Global view of vasomotor symptoms and sleep disturbance in menopause: a systematic review.

Studies have shown racial/ethnic differences in the prevalence of vasomotor symptoms (VMS), sleep disturbance and VMS treatment in menopause. To assess the reproducibility of these differences, we systematically reviewed observational studies, published in 2000-2021, reporting the prevalence/incidence of VMS, sleep disturbance or treatment use in menopausal women stratified by race/ethnicity. We screened 3799 records from PubMed and Embase and included 27 papers (19 studies). No incidence data were found. Prevalence data varied widely, but some common patterns emerged. In all five studies comparing VMS between Black women and White, Hispanic and/or East Asian women, the prevalence was highest in Black women and lowest in East Asian women. The prevalence of sleep disturbance overall was compared among Black, White and East Asian women in two study populations, and was highest in White women in both papers. Sleep disturbance was more common than VMS in East Asian women. In all four studies comparing hormone therapy use between White women and Black and/or East Asian women, treatment use was more common in White women. These results highlight the need for individualized counseling and treatment, outreach to under-served minorities, and standardized definitions and outcome measures for VMS and sleep disturbance for future studies.

The yin and yang of GSM and low sexual desire.

Numerous surveys have documented that sexuality and/or sexual activity is important to women at all stages of adulthood, including postmenopause. Genitourinary syndrome of menopause (GSM) and hypoactive sexual desire disorder (HSDD) are common disorders in postmenopausal women and may co-occur. Both are often undiagnosed due to a lack of knowledge of the disorder, health-care professional discomfort in discussing sexual problems or a lack of routine screening. It is incumbent upon health-care professionals to identify and differentiate these conditions in women through a biopsychosocial assessment, and may require a focused physical examination. Numerous treatments, both non-pharmacologic and pharmacologic, are available to address GSM and HSDD.

Sexual Function and Help-Seeking Behaviors following Childbirth: A Cross-Sectional Study.

This study examined 573 postpartum women's perceptions of changes in their sexual function and their help-seeking behaviors. Women residing in Ohio, Michigan, or Pennsylvania, USA, completed an online survey. Most women reported decreased postpartum sexual desire and/or arousal. Among women reporting decreased sexual function, most did not seek help from informal sources of support or health care professions (HCPs). Of those who did seek help from an HCP, in each domain of sexual function, only around half received helpful treatment. Women who did not seek help for their decreased sexual desire or arousal reported greater negative perceived impact of pregnancy/childbirth on their sexual function than women who did seek help.

Sexual function after cancer: paying the price of survivorship.

Sexual dysfunction is one of the most prevalent and distressing treatment side effects for millions of female cancer survivors, yet the majority of survivors do not receive necessary information, support, or treatment for these sexual consequences. Cancer can devastate the body and impair sexual function and body image. Furthermore, all primary modalities of cancer treatment (surgery, radiotherapy, chemotherapy, and hormonal therapy) have the potential to negatively impact sexual function. Assessment and identification by clinicians can be done efficiently and easily with short validated tools using a style of inquiry which starts by acknowledging how common sexual dysfunction is amongst cancer survivors rather than asking direct questions. Sexual concerns are impacted by psychological, biological, and interpersonal factors, and a multidisciplinary approach to treatment allows clinicians to comfortably inquire, assess, and refer if treatment is beyond their comfort or expertise.

Sexual well-being after menopause: An International Menopause Society White Paper.

Sexual well-being frequently declines following the menopause transition and can be associated with significant personal and relationship distress. This distress is the hallmark of female sexual dysfunction (FSD). FSD is highly prevalent in postmenopausal women. The prevalence of sexual problems increases with age, but conversely this is associated with decreasing distress with advancing age. This pattern has been seen across multiple international populations with varied cultural norms. While the etiology of FSD is multifactorial, the physiological changes of sex hormone insufficiency and postmenopausal symptoms, such as dyspareunia, are primary factors contributing to FSD at midlife. The International Menopause Society is working to increase awareness of FSD and to provide a framework for practitioners to address sexual medicine concerns. This White Paper aims to review the process of care for female sexual well-being following menopause, from initially approaching the discussion of FSD, to identifying clinical signs and symptoms, and ultimately determining the best available biopsychosocial therapies. As with most processes of care, the first step is often the most difficult. Health-care practitioners need to broach the topic of sexuality in the clinical setting. Lack of information on, comfort with, and biases about the topic of sexuality after menopause are significant hurdles that the International Menopause Society addresses in this document. Each member of the Writing Group remains committed to continued advocacy for the validity of FSD as a diagnosis, the need for therapies for women to be both available and included in health insurance coverage, and continued therapeutic research to provide evidence-based solutions.

