The effects of oestrogen therapy on the sex life of post-menopausal women

The literature concerning sexual behaviour around the time of the menopause is reviewed. Mentioned is a decline in sexual activity and satisfaction in women which is attributed to the changes in the women themselves, and not merely a reaction to the decline in the sexual capacity of their husbands.

Forty women were treated during 1 yr with oestrogens. The eventual effect of this treatment on sexual activity and satisfaction was investigated and compared with a group who had undergone partial treatment only. The results show that in the completely treated Group A, symptoms such as hot flushes and depression diminished, and the pain of sexual relations was relieved. As a consequence of this improvement, coital activity and satisfaction were more gratifying. The partially treated Group B showed a clear decline in sexual activity and in sexual satisfaction.     

Transdermal testosterone treatment in women with impaired sexual function after oophorectomy

BACKGROUND: The ovaries provide approximately half the circulating testosterone in premenopausal women. After bilateral oophorectomy, many women report impaired sexual functioning despite estrogen replacement. We evaluated the effects of transdermal testosterone in women who had impaired sexual function after surgically induced menopause. METHODS: Seventy-five women, 31 to 56 years old, who had undergone oophorectomy and hysterectomy received conjugated equine estrogens (at least 0.625 mg per day orally) and, in random order, placebo, 150 microg of testosterone, and 300 microg of testosterone per day transdermally for 12 weeks each. Outcome measures included scores on the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and a sexual-function diary completed over the telephone. RESULTS: The mean (+/-SD) serum free testosterone concentration increased from 1.2+/-0.8 pg per milliliter (4.2+/-2.8 pmol per liter) during placebo treatment to 3.9+/-2.4 pg per milliliter (13.5+/-8.3 pmol per liter) and 5.9+/-4.8 pg per milliliter (20.5+/-16.6 pmol per liter) during treatment with 150 and 300 microg of testosterone per day, respectively (normal range, 1.3 to 6.8 pg per milliliter [4.5 to 23.6 pmol per liter]). Despite an appreciable placebo response, the higher testosterone dose resulted in further increases in scores for frequency of sexual activity and pleasure-orgasm in the Brief index of Sexual Functioning for Women (P=0.03 for both comparisons with placebo). At the higher dose the percentages of women who had sexual fantasies, masturbated, or engaged in sexual intercourse at least once a week increased two to three times from base line. The positive-well-being, depressed-mood, and composite scores of the Psychological General Well-Being Index also improved at the higher dose (P=0.04, P=0.03, and P=0.04, respectively, for the comparison with placebo), but the scores on the telephone-based diary did not increase significantly. CONCLUSIONS: In women who have undergone oophorectomy and hysterectomy, transdermal testosterone improves sexual function and psychological well-being.     

Sexuality in sexagenarian women

Sexual behavior was examined in 59 healthy, post-menopausal women between 60 and 70 years of age. Subjects were interviewed by a psychologist, completed medical and sexual questionnaires and had a gynecologic exam and blood drawn for determination of estradiol, luteinizing hormone and total and free testosterone. Partners filled out a mail-back sexual questionnaire. Thirty-nine (66%) of the group were coitally active and twenty (34%) were abstinent. The coitally active group reported higher levels of sexual desire (P less than 0.03), greater sexual satisfaction (P less than 0.007), more comfort in expressing sexual preferences (P less than 0.009) and greater pre-menopausal sexual satisfaction (P less than 0.01) and on pelvic examination were noted to have less genital atrophy (P less than 0.0005) than the abstinent group. For the entire sample sexual complaints such as decreased desire and vaginal lubrication in the female and erectile difficulties in the male were reported frequently. Of the hormones studied, higher serum levels of free testosterone were associated with reports of increased sexual desire.     

