Conference Report From the 10th World Congress on the Menopause

Professor Lorraine Dennerstein, AO MBBS, PHD, DPM, FRANZCP

Disclosures

July 03, 2002

In This Article

The Menopause and Sexual Functioning

The effect of the menopausal transition on women's sexual functioning was the subject of several presentations. During the sessions on management of sexual dysfunction[15] and the natural menopausal transition,[11] I presented data from the Melbourne study demonstrating that there is a profound negative effect of the menopausal transition on sexual functioning. Women in the Melbourne study completed the Personal Experiences Questionnaire annually. A total score of ≤ 7 derived from the short version of this scale has been used as a cut-off score to indicate sexual dysfunction.[16] In the first year of the study, 42% of women still in the early phase of the menopausal transition had scores ≤ 7. However, by year 8 of follow-up when women were postmenopausal, 88% had scores ≤ 7.

A significant reduction occurred in sexual responsiveness (arousal, orgasm, enjoyment), libido (interest in sex), and frequency of sexual activities, and a significant increase in vaginal dryness/dyspareunia was noted as women reached postmenopause.[17] These changes during the natural menopausal transition were shown to reflect declining estradiol levels, but no effect of androgens on sexual functioning was found.[18] A new analysis of the data was presented using structural equation modeling together with techniques allowing the measurement of autocorrelation and cross-correlation of variables. The most important predictor of any woman's sexual functioning in this analysis was her functioning level in the prior year. Other factors that had major effects on sexual functioning were any change in partner (marital) status, feelings towards her partner, and the level of estradiol. Thus, if marital status and the woman's feelings towards her partner are unchanged, she may still be aware of a decline in her interest and ability to respond to sex with the menopausal transition.

The use of HRT (by elevating estradiol levels) was demonstrated to have a positive effect on both sexual responsiveness (including libido) and vaginal dryness/dyspareunia. It is also evident that hormonal effects can be overwhelmed by partner-related effects (such as the advent of a new and loving relationship). The strong effects of prior sexual functioning indicate that women who enter the menopausal transition with strong sexual functioning will be less affected than those whose sexual functioning was already marginal.

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