Kao and colleagues  have recently reported the extent to which levels of estrogens and progesterone, vulvovaginal atrophy, cognitive-emotional factors, and dyadic adjustment are predictive of the intensity of postmenopausal dyspareunic pain. This study was conducted in a final sample of 182 postmenopausal women aged 45–78 years screened by a telephone interview who received a remuneration to undergo a structured interview concerning sociodemographic status as well as medical and pain histories, gynecological examination, cytological evaluation, a blood draw, and to answer a series of self-report questionnaires to measure pain experience, mood (anxiety and depression) and relationship adjustment and satisfaction. Both natural ([i]n[/i] = 153) and surgical ([i]n[/i] = 29) menopausal women were included, as well as those using different forms of hormone therapy.
Hormone levels were not found to be consistent predictors of pain severity. Maturation value and cognitive-emotional variables (e.g. catastrophization, depression, anxiety) were significant predictors of vestibular pain, which affected over 90% of the women. Relationship adjustment variables were inversely associated with pain severity within several genital locations.
The authors concluded that the traditional hypoestrogen and vulvovaginal atrophy conceptualization of postmenopausal dyspareunia is an insufficient explanatory model, and that pain is also influenced by cognitive, affective, and dyadic factors.
Gynecological Endocrinology & Menopause Unit, University of Pavia, Italy
Kao A, Binik YM, Amsel R, et al. Biopsychosocial predictors of postmenopausal dyspareunia: the role of steroid hormones, vulvovaginal atrophy, cognitive-emotional factors, and dyadic adjustment. J Sex Med 2012;9:2066-76.
Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Juliá MD. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005;52(Suppl 1):S46-52.
Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol 2000;96:351-8.
Sturdee DW, Panay N; International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric 2010;13:509-22.
Nappi RE, Polatti F. The use of estrogen therapy in womens sexual functioning. J Sex Med 2009;6:603-16.
Nappi RE, Albani F, Santamaria V, et al. Hormonal and psycho-relational aspects of sexual function during menopausal transition and at early menopause. Maturitas 2010;67:78-83.
van Lankveld JJ, Granot M, Weijmar Schultz WC, et al. Womens sexual pain disorders. J Sex Med 2010;7:615-31.
Goldstein I, Alexander JL. Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. J Sex Med 2005;2(Suppl 3):154-65.