Testosterone patch for the treatment of hypoactive sexual desire disorder in naturally menopausal women: results from the INTIMATE NM1 Study

OBJECTIVE: To evaluate the efficacy and safety of a testosterone patch for the treatment of women with hypoactive sexual desire disorder after natural menopause. DESIGN: A multicenter, randomized, double-blind, placebo-controlled, parallel-group trial was conducted in naturally menopausal women with hypoactive sexual desire disorder receiving a stable dose of oral estrogen with or without progestin (N = 549). Women were randomized to receive testosterone 300 microg/day or placebo patches twice weekly for 24 weeks. The primary efficacy measure was change from baseline in frequency of total satisfying sexual activity over a 4-week period (weeks 21-24). RESULTS: A total of 483 women (88%) were included in the primary analysis population (those with baseline sex hormone binding globulin levels < or = 160 nmol/L). The change from baseline in number of total satisfying sexual episodes was significantly greater for testosterone compared with placebo (participants with baseline sex hormone binding globulin levels < or = 160 nmol/L, mean change of 2.1 +/- 0.28 versus 0.5 +/- 0.23 episodes/4 weeks; P < 0.0001; intent-to-treat population, mean change from baseline of 1.9 +/- 0.26 versus 0.5 +/- 0.21 episodes/4 weeks, P < 0.0001). Testosterone also produced statistically significant improvements compared with placebo in all secondary efficacy measures, including sexual desire and personal distress. The testosterone patch was well tolerated. CONCLUSIONS: Testosterone patch treatment increased the frequency of satisfying sexual activity and sexual desire, decreased personal distress, and was well tolerated in naturally menopausal women with hypoactive sexual desire disorder.     

地黄叶总苷胶囊治疗糖尿病女性性功能障碍的临床研究

目的 评价地黄叶总苷胶囊治疗糖尿病女性性功能障碍的有效性及安全性。方法 选取2011年5月~2014年12月在我院治疗的糖尿病患者中存在女性性功能障碍者54例,随机分成观察组和对照组,各27例。观察组给予地黄叶总苷胶囊联合西地那非片治疗,对照组给予西地那非片治疗,比较两组患者中医证候积分、治疗前后体内性激素水平变化、女性性功能量表（FSFI）六大维度变化、不良反应发生率等。结果 治疗后治疗组总有效率90.30%,高于对照组的70.37%,统计学意义显著（P＜0.01）;两组较治疗前在中医证候积分改善方面均不同程度得到了改善,但是观察组较对照组改善更明显（P＜0.05）;对照组在性唤起、性欲方面有改善,在阴道湿润度、性交痛、性交满意度方面落后观察组,差异有统计学意义（P＜0.05）;观察组治疗后的雌二醇（E2）、睾酮（T）、孕酮（P）水平较治疗前升高（P＜0.05）,对照组治疗前后无明显变化（P＞0.05）;治疗组不良反应发生率为0,低于对照组的7.41%,差异具有统计学意义（P＜0.05）。结论 地黄叶总苷胶囊可有效改善糖尿病女性性功能障碍患者的幸福指数,在阴道湿润度和性交痛方面的效果优于单纯西药,能够降低西地那非片副作用,值得临床推广。     

Controlled prospective longitudinal study of women with cancer: I. Sexual functioning outcomes

The incidence and etiology of sexual difficulties for women with survivable cancer were studied. Women with early stage gynecologic cancer (n = 47) were assessed after their diagnosis but prior to treatment and then reassessed at 4, 8, and 12 months posttreatment. Sexual and medical outcomes were compared with data from members of two matched comparison groups who were also assessed longitudinally: women diagnosed and treated for benign gynecologic disease (n = 18) and gynecologically healthy women (n = 57). Global sexual behavior disruption did not occur, but the frequency of intercourse declined for women treated for disease, whether malignant or benign. In relation to the sexual response cycle, diminution of sexual excitement is pronounced for women with disease; however, this difficulty is more severe and distressing for women with cancer, possibly due to significant coital and postcoital pain, premature menopause, treatment side effects, or a combination. Changes in desire, orgasm, and resolution phases of the sexual response cycle may also occur, but they are of lesser magnitude or duration or both. Approximately 30% of the women treated for cancer were diagnosed with a sexual dysfunction. The nature, early timing, and maintenance of sexual functioning morbidity suggest the instrumental role that cancer and cancer treatments play in these deficits (particularly arousal problems) and suggest that preventive therapies are necessary.     

Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Women's Health Across the Nation (SWAN)

OBJECTIVE: To examine sexual function in a cohort of Baby Boomer women of diverse racial/ethnic backgrounds; to compare differences between pre-and early perimenopausal women; and to identify sociodemographic, health-related, and psychosocial (including psychological, behavioral, and relationship) factors related to sexual function. DESIGN: Six domains of sexual function were studied in 3,167 women in the baseline cohort of the Study of Women's Health Across the Nation (SWAN). Participants were 42 to 52 years old, pre-or early perimenopausal, and not using hormones. The study sample included non-Hispanic white, African American, Hispanic, Chinese, and Japanese women. RESULTS: Early perimenopausal women reported greater pain with intercourse than premenopausal women (P = 0.01), but the two groups did not differ in frequency of sexual intercourse, desire, arousal, or physical or emotional satisfaction. Variables having the greatest association across all outcomes were relationship factors, the perceived importance of sex, attitudes toward aging, and vaginal dryness. Despite controlling for a wide range of variables, we still found ethnic differences for arousal (P < 0.0001), pain (P = 0.03), desire (P < 0.0001), and frequency of sexual intercourse (P = 0.0003). African American women reported higher frequency of sexual intercourse than white women; Hispanic women reported lower physical pleasure and arousal. Chinese women reported more pain and less desire and arousal than the white women, as did the Japanese women, although the only significant difference was for arousal. CONCLUSIONS: Relationship variables, attitudes toward sex and aging, vaginal dryness, and cultural background have a greater impact on most aspects of sexual function than the transition to early perimenopause.     

Timed Sexual Intercourse Facilitates the Recruitment of Uterine CD56bright Natural Killer Cells in Women with Infertility

Problem  The aim of this study was to investigate the influence of sexual intercourse on uterine NK cell subsets.
Method of study  Mid-secretory endometrial samples obtained from 56 women were submitted for flow cytometric analysis. Basal body temperature was used to determine the day of ovulation. A total of 27 women had sexual intercourse before ovulation (pre-ovulation group) and eight women had only after ovulation (post-ovulation group) without any contraceptive devices. A total of 21 women did not have sexual intercourse during the experimental cycle (abstinence group). Endometrial NK cells were analyzed for the expression of CD16 and CD56 using 3-color flow cytometry.
Results  CD16⁻/CD56^bright cells were markedly increased in the pre-ovulation group as compared with that of the post-ovulation group ( P  < 0.01) and the abstinence group ( P  < 0.01). CD16⁺/CD56^dim cells were significantly decreased in the pre-ovulation group as compared with that of the post-ovulation group ( P  < 0.01) and the abstinence group ( P  < 0.05).
Conclusion  It is suggested that seminal plasma participates in the recruitment of CD56^bright NK cells into endometrium.     

Influence of endogenous androgens on carotid wall in postmenopausal women

OBJECTIVE: There is increasing evidence of a direct association between normal androgen levels and reduced cardiovascular morbidity and mortality in women. After menopause the influence of estrogens declines, whereas that of androgens increases. Therefore, we investigated the effects of androgens on atherosclerosis in postmenopausal women, by using carotid artery intimal-medial thickness as a marker of vascular damage. DESIGN: Blood pressure, body mass index, waist-to-hip ratio, serum dehydroepiandrosterone sulfate, androstenedione, total and free testosterone, estrone, insulin, lipid profile, and glucose were evaluated in 44 women in stable physiological menopause. All subjects underwent carotid ultrasound (Biosound 2000 II s.a. high-resolution unit). RESULTS: Spearman correlation coefficients indicated that serum androstenedione and free testosterone were negatively associated with several carotid intimal-medial thickness measures with correlation coefficients (r) ranging from 0.477 to 0.397 (p < 0.01-0.04). Moreover, age-adjusted androstenedione and free testosterone highest tertiles showed intimal-medial thickness values significantly (p < 0.03-0.05) lower than the other tertiles. There was a favorable association between hormones and the most important cardiovascular risk factors. This association, however, did not reach statistical significance. Stepwise multiple regression analysis showed that the inverse relationships between the hormones (androstenedione and free testosterone) and several intimal-medial thickness measures were maintained (F: 4.15-6.07, p < 0.05-0.02) after adjustment for major cardiovascular risk factors. CONCLUSIONS: Our data demonstrate that in postmenopausal women endogenous steroid precursors and androgens are inversely related to carotid intimal-medial thickness, an established marker of atherosclerosis. In addition, these hormones show favorable associations with cardiovascular risk factors. Therefore, our study suggests that, after menopause, normal androgen levels may benefit the carotid artery wall.     

