Sexual problems among women in the climacteric period in clinical practice

Perimenopausal period is often associated with disorders of mental condition and sexual activity in women. The cooperation of hormones: estrogen, progesterone and testosterone is responsible for physiological sexual reaction. Physiological model of sexual response includes: phase of sexual arousal, orgasm and phase of decreasing sexual excitation. Female sexual dysfunction is a multicausal and multidimensional problem combining biological, psychological and interpersonal determinants. A lot of physiological systemic changes occur in female body at the age of 40. They might have a negative influence on the general sexuality. The causes of sexual dysfunctions are varied. They are described as the decrease in hormones level, especially in estrogens and androgens, systemic chronic diseases, urological, gynaecological, neurological diseases and medicines used. The American Psychiatric Association (DSM-IV) developed a new classification system for female sexual dysfunction that included psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. The patient’s routine physical examination is a key aspect of the screening process to detect possible sexual dysfunction. A routine examination includes: medical history of a patient, physical examination with gynaecological one and diagnostic investigations. According to the Society of Obstetricians and Gynaecologists of Canada, hormonal and non-hormonal treatment is recommended for sexual dysfunctions. Hormonal pharmacotherapy consists of estrogen replacement therapy and androgen therapy. Non-hormonal treatment is divided into: small doses of antidepressive drugs, selective serotonin reuptake inhibitors (SSRIs), regular sexual activity, masturbation methods as well as individual, family and group psychotherapy.