FEMALE SEXUAL DYSFUNCTION
The most frequent is the Hypoactive Sexual Desire Disorder (TDH), which affects nearly to 30% of women up to 49 years of age and increases to 42% in women with menopause. About one in three women have some sexual dysfunction.
The TDSF consists in the persistent or recurrent absence of sexual fantasies and, or sexual activity that causes a personal anguish. The testosterone deficiency is linked to the decrease of the feeling of well-being, greater depression, the reduction of the sexual desire, the receptivity and sexual arousal.
Surgical menopause (removal of ovaries) causes the drastic fall of around 50% of testosterone levels, these women being the group most at risk of developing TDSH.
The problems of female sexual dysfunction have a high prevalence, up to 30% of women suffer them, being the main cause the lack of sexual desire, which manifests itself in 16% of women up to 49 years old and increases until the 42% from 50 years old.
The Hypoactive Sexual Desire Disorder (TDSH) consists in the persistent or recurrent absence of sexual fantasies and / or sexual activity desires that cause personal anguish and interpersonal relationship problems. Lack of sexual desire: first cause of dysfunction.
Types of dysfunction:
Sexual Desire Disorder
All these disorders are often related to each other and have a great psychic and physical impact on women.
Female Sexual Dysfunctions (FSD) are classified as Hypoactive Sexual Desire Disorder, Disorder of Excitement and Orgasm Disorder and its prevalence in Europe coincides with that of the USA, standing at between 27% and 30%, being the first cause in Europe the lack of sexual interest; the second cause, the problems of orgasm; the third cause, the problems of lubrication and the fourth, the pain problems when having sex.
Today we know that certain sexually transmitted diseases, urinary incontinence and emotional problems coexist with a clear increase in the problem of female sexual dysfunction and, vice versa, the problem of female sexual dysfunction has clearly been found to coexist with greater problems of dissatisfaction. sexual.
Women with a risk factor for suffering TDSH are hysterectomized, those who take antidepressants and those who suffer from urinary incontinence. Surgery to remove the ovaries and uterus, taking certain drugs and incontinence are the greatest risk of developing TDSH.
What is sexual dysfunction: It is considered a pathology, a disorder, which occurs when there is a significant change in the person’s habitual sexual behavior: thoughts diminish or disappear, sexual fantasies are postponed or relationships are avoided, an inability to enjoy, there is no satisfaction and this creates discomfort and personal concern because it affects the quality of life and personal relationships.
It supposes a loss of sexual desire in a significant, recurrent and persistent way, sometimes the loss is progressive but in most cases there is a sudden loss of desire, a total absence of sexual desire with a lot of worry and discomfort because women refer feel bad and seek solutions to their problem by first consulting their gynecologist, «explains sexologist and clinical psychologist Rosario Castaño, Director of the Female Sexual Dysfunction Unit of the Palacios Institute for Women’s Health Medical Center.
Impact of DSF on quality of life: Lack of desire is one of the most common disorders especially in women with surgical menopause and those who have significant menopausal symptoms. This disorder does not usually remit without treatment and is one of the causes of more frequent medical consultation.
Sexual disorders and especially Hypoactive Sexual Desire Disorder affect self-image and quality of life, because women perceive themselves and feel less feminine, with low self-esteem, insecure and worried, this affects their quality of life and your relationship These women with sexual dysfunction are more at risk of worsening their quality of life because they have little physical satisfaction and little emotional satisfaction.
Relationship between TDSH and menopausal women: The natural menopause and especially the surgical menopause have an important impact on women’s health, it implies an important hormonal change and its consequences on general health and sexuality is being carefully studied, both the perception that women have about their sexuality, the changes they perceive and the demand they are having in the medical consultations.
The most frequent symptoms that women present at the stage of natural or surgical menopause are usually: hot flushes; humor changes; loss of energy; genitourinary problems; sexual problems 14% of menopausal women are hysterectomized.
The role of testosterone: From the hormonal point of view progress has been made in the knowledge of the relationship of hormones and menopause. If until now he had focused on the role of estrogen, several clinical studies have shown the important role of testosterone levels.
Testosterone plays a fundamental role and is directly related to sexual desire and sexual motivation. Testosterone is the only hormone that has a clear relationship with these aspects of female sexual function.
There are two differentiated symptoms in menopause depending on the deficiencies of estradiol (estrogens) or testosterone. Thus, estradiol deficiency is related to hot flashes, sweating, mood swings, sleep disturbance and vaginal dryness, the latter is very important for a successful sexual relationship.
To date, testosterone deficiency has not been given importance, however, it must be given as it is directly related to the decrease in the sense of well-being, greater depression, reduction of sexual desire, receptivity and sexual arousal.
Advances in the diagnosis and treatment of TDSH:
To date there are effective diagnostic tests to detect TDSH.A significant advance is the validation of sexuality questionnaires approved by the Food and Drug Administration (FDA) to detect women who have problems sexual
These questionnaires have already been validated for application in Spain. They consist of two types of questionnaires: one to detect women suffering from sexual dysfunction and the other, to detect within the group with sexual dysfunction what this situation causes them concern, to be able to talk about the disorder and establish a diagnosis of sexual dysfunction. woman has to have sexual problems, but that they worry and want to improve.
The treatment of the diagnosis of TDSH has two components: a pharmacological treatment and a psychosocial treatment. There are patients who will be able to benefit from new treatments, such as the new treatment of the testosterone patch through which the lowest doses of testosterone are applied and it has been demonstrated in clinical trials great efficacy and safety. It was marketed under the name of intrinsa. But the Intrinsa patches were removed in Europe for commercial reasons in October 2012.
The Intrinsa patches contain the active ingredient testosterone, which is the same as the sex hormone that occurs naturally in both men and women.
Testosterone is known as an androgen (male hormone). In women, the ovaries also produce it in small amounts.
The ovaries also produce large amounts of the female sex hormone estrogen (estriol, estrone and estradiol) and progesterone (the main progestin), other gestagens are pregnanediol and pregnenolone, in varying amounts, depending on the time of the menstrual cycle, throughout its fertile age, which is declining in the climacteric, until menses ceases during menopause.
Estrone is the predominant estrogen which is increased by peripheral change of especially adrenal androgens, but is 10 times less potent than estradiol.
In both sexes, the precursor hormones (specifically testosterone) are converted by aromatization to estradiol. In particular, adipose tissue is active in converting precursors to estradiol, and continues to do so even after menopause. Estradiol is also produced in the brain and arterial walls.
The effect of estradiol (and other estrogens) on male reproduction is complex. Estradiol is produced in the Sertoli cells of the testes, comes from the aromatization of testosterone to estradiol. Its function is to prevent apoptosis of male sperm cells.
Several studies have noted a decrease in sperm counts in several parts of the world, and exposure to estrogens in the environment has been postulated as the cause.The suppression of estradiol production in a subpopulation of subfertile men could improve the semen analysis.
There are other non-hormonal means such as isoflavones, of plant origin (phytoestrogens) to alleviate the symptoms of menopause, due to its estrogenic activity, its use has spread.
After numerous investigations it was possible to verify that the dietary behavior of the population traditionally consuming phytoestrogens (in China) translated into a delay and fewer disorders linked to the menopause.