AB029. Meeting sexual health requirements in menopause

Many underlying psycho-physiological complexities can alter the normal manifestation of sexual responses in women. While these factors may be hormonal changes associated with pregnancy or lactation, medical or surgical debilitating illnesses, relationship issues or socio-cultural and environmental factors, a major hallmark along the life stages is menopause per se. The transition from reproductively active period to menopause is the key to a variety of physiological, psychological, functional and relationship adjustments and associated sexual difficulties. Particularly, the rapid hormonal descent during menopause appears to be the basis for personal distress in approximately 50% of women presenting with female sexual dysfunction (FSD) in their late fifties and beyond. Abrupt oestrogen decline in the postmenopausal period can lead to vaginal epithelial atrophy, dryness and pain in addition to negative impacts on sexual response and satisfaction. For this reason, surgical menopause is even more likely to precipitate FSD than a natural menopause. The interventional approaches require to be appropriately tailored to reduce the hormonal loss and level of personal distress in women going through this inevitable life-time adjustment. Although emotional, social and cultural taboos or boundaries may exert a significant impact on how Asian women react to sexuality in aging, a multitude of other factors warranting clinical attention is likely to co-exist in these older women. Therefore, integrating counseling and therapy with respective medical interventions for the predisposing and/or co-morbid conditions would optimize clinical outcomes for both the patient and her partner. Renewed emphasis through DSM V classification envisages a pro-active approach so that these women will continue to lead a healthy and fulfilling life, well beyond menopause. Therapeutic intervention classically uses hormonal treatment - estrogen as the mainstay and although evidence-based therapeutic relief with testosterone (in desire or interest disorders) is demonstrable, it remains non-FDA approved. Promising drugs include Flibanserin for efficacy in hypoactive sexual desire disorder (HSDD) in view of its preferential affinity for serotonin 5-HT (1A agonist and 2A antagonist) and dopamine D receptors and the new SERM, Ospemifene, which is FDA approved for dyspareunia and in the clinical management of genitourinary syndrome of menopause. While the future promises pharmaco-therapeutic advancements through several drugs in pipeline, it is imperative to ensure that the concomitant psychosocial or cultural limitations are also holistically addressed.