Clinical Crossroads Update
January 7, 2009

Update: A 60-Year-Old Woman With Sexual Difficulties

JAMA. 2009;301(1):94. doi:10.1001/jama.2008.932

In a Clinical Crossroads article published in February 2007,1 Jennifer E. Potter, MD, discussed the impact of menopause on female sexuality, the pathophysiology of female sexual dysfunction, and the available treatment options. Ms B, a happily married 60-year-old postmenopausal woman, described the sexual relationship with her husband as an important part of her marriage. After reaching menopause at the age of 58 years, Ms B underwent bladder suspension surgery for incontinence and hysterectomy for uterine fibroids. Following these surgeries, she began experiencing vaginal dryness and noticed her desire for intimacy had decreased. She also found that it was more difficult for her to achieve an orgasm. At that time, Ms B was treated with esterified estrogen, 0.625 mg/d, and methyltestosterone, 1.25 mg/d. These hormones improved her symptoms but were discontinued because of concerns about adverse effects. She was later treated with an estradiol vaginal ring. While this helped her vaginal dryness, it did not increase her desire. Ms B wondered what she and her husband could do to revitalize their sexual relationship—whether there were medications she could take or lifestyle changes she could undergo to improve her sexual function.

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