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Screening and Management of Female Sexual Dysfunction During the Second Half of Life

Abstract:

Female sexual dysfunction (FSD) includes different disorders that are highly prevalent in perimenopausal and older women which require precise diagnosis and management. Screening of FSD should be based on clinical history and the use of screening tools such as the 14-item Changes in Sexual Functioning Questionnaire, the 19-item Female Sexual Function Index (FSFI-19) and its short version (FSFI-6), or the Decreased Sexual Desire Screener. The clinical exam should include the assessment of menopausal symptoms, vulvovaginal atrophy, and comorbidity including pelvic floor disorders, endocrine disorders, depressive symptoms, cancer diseases, and chronic medication use that may interfere with sexuality. The management of genito-pelvic pain/penetration disorders includes the appropriate treatment of the genitourinary syndrome of menopause, urinary incontinence, and pelvic floor disorders with appropriate selection for surgery and/or other treatments. The management of female sexual interest/arousal disorder (also known as hypoactive sexual desire disorder) may include systemic or topical steroid hormone therapy, including dehydroepiandrosterone sulfate, central-acting agents (flibanserin, bupropion, bremelanotide), and/or natural remedies (Tribulus terrestris, Trigonella foenum-graecum). Female orgasmic disorder may be managed by conductual methods and/or drugs.