Confronting the challenges: Epidemiological study of female sexual dysfunction and the menopause

Introduction. Despite rapid current and anticipated growth in the number of women who will spend a substantial portion of their life span in the postmenopausal period, the nature, incidence, and prevalence of changes in sexual function during and after the menopausal transition remain poorly characterized. Aim. Challenges inherent in studying the menopausal transition and proposed additions and changes that have emerged from recent consensus conferences on female sexual dysfunction are reviewed. Methods. Specific topics related to female sexual dysfunction were presented in a Postmenopausal FSD Roundtable in which multidisciplinary international experts participated. Main Outcome Measure. Expert opinion was based on a review of evidence-based medical literature, presentation, and internal discussion. Results. Knowledge concerning sexual function in the menopause is limited, in part, due to the difficulty in designing and conducting studies that adequately address these changes over time, and which also permit the effects of menopause to be distinguished from more general changes associated with aging. Moreover, the study of female sexual function and dysfunction is in the midst of significant transition: a tentative definition of the stages of reproductive aging and menopause has recently been advanced, and a set of comprehensive changes to the diagnostic framework that defines female sexual dysfunction is under review. Conclusions. In spite of fast-moving changes in this field of study, it is possible to reach some tentative conclusions about how women's sexual function changes after menopause: postmenopausal women report a relatively high rate of sexual dysfunction (higher than men). There is a marked decline in sexual interest and frequency of sexual activity. This decline can be ameliorated by a number of psychosocial factors, although vaginal dryness and dyspareunia seem to be driven primarily by declining estradiol. The effects of menopause appear to be incremental and additional to those characteristic of aging.