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The importance of good sexual function for individuals, patients and their general health and well-being is well recognised. Testosterone is contributory to a healthy sexual life for both women and men. The British Society for Sexual Medicine (BSSM) has initiated and led the development of guidelines for the assessment and use of testosterone deficiency in both women and men for use within the UK and beyond. Clinical awareness of the possibility of testosterone deficiency and the impact this may have on an individual's sexual and somatic function and the need to make sufficient enquiry about the sex life of patients attending a broad clinical spectrum is emphasised. The management of testosterone deficiency is outlined in detail for both women and men.

Introduction The National Institute for Health and Care Excellence (NICE) guideline on the diagnosis and management of the menopause states that women who are likely to go through the menopause as a result of surgical treatment should be offered information about the menopause and the importance of starting hormonal replacement therapy before they have their treatment. Objectives To determine compliance with NICE guidelines at the Royal Derby Hospital. Study design We undertook a retrospective review of all pre-menopausal women undergoing bilateral salpingo-oophorectomy for benign pathology between 1 January 2016 and 30 June 2016. Results Thirty-six cases were reviewed. Women were aged between 32.5 and 49.8 years old (median 45.13, inter-quartile range 42.6-47.6). The commonest indications for bilateral salpingo-oophorectomy were dysfunctional uterine bleeding (36.1%), chronic pelvic pain (30.5%), complex cyst (13.9%), and pre-menstrual syndrome (13.9%). Fifteen women (41.7%) did not have hormonal replacement therapy discussed. Only two (5.6%) had hormonal replacement therapy discussed pre-operatively. The remaining 19 had hormonal replacement therapy discussed post-operatively, either on the ward prior to discharge (n = 3) or, more commonly, in clinic six to eight weeks later. Although hormonal replacement therapy was only contraindicated in one woman (3%), it was only prescribed to five (24%). Results were slightly better for women under 40 but still only 28.6% had hormonal replacement therapy discussed with them pre-operatively. Conclusion This audit has demonstrated that compliance with the NICE guidelines is poor. We suspect similar results might be found in other gynaecology departments nationally. A hospital guideline to aid clinicians and a patient information sheet to educate women has been devised. A re-audit is planned six months after ratification of these documents.

Key content Approximately 21 000 women in the UK were diagnosed with a gynaecological malignancy in 2015; although most of these malignancies occurred in postmenopausal women, 30–40% present in premenopausal or perimenopausal women. Management typically involves surgery and/or chemotherapy and/or radiotherapy, which in younger women may result in an induced menopause. Many women struggle with both the immediate symptoms and the long‐term consequences of estrogen deficiency, all of which are debilitating and compromise the quality and quantity of life, in addition to the cancer diagnosis and treatment. These patients represent a complex group and most units in the UK do not have easy access to menopause specialists. Gynaecologists may be reluctant to prescribe hormone replacement therapy (HRT) to these women; clinicians involved in the care of these women must appreciate when HRT is and is not contraindicated. Learning objectives To understand the safety of HRT in women who have undergone treatment for endometrial, ovarian, cervical, vulval or vaginal malignancies, with particular emphasis on the type, stage and grade of cancer. To establish an evidence‐based approach to the management of menopausal symptoms using HRT in women who have previously been treated for a gynaecological malignancy. To appreciate the role of non‐hormonal alternatives to HRT in these women. Ethical issues How to balance the known benefits of HRT against the potential risks, when evidence is limited in women who have undergone treatment for a gynaecological malignancy.