Menopause symptoms and quality of life in women aged 45 to 65 years with and without breast cancer

OBJECTIVE: To compare the prevalence of menopause symptoms, sexual activity, and quality of life in women with and without breast cancer. DESIGN: A cross-sectional study using one group for comparison was conducted on women aged 45 to 65 years who had not received hormone therapy or tamoxifen during the last 6 months. Participants were recruited from the Menopause and Breast Cancer Outpatient Facilities. One hundred eighty-two women were included, 97 with breast cancer and 85 without breast cancer. Sociodemographic and clinical features and prevalence of menopause symptoms were assessed. The quality of life was assessed by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire. To compare sociodemographic and clinical features between groups, the Student's t test or Fisher exact test was used. Multiple logistic regression and linear regression models were used to control for potential confounding variables. RESULTS: The mean age of participants with breast cancer was 53.2 +/- 6.2 years, and the mean age of those without cancer was 57.8 +/- 4.9 years (P < 0.01). Age at menopause was 47.2 +/- 5.1 years and 47.4 +/- 4.9 years for women with and without breast cancer (P = 0.76), respectively. Approximately one-fourth of women with breast cancer and 4.7% of women without cancer were premenopausal (P < 0.01). The prevalence of menopause symptoms was similar between the groups. Women with breast cancer reported less sexual activity (51.5%) than women without cancer (62.4%) (P < 0.01). Quality of life scores were good in both groups. There was a significant difference regarding physical functioning, with a median score of 90 for the cancer group and 75 for the group without cancer (P < 0.01). CONCLUSION: The prevalence of menopause symptoms was similar in women with and without breast cancer. Sexual activity was less frequent in women with breast cancer. Quality of life was good in women from both groups, although women with breast cancer had the highest level of physical functioning.     

产后女性进行盆底肌康复治疗对其性功能障碍的改善效果

目的:探究产后女性进行盆底肌康复治疗对其性功能障碍的改善效果。方法:随机选取我院收治的120例产后女性患者,按照数字表法分组,将其分为试验组、对照组两组,对照组采用常规康复治疗,试验组开展盆底肌康复训练治疗,对比分析两组患者预后情况。结果:试验组女性患者治疗后3个月、6个月的性交频率与对照组患者相比明显较高,差异有统计学意义(t=-17.0692,-20.9648;P0.05)。试验组女性患者治疗后3个月、6个月的性功能评分与对照组患者相比明显较高,差异有统计学意义(t=-18.1220,-10.8083;P0.05)。结论:产后女性进行盆底肌康复治疗后,有利于提高性功能,增加性交频率,预后效果显著,临床意义重大。     

The role of androgen in the maintenance of sexual functioning in oophorectomized women

Five aspects of sexual behavior were monitored daily in three groups of women who had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy approximately 4 years ago for benign disease. One group had been receiving an estrogen-androgen preparation intramuscularly once a month since their surgery (E-A). The second group had been receiving estrogen alone (E) and the third group of women had remained untreated. Plasma estradiol and testosterone were measured at an established baseline and again on days 2, 4, 8, 15, 21, and 28 postinjection. Women who received both sex steroids reported higher rates of sexual desire (p less than 0.01), sexual arousal (p less than 0.01), and numbers of fantasies (p less than 0.01) than those who were either given E or who were untreated. Moreover, changes in these behaviors covaried with plasma testosterone but not with plasma estradiol levels during the treatment month as the drug was being metabolized. Rates of coitus and orgasm were also higher in the E-A group during the first two postinjection weeks (p less than 0.01) coincident with their higher testosterone levels. These findings imply that androgen may be critical for the maintenance of optimal levels of sexual functioning in postmenopausal women.     

