Letters to the Editor

Abstract

We have read with interest the article written by Schnatz et al 1 called BOsteoporosis screening and treatment guidelines: are they being followed?[ 1 The conclusion was that the guidelines for dual-energy x-ray absorptiometry screening put forth by The North American Menopause Society are not being followed. In 2005, we looked at the adherence to the 2002 United States Preventive Service Task Force guidelines for osteoporosis screening, BScreening for osteoporosis in postmenopausal women: adherence to the 2002 USPSTF Guidelines.[ 2 Our analysis broke down patients by age groups (G50, 50-59, 60-65, and 965 y) and body mass (more or less than 70 kg). We found that there was an overuse of dual-energy x-ray absorptiometry scanning in women younger than 60 and an underuse in high-risk women (G70 kg) or women older than 65 years. This recent study has reinforced our previous conclusions, with the added analysis of undertreatment of those with indications for therapy and the overuse of therapy for those in which none is indicated. The study by Prairie et al 1 (BA higher sense of purpose in life is associated with sexual enjoyment in midlife women[) is to be commended for its multidisciplinary approach, which yielded multidisciplinary answers. Purpose is noted to be a cognitive variable. In the opinion of the authors, how adequate for understanding the diverse results of this study might a neurological interpretation be? An attempt to summarize it in such terms is given below.MacLean's 2 classic model offers a convenient framework, in which each higher brain level tends to control lower levels, whereas lower levels report continuously to higher. The three major brain levels involved in this model are the cerebrocortical, which involves cognition and is distinctly human; the limbic system, which is emotional, our mammalian heritage; and the thalamic-hypothalamic system, our sensory reptilian inheritance.A sense of purpose is a distinctly human cortical event involving typical frontal lobe action. So massive are the cerebral hemispheres, however, that, as revealed in this study, senses of purpose and of sexual satisfaction can Bcosegregate[ or act as separate variables in different motivational contexts. When integrated with emotional feeling and sexual need, however, the sense of purpose is found to add to overall sexual enjoyment.Sexual enjoyment involves emotional aspects, input from the limbic system, and sensory aspects or impulses from the thalamus and hypothalamus. Although the findings relating to hormone therapy in this study did not quite reach statistical significance, there are strong suggestions that in their reporting of function to higher levels, the hormonal status of peripheral tissues influences sexual pleasure. Vaginal dryness significantly detracts, whereas hormone therapy appears to enhance sexual performance.Although a sense of purpose adds to sexual enjoyment, this higher dimension, in itself, does not lead to more frequent sexual experience. In the results of this study, the rate of sexual activity...