Survey: Sexual Dysfunction with Menopause Neglected

A large majority of postmenopausal women experienced painful intercourse, vaginal dryness, itching or irritation, but only a small percentage asked for treatment, according to a small survey presented at the North American Menopause Society annual meeting in Orlando -- apparently because they waited in vain for their physician to bring it up.

Eighty-one percent of women were unaware that vulvar and vaginal atrophy was a medical condition, and 42% of respondents simply considered it "a normal part of aging," reported Sheryl Kingsberg, PhD, of University Hospitals in Cleveland, and colleagues.

But while 89% reported experiencing painful intercourse and vaginal dryness, and 70% had experienced vaginal itching and irritation, only 7% of women reported ever using prescription hormone therapy (defined as local estrogen creams, tablets, inserts, or oral selective estrogen receptor modulators). Only a quarter had even used over-the-counter remedies, such as moisturizers and lubricants.

Half reported never using any treatment. In addition, nearly three-quarters of those who did not seek treatment had never discussed their symptoms with a healthcare professional.

While not involved with the research, sexual medicine specialist Lauren Streicher, MD, of Northwestern University, said that women do not make a separate appointment to discuss these symptoms. Because they are already there for a problem visit or an exam, doctors have so many other issues that need to be addressed during the visit, she said.

"We have this enormous unmet need and we have this enormous population who is not seeking treatment," Streicher told MedPage Today. "Millions of women are truly having a hard time with this and it's this bizarre combination of don't ask, don't tell, don't treat."

The EMPOWER survey -- funded by TherapeuticsMD, which sells women's health products -- was conducted via the Internet, and participants were comprised of 1,858 postmenopausal women ages 45 and older. The median age of participants was 58 years, and they were mostly white, college-educated and married. These women were also provided compensation of approximately $10 for their participation in the survey.

A substantial portion of women appeared to be looking to their doctor for guidance about this issue. About two-thirds of participants said they would consider using hormone therapy if properly educated, informed, and if it was recommended. In addition, when asked about preferred sources of information about their symptoms and treatment options, 46% preferred receiving material from a healthcare provider's office, while 41% preferred to fill out a questionnaire before talking to the healthcare provider.

But while respondents said that around a quarter of the time, their healthcare providers (mostly gynecologists) recommended hormone therapy, 85% of these discussions were initiated by the woman.

Streicher said that another reason doctors do not bring up these topics is they do not feel comfortable discussing them with their patients. In that case, she recommends referring the patient to a provider who is more familiar with the subject.

"You may not feel comfortable treating this, but you can identify this in your patients and refer them to someone who might be able to help them," she noted. "But I think this is really a call to action – a call to say this problem exists and patients want to talk about it."

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