Bienestar sexual después de la menopausia: documento técnico de la Sociedad Internacional de la Menopausia / Sexual well-being after menopause: document Technician of the International Menopause Society

El bienestar sexual frecuentemente disminuye después de la transición de la menopausia y puede asociarse con estrés personal y de la relación. Este estrés es la característica típica de la disfunción sexual femenina (DSF). La DSF es altamente prevalente en mujeres posmenopáusicas. La prevalencia de problemas sexuales aumenta con la edad, pero por otra parte, esto se asocia con una disminución del estrés con el avance de la edad. Este patrón se ha visto en múltiples poblaciones internacionales con variadas normas culturales. Si bien la etiología de la DSF es multifactorial, los cambios fisiológicos de la insuficiencia de las hormonas sexuales y los síntomas posmenopáusicos, como la dispareunia, son los principales factores que contribuyen a la DSF en la mediana edad. La Sociedad Internacional de Menopausia está trabajando para incrementar el conocimiento de la DSF y proporcionar un esquema para que los profesionales aborden las preocupaciones sobre medicina sexual. El presente documento técnico tiene como objetivo revisar el proceso de cuidado del bienestar sexual femenino después de la menopausia, desde un abordaje inicial de la discusión de DSF hasta identificar signos y síntomas clínicos y, en última instancia, determinar las mejores terapias biopsicosociales disponibles. Al igual que con la mayoría de los procesos de atención, el primer paso es a menudo el más difícil. Los profesionales de la salud necesitan abordar el tema de la sexualidad en el entorno clínico. La falta de información, comodidad al respecto, y los prejuicios sobre el tema de la sexualidad después de la menopausia son obstáculos importantes que la Sociedad Internacional de Menopausia aborda en este documento; cada miembro del grupo que lo escribe sigue comprometido con la defensa continua para la validación de la DSF como un diagnóstico, la necesidad de que las terapias para mujeres estén disponibles e incluidas en la cobertura del seguro de salud, y la investigación terapéutica continua para proporcionar soluciones basadas en la evidencia.

Female sexual function improved with ospemifene in postmenopausal women with vulvar and vaginal atrophy: results of a randomized, placebo-controlled trial.

BACKGROUND: Ospemifene is a non-estrogen, tissue selective estrogen receptor agonist/antagonist, or selective estrogen receptor modulator, recently approved for the treatment of dyspareunia, a symptom of vulvar and vaginal atrophy (VVA), due to menopause. Postmenopausal dyspareunia is often associated with female sexual dysfunction (FSD). In this report, we present data that demonstrate the effect of ospemifene 60 mg/day on FSD assessed by the Female Sexual Function Index (FSFI), a widely used tool with six domains (Arousal, Desire, Orgasm, Lubrication, Satisfaction, and Pain). METHODS: A phase-3, randomized, double-blind, 12-week trial (n = 919) compared the efficacy and safety of oral ospemifene 60 mg/day vs. placebo in postmenopausal women with VVA in two strata based on self-reported, most bothersome symptom of either dyspareunia or dryness. Primary data were published previously. We report herein pre-specified secondary efficacy endpoints analyses, including changes from baseline to Weeks 4 and 12 for FSFI total and domain scores as well as serum hormone levels. RESULTS: Ospemifene 60 mg/day demonstrated a significantly greater FSFI total score improvement vs. placebo at Week 4 (p < 0.001). Improvement in FSFI scores continued to Week 12 (p < 0.001). At Week 4, the FSFI domains of Sexual Pain, Arousal, and Desire were significantly improved with ospemifene vs. placebo; at Week 12, improvements in all domains were significant (p < 0.05). Changes in serum hormones were minor and uncorrelated with changes in sexual functioning. CONCLUSION: In a large, randomized, double-blind, placebo-controlled trial, ospemifene 60 mg/day significantly improved FSD in women with VVA. Consistent effects across FSFI domains were observed.

