What is decreased libido, arousal, orgasm, and genital sensation in aging women directly associated with?

Decreased Libido, Arousal, Orgasm, and Genital Sensation in Aging Women is Associated with Diminished Estrogen and Testosterone Levels

Decreased libido, arousal, orgasm, and genital sensation in aging women is directly associated with diminished serum levels of estrogen and testosterone. 1, 2 The hormonal changes that occur during menopause significantly impact female sexual function through multiple physiological mechanisms.

Hormonal Factors in Female Sexual Dysfunction

Estrogen Deficiency Effects

• Low serum estrogen causes:
  • Vaginal atrophy and higher vaginal pH 3
  • Reduced vaginal lubrication and expansion on stimulation 3
  • Decreased blood flow to vagina and vulva 3
  • Impaired clitoral nitric oxide regulation, affecting vaginal mucosal health 3
  • Atrophic vaginitis (affects ~50% of postmenopausal women) 1

Testosterone Deficiency Effects

• Declining testosterone levels contribute to:
  • Decreased sexual desire (affects 23-64% of postmenopausal women) 1
  • Reduced arousal response 1, 4
  • Diminished orgasmic function 4
  • Sex hormone-binding globulin (SHBG) increases with age, further reducing free testosterone availability 1

Prevalence and Manifestation of Sexual Dysfunction

Sexual function typically worsens with advancing menopause status 2. The most commonly reported symptoms include:

• Decreased libido/desire (40-55% of postmenopausal women) 1
• Arousal or lubrication problems (20-48%) 1
• Orgasmic difficulties (16-36%) 1
• Dyspareunia/painful intercourse (12-45%) 1, 2

Evaluation of Hormonal Status

Assessment of sexual functioning in aging women should include:

• Determination of menopausal status 1
• Assessment of genital sensation level, dyspareunia, vulvar pain 3
• Evaluation of domains of sexual functioning: desire, arousal, lubrication, orgasm, satisfaction, and pain 3
• Use of standardized questionnaires like Female Sexual Function Index (FSFI) 3, 1
• Review of current medications that may affect sexual function 3, 1

Treatment Approaches

Hormone Replacement Options

• Estrogen therapy:

  • Local vaginal estrogen effectively reverses vaginal atrophy and reduces dyspareunia 5
  • Systemic estrogen may improve overall sexual function 5
  • Should use lowest effective dose for shortest duration 6
  • Women with a uterus require progestin to reduce endometrial cancer risk 6

• Testosterone therapy:

  • Consider when laboratory confirms deficiency 1
  • Topical vaginal testosterone shows improvement in sexual desire, lubrication, satisfaction, and reduced pain 4
  • Monitor for improvement in sexual function within 12 months 1

Non-Hormonal Options

• Vaginal moisturizers and lubricants for vaginal symptoms 1
• Vaginal dilators and pelvic floor relaxation techniques for dyspareunia 1
• Polyacrylic acid has shown improvements in desire, lubrication, and pain reduction 4

Important Clinical Considerations

• Pitfall to avoid: Assuming sexual dysfunction is an inevitable consequence of aging. Research shows many men and women remain sexually active well into later life 7.

• Complicating factors: Depression, anxiety, emotional lability, changes in physical appearance, medical comorbidities (cardiovascular disease, diabetes), and medications (antidepressants, beta-blockers) can all contribute to sexual dysfunction 1.

• Treatment monitoring: Regular assessment of symptom improvement is essential; discontinue hormone therapy if no improvement is observed after an adequate trial period 1.

• Individualized approach: Consider severity of symptoms, potential adverse effects, and patient preferences when selecting treatment options 2.