A randomized comparative study of the effects of oral and topical estrogen therapy on the vaginal vascularization and sexual function in hysterectomized postmenopausal women

OBJECTIVE: To compare the effects of oral and vaginal estrogen therapy (ET) on the vaginal blood flow and sexual function in postmenopausal women with previous hysterectomy. DESIGN: Fifty-seven women were randomized to receive either oral (0.625 mg of conjugated equine estrogens per tablet; n = 27) or topical (0.625 mg conjugated equine estrogens per 1 g vaginal cream; n = 30) estrogen administered once daily. All women underwent estradiol measurements, urinalysis, pelvic examination, introital color Doppler ultrasonographies, and personal interviews for sexual symptoms using a validated questionnaire before and 3 months after ET. RESULTS: A higher serum level of estradiol was noted in the oral group compared with the topical group after 3 months of ET. There were significant increases in the number of vaginal vessels and the minimum diastole (P < 0.01), and marked decreases of pulsatility index values (P < 0.01) in both groups after ET. Regarding the systolic peak, we found a significant decrease only in the topical group (P < 0.05). Although the post-ET prevalence of anorgasmia decreased significantly in both groups (P < 0.05), changes in other domains, including the rates of low libido and coital frequency, were not statistically significant (P > 0.05). In the topical group, ET improved sexual function on the vaginal dryness and dyspareunia domains in a statistically significant manner (P < 0.05), but this was not the case in the oral group (P > 0.05). However, the efficacy of oral ET for vaginal dryness and dyspareunia reached 80% and 70.6%, respectively. The corresponding figures of the topical ET were 79.2% and 75%. CONCLUSIONS: The results of our study suggest that ET alone in hysterectomized postmenopausal women increases the vaginal blood flow and improves some domains of sexual function, but it may not have an impact on diminished sexual desire or activity. Compared with systemic therapy, topical vaginal preparations are found to correlate with better symptom relief despite the lower serum level of estradiol.     

A study of the psychological status and sexuality in middle-aged Bulgarian women: significance of the hormone replacement therapy (HRT)

OBJECTIVE: The psychoemotional and sexual status of Bulgarian urban postmenopausal women 10 years after the beginning of the period of extensive political, social, economic and cultural transitions was studied. SUBJECTS AND METHODS: Three hundred and thirty-two postmenopausal women (83.5% in natural menopause and 16.5% in surgical menopause) and 295 women with normal menstrual cycle in several Bulgarian cities and the capital were studied. A campaign for free-of-charge bone density measurement was announced and the examined subjects filled in an individual anonymous questionnaire. SPSS for Windows version 8.0 was used for the statistical processing of the results. The comparison was made between normally menstruating women (n=295), postmenopausal women on hormone replacement therapy (HRT) (n=36) and postmenopausal subjects without HRT (n=296). RESULTS: A significant correlation was observed between depression and sexual aversion, depression and pain with intercourse, depression and the change in the sexual life after menopause. The correlation between self-esteem and sexual thoughts, self-esteem and sexual desire, self-esteem and the arousal from the partner, self-esteem and orgasm also proved important. About 20% of the studied subjects reported depressive thoughts, 50% reported anxiety and the self-esteem was very low in 13%. These results can be explained in part with the economic stagnation in the country, the unemployment and uncertainty. However, 94% of Bulgarian women believe that they do well in life and rely on their professionalism and social positions. All parameters of sexual life are significantly lower in the postmenopausal group without HRT as compared both with menstruating women and postmenopausal women on HRT. Marital status influences them too. CONCLUSION: The change in the sexuality is related to the decline in the estrogen activity, the influence of the psychosocial factors, the lack of a permanent intimate partner, and the derogatory attitude of the society towards the sexuality of postmenopausal women.     

Sexual functioning throughout menopause: the perceptions of women in a British cohort

