Hormone replacement therapy

Hormone replacement therapy (HRT) has the ability to improve a woman's sexual satisfaction.^[17] Estrogens are responsible for the maintenance of collagen, elastic fibers, and vasoculature of the urogenital tract, all of which are important in maintaining vaginal structure and functional integrity; they are also important for maintaining vaginal pH and moisture levels, both of which aid in keeping the tissues lubricated and protected.^[1] Prolonged estrogen deficiency leads to atrophy, fibrosis, and reduced blood flow to the urogenital tract, which is what causes menopausal symptoms such as vaginal dryness and pain related to sexual activity and/or intercourse.^[1] It has been consistently demonstrated that women with lower sexual functioning have lower estradiol levels.^[1]

Even though estrogen replacement therapies (ERT) and HRTs have been shown to be effective for the treatment of vaginal atrophy, there has not been consistent evidence to suggest that these therapies increase sexual desire or sexual activity; therefore, many women with sexual dysfunctions remain unresponsive.^[22] There are two broad categories that address the management of sexual well being during menopause: pharmacological treatments that focus on correcting these difficulties, and psychological interventions. Because of the complexity of the female reproductive system, which includes a psychological aspect, it is not surprising that a female Viagra has not been found to work in women. Both the treatment and management of sexual functioning during the menopausal period should be unique to the individual based on her health history and her current needs.^[22]

Androgen therapy is one method of pharmacological treatments that has been used for hypoactive sexual desire disorder (HSDD). This is generally more commonly used among women who have had an oophorectomy or who are in a postmenopausal state. However, like most treatments, this is also controversial. One study found that after a 24-week trial, those women taking androgens had significantly higher scores of sexual desire compared to a placebo group.^[1] As with all pharmacological drugs, there are side effects in using androgens, which include hirutism, acne, ploycythaemia, increased high-density lipoproteins, cardiovascular risks, and endometrial hyperplasia is a possibility in women without hysterectomy.^[1] This is another area in which long-term use has not been demonstrated. Alternative treatments include topical estrogen creams and gels can be applied to the vulva or vagina area to treat vaginal dryness and atrophy