RESULTS

Up to 70% of patients with depression may have sexual dysfunction. Tricyclic antidepressants, selective-serotonin reuptake inhibitors and venlafaxine are most and the non-serotonergic antidepressants and duloxetine least likely to produce sexual dysfunction. Pharmacological treatment options include antidepressants less likely associated or 'antidotes' to reverse sexual dysfunction.

CONCLUSION

Sexual dysfunction may be a preventable or treatable side-effect of antidepressants. Patients need routinely to be asked about sexual function to identify problems early. If sexual dysfunction is ignored it may maintain the depression, compromise treatment outcome and lead to non-compliance.

The relationship between overactive bladder and sexual activity in women

PURPOSE

We assessed the relationships between bladder symptoms, demographic, and medical history variables and sexual dysfunction in women with overactive bladder (OAB) disorder.

MATERIALS AND METHODS

Seventy-eight women diagnosed with OAB completed self-administered questionnaires related to overall heath status, bladder function, and sexual function. Data were compiled for questionnaire responses, and multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction.

RESULTS

Bothersome bladder symptoms were reported by > or = 60% of the sample. Sixty-percent of the sample was sexually active in the past month. Difficulty with sexual arousal, orgasm, and sexual enjoyment were reported by about 25% of the women. Sexual partner status was the best predictor of sexual arousal, orgasm, and sexual enjoyment. Menopausal status emerged as an important predictor of arousal and sexual enjoyment.

CONCLUSION

The majority of women with symptoms of OAB viewed these symptoms as bothersome. However, the extent of symptom bother did not predict aspects of female sexual dysfunction (FSD). Instead, menopausal and partner status emerged as the best predictors of FSD in our sample.

Female Sexuality and Sexual Dysfunction: Are We Stuck on the Learning Curve?

INTRODUCTION

Female sexual dysfunctions (FSDs) are very prevalent, multifaceted problems that continue to be under-recognized and undertreated. Improved recognition and management depend on physicians' inclination and ability to communicate with female patients about their sexual function. Many women hesitate to share sexual complaints due to concerns about physicians' time constraints or their interest in addressing it. Direct questioning by physicians about sexual function is often critical to patients' reporting of sexual concerns.

AIM

To obtain pilot data on physicians' knowledge, perceptions, and practices regarding FSDs, which may help uncover means of facilitating future dialog between physicians and patients.

METHODS

A self-reply questionnaire was used to survey physicians and other health professionals attending the 2004 annual meetings of four major specialty societies.

MAIN OUTCOME MEASURES

Survey questions were included on the prevalence of FSDs; dialog on sexual function/activity; obstacles to appropriate evaluation and management of FSDs; effectiveness of current treatment options; and referral patterns.

RESULTS

A total of 1,946 attendees completed the survey. Most respondents (60%) estimated that one- to three-quarters of their patients had FSDs. Low sexual desire was the most prevalent FSD observed. A total of 58% of participants reported initiating the first discussion of FSDs in one-quarter or less of patients. Obstacles to discussing sexual health included limited time and training, embarrassment, and absence of effective treatment options. Approximately 60% of participants rated both their knowledge of and comfort level with FSDs as only fair or poor. Eighty-six percent rated current treatment options as fair or poor.

CONCLUSION

Healthcare professionals are aware of the high prevalence of FSDs but infrequently initiate a discussion of sexual function with their female patients or conduct a comprehensive evaluation for FSDs. Additional medical education and training are needed to improve the identification and management of FSDs in women.

Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women's lives

This article examines published evidence from longitudinal studies of the menopausal transition that address the following questions: (1) Which symptoms do women report during the perimenopause, and how prevalent are these symptoms as women traverse the menopausal transition? (2) How severe are symptoms and for how long do they persist? (3) To what do women attribute their symptoms, and do their attributions match findings from epidemiologic studies of community-based populations? (4) How significant are these symptoms in women's lives? Data from published longitudinal studies were examined for evidence bearing on each of these questions. Only vasomotor symptoms, vaginal dryness, and sleep disturbance symptoms varied in prevalence significantly across menopausal transition stages and postmenopause in >1 population studied. A minority of women report severe symptoms. Given the limited follow-up data available, it is unclear how long symptoms persist after menopause. Women attribute their symptoms to a variety of biologic and psychosocial factors, and their attributions correspond well to those correlates identified in epidemiologic studies of community-based populations. The significance of symptoms for women's lives remains uncertain. The impact of symptoms during the perimenopause on well-being, role performance, adaptation to demands of daily living, and quality of life warrants additional study. The appraisal of the consequences of perimenopausal symptoms by women from different ethnic groups will be enhanced significantly as a result of the Study of Women's Health Across the Nation (SWAN) and other studies in progress.

The Impact of Aging on Sexual Function and Sexual Dysfunction in Women: A Review of Population‐Based Studies

INTRODUCTION

Scientific interest in the impact of aging on women's sexual function and dysfunction has increased in the half century since Kinsey described age-related changes in women's sexual activities. However, a range of methodological issues limit the conclusions that can be drawn from many published studies in this area.

AIM

To review community-based studies investigating changes in women's sexual function and sexual dysfunction with age, taking into account confounders to aging and methodological limitations.

METHODS

Electronic databases were searched for published studies investigating changes in sexual function and dysfunction with age. A critical review was carried out.

MAIN OUTCOME MEASURES

Age-related changes in sexual function and dysfunction.

RESULTS

There are inconsistencies in the way sexual function and sexual dysfunction are measured. Validated scales are infrequently used. Low response rates, limited age ranges, and restrictive inclusion criteria limit the generalizability of many studies. Confounders are often either not measured or not analyzed. Longitudinal studies are rare, making it difficult to separate the effects of birth cohort and aging. The evidence indicates that a woman's sexual function declines with age. This decline begins in a woman's late 20s to late 30s. Specifically, desire, frequency of orgasm, and frequency of sexual intercourse decrease with age. However, it is not clear whether arousal decreases or remains relatively constant. In longitudinal studies, decline in women's sexual function has also been detected, but patterns of stability and improved sexual function have also been observed for short periods of time. The prevalence of most sexual difficulties or dysfunctions changes little with age, with the exception of sexual pain, which may decrease.

CONCLUSIONS

Age-related changes in sexually related personal distress may help explain why the prevalence of sexual dysfunctions remains constant with age while sexual function declines. More research is needed to demonstrate this.

Acute consequences of the menopausal transition: the rise of common menopausal symptoms

More than 80% of women experience psychologic or physical symptoms in the late reproductive years, with varying degrees of severity and disruption in their lives. Patients and clinicians have misconceptions about what changes are considered "normal" or"abnormal" during this period. Of importance to clinicians, large-scale longitudinal studies recently have been conducted to better characterize and explore changes during this period. This article re-views the current evidence regarding the acute symptoms of the menopausal transition, including vasomotor symptoms, mood changes, sleep problems, and changes in sexual functioning.