OBJECTIVE: Previous studies on menopausal transition and sexual functioning have mixed findings. Most are cross-sectional, exclude hormone therapy users and hysterectomized women, and are unable to separate the effects of age from menopause or account for psychosocial, vasomotor, and somatic factors. We examine relationships between women's reports of a change in sex life and difficulties with intercourse and their experience of menopausal transition, use of hormone therapy, and hysterectomy. DESIGN: A British cohort study with 1,525 women were followed since their birth in 1946 and annually from age 47 to 54 years. The outcome measures were self-reported change in sex life and difficulties with sexual intercourse over 8 consecutive years. RESULTS: Compared with women who remained premenopausal, peri- and postmenopausal women reported a decline in sex life (mean difference [95% CI]: perimenopausal, -0.1 [-0.2 to -0.03]; became postmenopausal, -0.1 [-0.2 to -0.1]) and were more likely to report difficulties with intercourse (perimenopausal, 0.6 [0.1 to 1.1]; postmenopausal, 1.0 [0.5 to 1.5]) beyond the effects of aging and other psychosomatic factors. Women reported difficulties with intercourse more often if they had been on hormone therapy for more than a year (0.5 [0.03 to 1.0]) or if they had undergone a hysterectomy (0.6 [0.1 to 1.1]); no differences were found for change in sex life. For both outcomes, vaginal dryness was the major risk factor. Married women were also more likely to report adverse outcomes. Somatic symptoms and hot flushes/cold sweats were associated with difficulties with intercourse, whereas psychological symptoms, stressful lives, increasing age, and smoking were associated with a decline in sex life. CONCLUSIONS: Menopausal transition status had an independent effect on the reported change in sex life and difficulties with intercourse. The results support health professionals in their development of management strategies that (a) consider treatments directly for vaginal dryness, (b) identify somatic symptoms for difficulties with intercourse, (c) investigate psychological factors for a reported decline in sex life, and (d) for both outcomes, consider the potential role of intimate partners.     

Effects of the insulin sensitizing drug metformin on ovarian function, follicular growth and ovulation rate in obese women with oligomenorrhoea

Hyperinsulinaemic insulin resistance is commonly associated with hyperandrogenaemia, and menstrual dysfunction. The aim of this study was to examine the effects of the insulin sensitizing drug, metformin, on ovarian function, follicular growth, and ovulation rate in obese women with oligomenorrhoea. Twenty obese subjects with oligomenorrhoea [polycystic ovarian syndrome; (PCOS)] were observed longitudinally for 3 weeks prior to and for 8 weeks during treatment with metformin (850 mg twice per day). Fifteen patients completed the study. The frequency of ovulation was significantly higher during treatment than before treatment (P = 0.003). A significant decline in both testosterone and luteinizing hormone concentrations was recorded within 1 week of commencing treatment. Patients with elevated pretreatment testosterone concentrations showed the most marked increase in ovulation rate (P < 0.005), and significant reductions in circulating testosterone from 1.02 to 0.54 ng/ml (P < 0.005) after only 1 week of treatment. However, the sub-group with raised fasting insulin showed less marked changes, and the sub-group with normal testosterone concentrations showed no effect of treatment. Metformin had a rapid effect upon the abnormal ovarian function in hyperandrogenic women with PCOS, correcting the disordered ovarian steroid metabolism and ovulation rate; however, there appeared to be no effect in cases where the circulating androgen concentration was normal.     

Efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial

OBJECTIVE: Evaluation of the use of testosterone therapy for hypoactive sexual desire disorder (HSDD) after oophorectomy has mostly involved women treated with oral estrogen preparations. We investigated the efficacy and safety of a testosterone patch in surgically menopausal women receiving concurrent transdermal estrogen. DESIGN: Women with HSDD after oophorectomy, for whom this was a concern, who were using transdermal estrogen, were recruited to a 24-week, randomized, double-blind, placebo-controlled trial in Europe and Australia. Patients were randomly allocated to placebo (n = 40) or testosterone 300 microg/day (n = 37) treatment. Primary endpoints were changes in sexual desire measured by the sexual desire domain of the Profile of Female Sexual Function and the frequency of satisfying sexual activity at 24 weeks. RESULTS: Sixty-one women (79%) completed the trial. All subjects who received at least one application of study medication were included in analysis. The testosterone-treated group experienced a significantly greater change from baseline in the domain sexual desire score compared with placebo (change from baseline, 16.43 versus 5.98; P = 0.02). The domain scores for arousal, orgasm, decreased sexual concerns, responsiveness, and self-image as well as decreased distress were also significantly greater with testosterone therapy than placebo. The frequency of satisfactory sexual events increased but was not statistically different between treatment groups (P = 0.06) Adverse events occurred with similar frequency in both groups, and no serious risks of therapy were observed CONCLUSIONS: In this study, transdermal testosterone therapy via a skin patch improved sexual desire and other sexual function domains. It was well tolerated in these oophorectomized women with HSDD receiving concomitant transdermal estrogen.     

