Sexual dysfunction in women with premature menopause

Objective: To discuss assessment and management of sexual dysfunctions associated with premature menopause. Design: Literature review plus clinical observations. Results: Studies on assessment and management of sexual dysfunctions associated with premature menopause are minimal. Premature menopause affects sexual identity, sexual function, and sexual relationship. Major modulating factors include etiology, life cycle stage, factors personal to the woman, and family and societal influences. Loss of ovarian function in adolescence may delay psychosexual maturity via psychological and biological mechanisms. Maternity becomes impossible, unless ovodonation is feasible, accepted, and legally available. Loss of sexual desire, subjective and genital arousal, and orgasm may be highly distressing. Reduction of sex hormones and psychological reactions of both partners to the prematurity and infertility are etiologically important. Estrogen therapy is usually indicated, but long-term safety data in this population are lacking. Testosterone therapy, also lacking in safety data and mainly investigational, may be needed to restore sexual arousability. Presence, age, and sexual health of the partner, having children, and quality of intimacy in previous and present relationships modulate coping attitudes and clinical outcome. Conclusions: An interdisciplinary medical and psychosexual approach comprises individualized hormone therapy and specific psychosexual treatment(s). Research into optimal management of sexual dysfunction with premature menopause is urgently needed.