The testosterone patch for women.

Has the FDA discriminated against female sexual dysfunction by not endorsing Procter & Gamble's (P&G) Intrinsa? Has the pendulum swung so far to the right that drugs for sexual medicine receive undue scrutiny? Why is testosterone replacement therapy available for men, but not for women? How should the pharmaceutical industry proceed with future studies? How should clinicians guide their patients? In this third and final perspective regarding Intrinsa, Sheryl Kingsberg, PhD, an expert on female sexual dysfunction and one of the lead investigators of the Intrinsa clinical trials, addresses these questions. This is a highly charged issue that appears to be on the agenda for the foreseeable future.

A comprehensive approach to enhancing sexual health education in the Case Western Reserve University School of Medicine.

We report on the Sexual Health Curriculum Enhancement project at Case Western Reserve University School of Medicine. Using a US dollars 100000 grant from Pfizer Pharmaceuticals, Inc., we have developed and are in the process of implementing a comprehensive, cross-disciplinary and innovative curriculum that is based on three primary objectives for teaching sexual health: attitude change, behavior change, and knowledge acquisition. Five general strategies to incorporate specific sexual health content into the medical school curriculum have been implemented: (1). Faculty Development; (2). Additional Didactics; (3). Cased-Based Learning; (4). Testing and Assessment; and (5). Electronic (Computer/Web-Based Enhancements).

Clinical approaches to women's sexual dysfunctions.

OBJECTIVES: (1) to delineate the female sexual dysfunctions; (2) to present methods of identifying and treating female sexual problems or concerns.

The psychological impact of aging on sexuality and relationships.

Aging has a powerful impact on the quality of relationships and sexual functioning. The psychological impact of aging after midlife is a particularly timely topic given improved medical and psychological understanding of sexuality in both women and men, as well as more effective treatment for age-related sexual dysfunctions. It is time to dispel the stereotype of the midlife relationship as the continuation of a traditional heterosexual marriage with grown or almost grown children in order to more effectively address emotional and sexual issues arising in relationships. Regardless of the length or nature of the relationship, however, its quality is enhanced by emotional intimacy, autonomy without too much distance, an ability to manage stress and distractions by external factors, and achieving a satisfying sexual equilibrium. Perception of the quality of the primary relationship and sexuality is influenced by the other factors in a person's life. Thus, the relationship must be examined and issues must be addressed taking these external factors into consideration. Among the most powerful external factors is one's occupation or avocation, as it tends to strongly influence one's sense of identity, self-esteem, and self-worth in all areas of life. To understand and treat effects of aging on sexuality, it is important to address the three components of sexual desire: drive, beliefs/values, and motivation, as well as the sexual equilibrium within the primary relationship. It is also essential to understand how the physiological changes in male and female sexual functioning affect desire and equilibrium. Other health-related changes that occur with aging must be recognized and addressed, including the fact that the oldest of old women will outlive their corresponding male cohort. Treatment implications for these issues are discussed.

Embryo donation programs and policies in North America: survey results and implications for health and mental health professionals.

OBJECTIVE: To use survey results from Society of Assisted Reproductive Technology to describe program policies regarding embryo donation, report protocols used for the disposition of cryopreserved embryos, and discuss clarification of guidelines governing ethical and psychosocially informed embryo donation. METHOD(S): A 66-item questionnaire was sent to the 312 Society of Assisted Reproductive Technology programs, generating 108 responses. RESULT(S): Seventy-eight (72%) of 108 programs offer embryo donation. Forty (37%) have actually performed donation, with 246 cycles completed and 53 "take-home babies." Disposition agreements for donors address divorce (92%) and death (90%). Only 28% require that potential donors undergo psychologic evaluation. Ninety-five percent of programs do not compensate donors. Seventy-one percent require a complete medical and psychologic history and 10% require genetic karyotyping. Three percent limit the number of donations. Eligible recipients include married couples (100%), unmarried couples (61%), lesbian couples (55%), and single women (59%). Sixty-four percent of programs require psychologic screening. Storage limits range from 2-10 years. Forty-nine percent of programs have unclaimed embryos in storage. CONCLUSION(S): Embryo donation is more often contemplated than performed. Variability in program procedures and policies suggests that guidelines need to be clarified. The complexity of the psychosocial and ethical issues underscores the importance of a routine, comprehensive psychologic assessment.