Psychoendocrine correlates of sociosexual responsivity in older premenopausal primates

Cycling older premenopausal female bonnet macaques (17 to 18 years) show decreased attractivity (mounting indices) and responsivity to males in short-term pair-testing compared to younger, fully mature cycling females (9 to 13 years). Comparison of age-group mean circulating levels of estrogen, progesterone, and testosterone during four phases of the menstrual cycle shows a significant decrement in older females only in the height of the estrogen surge during the periovulatory (estrous) phase of the cycle. Supplementation of older females with an estradiol + testosterone preparation (Deladumone, Squibb) did not restore behavioral sexual interaction to the level of younger females. The data suggest a gradual decline in sexual responsivity or arousal in older females which precedes the major endocrine changes of menopause. Such a lowering of responsivity appears comparable to that observed in aging (albeit sexually functional) human males.     

Menopause and risk factors for coronary heart disease

Postmenopausal women are believed to have a higher risk of coronary artery disease than premenopausal women. In this study, we prospectively determined changes in coronary risk factors that were attributable to natural menopause in 541 healthy, initially premenopausal women 42 to 50 years of age. After approximately 2 1/2 years, 69 women had spontaneously stopped menstruating for at least 12 months, and 32 women had stopped natural menstruation and received hormone-replacement therapy for a period of at least 12 months. An equal number of age-matched premenopausal women in the study group served as controls. In women who had a natural menopause and did not receive hormone-replacement therapy, serum levels of high-density lipoprotein (HDL) cholesterol declined as compared with those of premenopausal controls (-0.09 vs. 0.00 mmol per liter; P = 0.01), and levels of low-density lipoprotein (LDL) cholesterol increased (+0.31 vs. +0.14 mmol per liter; P = 0.04). In menopausal women who received hormone-replacement therapy, HDL and LDL cholesterol levels did not change, but the levels of triglycerides (+0.42 vs. -0.04 mmol per liter; P less than 0.001), apolipoprotein A-I (+0.18 vs. +0.03 g per liter; P less than 0.01), and apolipoprotein A-II (+0.05 vs. -0.03 g per liter; P less than 0.05) increased as compared with premenopausal controls. Natural menopause did not affect blood pressure, plasma glucose or insulin levels, body weight, the total number of kilojoules consumed in the diet, or the total number of kilojoules expended in physical activity. These results suggest that a natural menopause has an unfavorable effect on lipid metabolism, which may contribute to an increase in the risk of coronary disease. Hormone-replacement therapy may prevent some of these changes.     

Sexuality of Chinese women around menopause

ObjectiveTo study the sexual activities and prevalence of sexual dysfunctions in midlife Chinese women and their correlations with demographic factors, sexual dissatisfaction and interpersonal difficulty.Study designThis is a cross-sectional survey of a convenience sample of women aged 40–60, who requested gynecological checkup or attend social activities at Women's Club.Main outcome measuresSexual activities, sexual dysfunctions, sexual dissatisfaction, demographic factors and interpersonal difficulty were assessed by self-administered questionnaire.ResultsAmong 371 eligible subjects, 22.4% and 39.6% women had low intimacy and coitus frequency (0 to <12 acts in one year), respectively. The odds ratios for low coital frequency in the natural menopausal and surgical menopausal subgroups were 3.00 and 5.09, respectively (95% confidence interval: 1.73–5.19 and 1.77–14.69, respectively). Overall, 77.2% women had at least one type of sexual dysfunctions; this proportion was highest in the surgically menopausal subgroup (88.9%) followed by the naturally menopausal subgroup (79.3%), the perimenopausal subgroup (78.2%) and the premenopausal subgroup (72.2%) (p = 0.003). No lubrication (42.9%) was the commonest sexual dysfunction and predominantly affected naturally and surgically menopaused women (p = 0.001). Sexual dysfunction was the major contributor to sexual dissatisfaction (0.80), followed by interpersonal difficulty (0.2). Arousal disorder was the pivot of interaction between sexual dissatisfaction, menopausal status and low coital frequency.ConclusionsChinese women had fewer intimate contacts and less coitus when menopause progressed. No lubrication was the commonest sexual dysfunction and predominantly affected menopaused women. Our model showed that sexual dysfunction is the main contributor to sexual dissatisfaction.