Aging, Menopause Both Contribute to Women's Declining

Sexual Responsivity by Sheryl Kinsberg, MD

WESTPORT, CT (Reuters Health) Sept 13 - 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.