Evaluation and Treatment of Sexual Dysfunction in an Older Woman

Sexual concerns and problems have drawn increased attention from health care providers and the general public in the last decade, in part due to the publicity surrounding Viagra, approved in 1998. Most research in the area of assessment and treatment of sexual dysfunction has targeted men. A Medline search of the term “sexual dysfunction” retrieves 9000 citations addressing female dysfunction as compared with 17,000 addressing male dys­ function. in contrast, according to the results of the national Health and Social life Survey, 43% of American women re­ ported having a sexual problem versus 31% of men [1]. There are a number of reasons why there is significantly less research addressing sexual dysfunction in women as compared with men. One of the most important reasons is the difficulty in measuring appropriate endpoints. Until re­ cently, there have been few sensitive, specific, and validated outcome measures for assessing female sexual desire and arousal. in contrast, assessment of male arousal (ie, erections) is relatively straightforward. in addition, there is significant overlap among the female sexual dysfunction disorders, making diagnosis and treatment approaches more difficult. Current models for understanding the female sexual response reflect its complicated and multifactorial nature. A model for female sexual response developed by Basson [2] acknowledges the importance of emotional intimacy, psychologic factors, and sexual stimuli in the female sexual cycle as well as posits that arousal often precedes desire (Figure). This model updates the traditional linear models of Masters and Johnson and Kaplan [3], in which desire precedes arousal. levine’s [4] conceptualization of desire as comprised of drive (spontaneous biologically driven sexual interest), beliefs/values, and psychologic motivation further amplifies the complexity of desire. Research suggests that while both men and women experience a normal gradual decline in sexual interest and response with age, the majority of postmenopausal women consider sexuality to be an important aspect of their lives. However, many factors can affect women’s sexuality The following article, “Evaluation and Treatment of Sexual Dysfunction in an Older Woman” is a con­ tinuing medical education (CME) article. To earn credit, read the article and complete the CME evalu­ ation on pages 119 and 120.