Author: Ridheeka Jhanvi Jeetooa
jhanvi2350@gmail.com
Abstract:
Menopause is a normal stage of every woman’s life but whether their experience is good or bad is dependent on several factors, such as their mental and physical health. However, hormonal changes are believed to be one of the major causes of the female sexual dysfunction (FSD)(Graziottin & Leiblum, 2005). The latter is a sexual dysfunction in women that causes sexual pain during penetration, low libido, problems with arousal, and difficulty having an orgasm. Thus, it is important for women’s well-being that the correlation between the pervasiveness of female sexual dysfunction (FSD) and menopause is investigated, as this would allow women to be more aware of their health and to quantify(Nathan, 1986) the dysfunction and this will allow the mitigation of the increased FSD rate in menopausal women, as well as to reduce the depression rate among menopausal women. Furthermore, with the correct diagnosis, practitioners would be able to choose an accurate treatment for the patient such as hormone therapy, psychological counseling or flibanserin, a medicinal drug for postmenopausal women (Thornton et al., 2015).
Keywords: Menopause, female sexual dysfunction, hormonal changes, estrogen, hormone therapy
Introduction:
Menopause is when a woman stops having her menstrual cycle which is usually from the loss of ovarian follicular activity(Erbil, 2018) and this leads to drastic changes in hormones as the estrogen level decreases, FSH(Follicle-Stimulating Hormone) and LH(Luteinizing Hormone) levels increase, and the levels of prolactin, thyroid and parathyroid hormone also decrease (Erbil, 2018). This is harmful for the health of women as comorbidities, influenced by the decrease in sexual hormone, become more common leading to desire and mood disorders, urogenital and sexual pain disorders which normally tend to be underreported or overlooked by clinical practitioners(Graziottin & Leiblum, 2005). Therefore, it is of utmost importance to emphasize that sexual dysfunction is mainly from different predisposing, precipitating, and maintaining factors(Graziottin & Leiblum, 2005). The precipitating factors are events, situations and comorbidity which directly cause dysfunctions and since menopause itself is a biological precipitating event, it’s side effects such as a decrease in progesterone and estrogen, contributes to the development of female sexual dysfunction(Graziottin & Leiblum, 2005).
Retaining a good sexual function is important for every woman as with the increasing life expectancy, women want a fulfilling and healthy life(Thornton et al., 2015). Since menopausal symptoms like decrease in estrogen and sexual dysfunctions can negatively affect the quality of life for women, it is important to discover the etiology and identify factors like menopause that influence sexual function as this would help in finding an appropriate treatment. As female sexual dysfunction is related to ageism and is extremely prevalent, affecting 30% to 50% of woman(Berman et al., 1999; McCool et al., 2016). Therefore, it is important to test whether the reduction of estrogen during menopause contributes primarily to FSD(Female Sexual Dysfunction) as the menopausal transition is identified as ‘the nexus of a variety of hormonal, physiological, emotional, psychosocial and relational changes that are associated with an increased risk for sexual dysfunction.’(Graziottin & Leiblum, 2005).
Aim:
To improve the knowledge and the amount of certified research available that would help us to understand both existing and concurrent female sexual dysfunction and to also develop treatments. To understand the correlation between menopause, estrogen and female sexual dysfunction.
Literature Review:
Vaginal dryness increases from early to late perimenopause and only slightly during post menopause; the lubrication and integrity of the vaginal tissues are impacted by both the decrease of androgen and estrogen(Dennerstein et al., 2000; Traish et al., 2002). Also, the pervasiveness of dyspareunia(painful intercourse) increases during menopause and is mainly due to vaginal dryness and low levels of estradiol(Sarrel, 1990). Therefore, since vaginal dryness depends on low levels of estrogen and the latter is mainly due to menopause, it can be said that the pervasiveness of female sexual dysfunction is mainly due menopause and that understanding the complex phenomenon of menopause, will help improve the sexual function of women as ‘in the Woman’s Healthy Ageing Project(WHAP) cohort, an extension of the Melbourne Woman’s Midlife Health Project, a significant decline from 74 to 56% in sexual activity(p<0.001) was reported between early postmenopausal woman and late menopausal woman’(Thornton et al., 2015, p. 2). Thus, a decline in sexual hormone like estrogen do lead to a decline in sexual activity and an increase in sexual dysfunctions and pelvic floor dysfunctions.
Methodology:
A population-based sample of 1000 women from the same country and having the same cultural background, transitioning through menopause; including premenopausal and postmenopausal women who do not smoke, do not consume alcoholic drinks, did not have a surgical menopause, not obese nor have any chronic diseases are taken for evaluation.
Sexual functioning in terms of satisfaction, frequency, desire, difficulty with orgasm, pain, level of estradiol, estrone, estrogen and follicle-stimulating hormone were measured and predictors variables like vasomotor symptoms, partner variable and lifestyle variables were also taken into consideration(Avis et al., 2000).
As a control, another 1000 young adult woman from the same country and cultural background are taken and their estrogen level and sexual functioning were measured like in a retrospective study.
The correlation between estrogen decrease with age(menopause) and sexual functioning (FSD-Female Sexual Dysfunction) is studied.
Prediction:
The level of estrogen that decreases during menopause contribute primarily to female sexual dysfunction.
Conclusion:
Female sexual dysfunction is more prevalent in menopausal women due to the decrease in sexual hormones like estrogen.
References:
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