Postmenopausal sexual functioning: a case study.

Most men and women remain sexually active into mid-life and beyond. However, sexual functioning in peri- and postmenopausal women, and their partners, is widely variable. Somatic symptoms, psychological issues, partner's physical, psychological, and relationship status are all important to one's perceived quality of life, and may greatly affect sexuality. These wide-ranging influences complicate assessment, diagnosis, and subsequent management of sexual problems. A number of factors influence sexual functioning in menopausal women. There are age-related changes that are unrelated to menopause, which include changes in drive, body image, and general health status. Beliefs about menopause and sexuality impact sexual functioning in women. Changes in relationship status and the physical health of a partner may also influence sexuality. Physiologic changes, directly related to menopausal hormone changes, often impact sexual functioning, both directly and indirectly. Health care providers can play an important role in treating sexual problems and enhancing sexuality in aging patients. Effective evaluation will result in accurately determining the source(s) of an individual's or a couple's sexual dysfunction. Treatment may include the following: basic education about sexuality and sexual functioning, normalizing sexual activity in aging adults, medical management of symptoms or problems that are interfering with sexual desire or activity (such as HRT for vaginal atrophy or in reduction of hot flashes), referral for treatment of the partner's physical or psychological problem, and/or sex therapy to treat a sexual dysfunction or to manage a chronic physical problem that requires a change in a person's or couple's typical sexual repertoire. This paper includes a detailed case history of a couple to illustrate the concepts mentioned above.

Books helpful to patients with sexual and marital problems: a bibliography.

The aim of this project was to develop a current, problem-focused list of books helpful to patients with sexual and/or marital problems. Survey forms requesting respondents to list books helpful to patients with specific marital/sexual problems were sent to all members of the Society for Sex Therapy and Research (SSTAR) and the clinical members of the Society for the Scientific Study of Sex (SSSS). Of 933 forms, 170 (18%) were returned. Responses were verified for accuracy and a full citation was developed for each. Tabulations of responses were calculated and a bibliography developed.

Cerebral lateralization of familiar and unfamiliar music perception in nonmusicians: a dual task approach.

In a dual task procedure that controls for attentional trade-off effects, asymmetrical interference effects were observed in dual task conditions of finger tapping and concurrent processing of familiar and unfamiliar music. Laterality effects suggested that perception of orchestral presentations is largely lateralized to the left hemisphere in both males and females. In a second dual task condition of vocalization and music processing, both males and females displayed interference in speech production during concurrent music processing. Males showed greater left hemispheric interference effects during simultaneous vocalization and music processing.

Cerebral lateralization of music perception in the dual task paradigm: unfamiliar melody recognition in sinistrals.

A dual task study of unfamiliar music perception during concurrent right and left hand finger tapping was conducted with a group of left-handed non-musicians. A pattern of symmetrical, bilateral suppression of finger tapping was observed during a concurrent music task of unfamiliar melody recognition. There was no evidence of trade-off effects in the dual task inasmuch as no interference in melody recognition was observed. The absence of attentional shifts strongly suggests that the bilateral symmetry in motor performance in the dual task condition reflects bilateralized cerebral organization among sinistrals for processing unfamiliar music.

The effects of concurrent vocalization on foot and hand motor performance: a test of the functional distance hypothesis.

The effects of concurrent vocalization on hand and foot motor performance were examined in two dual-task experiments as a test of the functional distance hypothesis. No interference effects were found with either hand or foot tapping under two difficulty levels of verbal activity. There was no evidence of differential or asymmetrical interference patterns despite the differential functional and anatomical distances of these motor centers from the speech centers. Consequently, the data provided no support for the functional distance hypothesis.