title: Sexuality during the climacteric period.
abstract: BACKGROUND
  Cultural, social, physiological and psychological factors may alter the course of sexual function in climacteric women.
  
  
  OBJECTIVE
  The objective of the present literature review is to survey the prevalence of sexual dysfunctions in the climacteric and to establish the association between the organic and psychic changes that occur during this phase and sexual dysfunction. We also discuss potential treatments.
  
  
  METHODS
  We evaluated the data available in PubMed (1982-2008). For each original article, two reviewers analyzed the data independently and considered a study to be of high quality if it had all three of the following characteristics: prospective design, valid data and adequate sample size. Both reviewers extracted data from each of the 99 studies selected: 34 cross-sectional studies, 25 cohort studies, 9 trials, 31 reviews related to sexuality in pre- and post-menopausal women.
  
  
  RESULTS
  Sexual dysfunction among climacteric women is widespread and is associated with bio-psychosocial factors. However, there is not enough evidence to correlate sexual dysfunction with a decrease in estrogen levels and biological aging. A strong association exists between climacteric genital symptoms and coital pain. There is, however, sufficient evidence demonstrating the benefits of local estrogen therapy for patients with genital symptoms.
  
  
  CONCLUSIONS
  A significant decline in sexual function occurs in climacteric women, although it is still unclear whether this is associated with the known decrease in estrogen levels or with aging, or both. Relational factors may interfere with sexual function during this phase. The climacteric genital symptoms improve with estrogen replacement therapy, and positively influence sexual function. Further studies are needed to establish the actual impact of the decrease in estrogen levels and of aging on the sex life of climacteric women.
authors.affiliation: Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, São Paulo University, Brazil-University Hospital, 14049-900 Ribeirão Preto, SP, Brazil. luciaalvess@yahoo.com.br
authors.forename: Lucia Alves
authors.initials: LA
authors.lastname: da Silva Lara
authors.forename: Bernardo
authors.initials: B
authors.lastname: Useche
authors.forename: Julio Cesar
authors.initials: JC
authors.lastname: Rosa E Silva
authors.forename: Rui Alberto
authors.initials: RA
authors.lastname: Ferriani
authors.forename: Rosana Maria
authors.initials: RM
authors.lastname: Reis
authors.forename: Marcos Felipe Silva
authors.initials: MF
authors.lastname: de Sá
authors.forename: Bruno Ramalho
authors.initials: BR
authors.lastname: de Carvalho
authors.forename: Maria Angela Cury Ramos
authors.initials: MA
authors.lastname: Carvalho
authors.forename: Ana Carolina Japur
authors.initials: AC
authors.lastname: de Sá Rosa E Silva
mesh_terms: D002979:Climacteric / Q000502:physiology* / Q000523:psychology; D005260:Female; D006801:Humans; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000628:therapy; D019529:Sexuality / Q000502:physiology / Q000523:psychology