How to address sexual dysfunction during menopause

Contemporary OB/GYN:

Can you describe your presentation at The Menopause Society 2023 Annual Meeting on sexual dysfunction?

James A. Simon, MD:

Sure. I'm Dr. Jim Simon, I'm a reproductive endocrinologist turned menopause and sexual medicine guru in Washington DC. My office is about five blocks from the White House, so you can imagine the challenging patients I see every day. My lecture here at The Menopause Society was about sexual dysfunction in menopausal women. It was an overview for the Menopause 101 basic learning class, and we talked about all the different changes across the women's lifecycle in their sexual interest, arousal, orgasm, and the changes that occur simply with age, but also impacted by menopause itself, and the hormonal changes that affect sleep, and physical problems like vaginal dryness, arousal, and orgasm. So, then I reviewed the 2 FDA approved products for low sexual desire and the impact of hormones, and in particular, the impact of testosterone, which is decreasing, since we're in our 20s and 30s, up until menopause, which continues until there's almost none left in the body, no testosterone left by about age 60, and about how we as practitioners can safely and effectively replace testosterone in menopausal women for all of its benefits on strength, lean muscle mass, but in this particular setting, on sexual function.

Contemporary OB/GYN:

What information can clinicians incorporate into their practice?

James A. Simon, MD:

So, the first is that sex is complicated, and there's a partner, but it doesn't mean it has to take a long time in the office, and it doesn't mean you won't be rewarded in many ways that clinicians are rewarded by taking the challenge on. So, a couple of pearls as they relate to menopausal women. First, menopausal women have sexual pain. No one's interested in doing something, in this case having sex, if there's pain. So, you got to eliminate the pain, and nearly every OBGYN or primary care doctor knows how to address vulvovaginal pain, maybe not as well as some, but the answer is you can ask a question. Are you having pain? Are you having dryness? And it's relatively straightforward to address. Once you've fixed any pain, or eliminate that as a possibility, then investigating whether there is decreased desire. And there are standardized forms that incorporate only 4 yes-no questions and 1 qualitative question that can answer whether this woman sitting there in front of you has a disorder related to low sexual desire and having distress about it. It takes about 1 minute to 90 seconds to do that. And if you've covered the pain, and you covered low desire, you covered the overwhelming number of women that have any sexual complaint at menopause. And if they don't have that, and there's more to it, I'd send them off to the local referral expert in your region of the country. And you've done your due diligence but do those 2 things and you've covered the majority of the landscape.

Contemporary OB/GYN:

Is there anything you would like to add?

James A. Simon, MD:

Most gynecologists, myself included, see patients once a year. And they, the patients, want every single problem put together, lumped together, packaged up together, answered, fixed along with their annual visit. It's not possible. These days, what I do, and it's really easy to do, you do their annual visit. You tell them, listen, I hear you. I've got the fact that you're having sexual pain, low desire problems with your husband, your boyfriend, your girlfriend, whatever. Let's take that on full force, and start at our next visit. Make an appointment for a problem visit having to do with sex, and I'll see you in 4 weeks, 3 weeks, 8 weeks, whatever the schedule allows, and we'll take that head on as a new issue unrelated to your healthy well woman visit.