Sexuality during the climacteric period.
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.
da Silva Lara
Lucia Alves
LA
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
Useche
Bernardo
B
Rosa E Silva
Julio Cesar
JC
Ferriani
Rui Alberto
RA
Reis
Rosana Maria
RM
de Sá
Marcos Felipe Silva
MF
de Carvalho
Bruno Ramalho
BR
Carvalho
Maria Angela Cury Ramos
MA
de Sá Rosa E Silva
Ana Carolina Japur
AC
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