Menopause Live - IMS Updates

Date of release: 29 August, 2011

Female sexual dysfunction is more than just a hormonal problem

Moghassemi and colleagues [1] have recently reported the prevalence of sexual dysfunction in Iranian postmenopausal women and its relationship to levels of estradiol, testosterone and sex hormone binding globulin (SHBG). This cross-sectional study was conducted in a clinical sample of 149 healthy, naturally postmenopausal women aged 43–64 years. Female sexual function was evaluated by utilizing the Female Sexual Function Index. Hormonal serum concentrations were measured by enzyme-linked immunosorbent assay (ELISA). The mean age of the women was 52.19 ± 3.76 years with 47.48 ± 36.5 months of amenorrhea. In the study, 69.8% of women showed sexual dysfunction in the Desire domain, 61.7% in the Arousal domain, 49.7% in the Lubrication domain, 45% in the Pain domain, 40.3% in the Orgasm domain and 36.9% in the Satisfaction domain. There was no difference between the two groups – with and without dysfunction – in hormone levels and SHBG. The authors concluded that, in Iranian postmenopausal women, desire and arousal are the most prevalent menopausal sexual dysfunctions, and female sexual dysfunction is much more than just a hormonal problem.


A large number of biological, psycho-relational and sociocultural factors are related to women’s sexual health and they may negatively affect the entire sexual response cycle, inducing significant changes in sexual desire, arousal, orgasm and satisfaction during the entire reproductive life span [2]. Natural menopause is associated with a high rate of sexual symptoms, with a variable prevalence across studies depending on several factors (for example, sample, design, symptomatology, sociocultural background) [3]. Age and menopausal transition may impair the integrity of multiple biological systems involved in the normal sexual response. On the other hand, several intrapersonal and interpersonal issues may also may affect feminine identity and quality of relationships which are equally important for expressing sexual feelings and behaviors [4,5].
Levels of sex hormones, mainly low levels of estradiol, are relevant for the lack of sexual awareness and vaginal receptivity in naturally menopausal women [6]. Even diminished levels of androgens, as more frequently occur in surgically menopausal women, have a negative impact on desire and sexual responsiveness [7]. However, sex hormones do not seem to correlate with the presence of female sexual dysfunction [8] because the sexual behavior of midlife and older women is highly dependent also on other factors such as general physical and mental well-being, quality of relationships and life situation. In addition, it is likely that, in routine practice, we do not use assays that are sensitive enough to detect small differences among groups of women or, alternatively, sex hormones play a role in the sexual function of menopausal women through other actions (i.e. intracrinology) [9]. It is important to underline that the data from Moghassemi and colleagues [1] are in line with many other reports in which desire and arousal disorders are the more prominent diagnoses worldwide [10,11]. Being aware that culturally dependent lifestyle factors significantly contribute to sexual attitudes across menopause, we believe that it is crucial to collect data from different countries in order to help clinicians to tailor strategies in line with women’s real needs. On the other hand, the evidence, that the rate of female sexual dysfunction is not so different among countries with extremely diverse cultures, underlines the importance of the organic impairment of sexual response at menopause and this deserves further attention for the better care of women.


Rossella Nappi
Gynecological Endocrinology & Menopause Unit, University of Pavia, Italy


  1. Moghassemi S, Ziaei S, Haidari Z. Female sexual dysfunction in Iranian postmenopausal women: prevalence and correlation with hormonal profile. J Sex Med 2011 Jun 15. Epub ahead of print.

  2. Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition. Fertil Steril 2002;77:S42-8.

  3. Nappi RE, Lachowsky M. Menopause and sexuality: prevalence of symptoms and impact on quality of life. Maturitas 2009;63:138-41.

  4. Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol 2000;96: 351-8.

  5. Dennerstein L, Dudley E, Burger H. Are changes in sexual functioning during midlife due to aging or menopause? Fertil Steril 2001;76:456-60.

  6. Nappi RE, Polatti F. The use of estrogen therapy in womens sexual functioning. J Sex Med 2009;6:603-16.

  7. Davis SR, Tran J. Testosterone influences libido and well being in women. Trends Endocrinol Metab 2001;12:33-7.

  8. Davis SR, Davison SL, Donath S, Bell RJ. Circulating androgen levels and self-reported sexual function in women. JAMA 2005;294:91-6.

  9. Wierman ME, Nappi RE, Avis N, et al. Endocrine aspects of womens sexual function. J Sex Med 2010;7:561-85.

  10. Avis NE, Zhao X, Johannes CB, Ory M, Brockwell S, Greendale GA. Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Womens Health Across the Nation (SWAN). Menopause 2005;12:385-98.

  11. Dennerstein L, Lehert P. Womens sexual functioning, lifestyle, mid-age, and menopause in 12 European countries. Menopause 2004;11:778-85.