Continuing Medical Education: The Use of Estrogen Therapy in Women’s Sexual Functioning (CME)

Abstract

Introduction Estrogen is relevant to women’s well-being including sexual functioning. Aim The goal of this Continuing Medical Education article was to provide a comprehensive review of the effect of exogenous estrogen use on women’s sexual function. Main Outcome Measures We present a literature review. Methods The medical literature was accurately searched (1990–2008) with regard to estrogen therapy in menopausal women by using several terms related to and including the terms “estrogen” and “sexual function.” Results A review of the studies most useful to guide menopausal practice. Conclusions Estrogen decline is one of the key factors contributing to sexual functioning during menopausal transition and beyond. Systemic estrogen treatments are associated with significant benefits in some domains of menopausal sexual function, especially when estradiol is delivered transdermally, whereas local estrogens are effective in preventing urogenital aging. Even tibolone, a selective tissue estrogenic activity regulator, displays positive effects in postmenopausal women with sexual complaints. However, a tailored approach to the individual woman is always needed.

Low Sexual Desire — Is it All in Her Head? Pathophysiology, Diagnosis, and Treatment of Hypoactive Sexual Desire Disorder

“…A recent review concluded that systemic estrogen treatments were associated with significant benefits in some domains of menopausal sexual function, particularly with transdermal delivery of estradiol, whereas local estrogens are effective in the prevention of urogenital aging. 46 Testosterone Postmenopausal women have lower levels of testosterone than premenopausal women, probably due to aging rather than menopause itself, since testosterone levels in women in their 40s are approximately half that of women in their 20s. 47 However, currently available assays have made it difficult to accurately measure testosterone levels in women, 48,49 and a large crosssectional study failed to show a significant relationship between testosterone levels and female sexual function.…”

Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause

“…In addition to the local negative effects in the vagina, VVA is frequently associated with emotional distress and reduced quality of life, [6][7][8] with extension to the sexual partner. 9 The VVA symptoms are reported in up to approximately 60% of postmenopausal women. 7,10,11 Despite their benefits on vasomotor symptoms, 40% of women receiving systemic estrogen therapy have persistent vaginal symptoms.…”

LEI (Lack of tEstosterone Impact) survey in a clinical sample with surgical menopause

“…Indeed, it is extremely common to observe a lack of mental arousal and a decline of sexual desire following a history of sexual pain; the consequent reduction of orgasmic capacity may, then, reduce sexual satisfaction which, in turn, negatively influences sexual motivation, activity and the couple's relationship. On the other hand, if HSDD is present, as the result of androgen insufficiency related to the removal of the ovaries or to other medical conditions, it is likely that the entire sexual response may be compromised, regardless of the adequate management of the estrogen-dependent consequences of urogenital aging 11,21 . In a recent review of the literature, Shifren and Avis concluded that the impact of hysterectomy, often with concurrent oophorectomy, on well-being and sexuality will vary depending on many factors, including a woman's preoperative mental health and sexual function, the indications for surgery, the specific procedure being performed and the option of estrogen therapy.…”