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Distressing Sexual Function at Midlife

Unmet Needs, Practical Diagnoses, and Available Treatments

Simon, James A. MD; Lukas, Vanessa A. BA

doi: 10.1097/AOG.0000000000002268
Contents: Clinical Expert Series
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Expert Discussion
Spanish Translation

Female sexual dysfunction (FSD) is characterized as chronic sexual symptoms that manifest with personal distress in the domains of desire, arousal, orgasm, and pain. Extensive epidemiologic evidence estimates that almost 50% of perimenopausal and postmenopausal women experience FSD. Screening for FSD is not readily conducted and patient–physician discussion of sexuality is limited by the lack of physician training on the topic and by the patient-held belief that sexual issues are not medical in nature. The purpose of this commentary is to provide clinicians with a framework to approach the discussion of FSD, to clinically identify FSD through patient symptoms and physical signs, and to manage FSD in perimenopausal and postmenopausal patients with the available U.S. Food and Drug Administration–approved and off-label treatments. Particular attention will be paid to FSD with common midlife onset including vulvovaginal atrophy, vulvodynia, and hypoactive sexual desire disorder. Although evaluating FSD can be a challenge, triaging symptoms by addressing pain before desire and arousal will improve patient outcomes and greatly simplify FSD management.

Female sexual dysfunction with onset at or after midlife is highly prevalent, and its diagnosis and treatment should be addressed with patients.

Department of Obstetrics & Gynecology, George Washington University, and Women's Health & Research Consultants, Washington, DC.

Corresponding author: James A. Simon, MD, Obstetrics & Gynecology, George Washington University, School of Medicine, Women's Health & Research Consultants, 1850 M Street NW, Suite 450, Washington, DC 20036; email:

Financial Disclosure Dr. Simon has served (within the last year) or is currently serving as a consultant to or on the advisory boards of: AbbVie, Inc (North Chicago, Illinois), Allergan, Plc (Parsippany, New Jersey), AMAG Pharmaceuticals, Inc (Waltham, Massachusetts), Amgen Inc (Thousand Oaks, California), Apotex, Inc (Toronto, Canada), Ascend Therapeutics (Herndon, Virginia), Azure Biotech, Inc (River Vale, New Jersey), JDS Therapeutics, LLC (Purchase, New York), Merck & Co, Inc (Whitehouse Station, New Jersey), Millendo Therapeutics, Inc (Ann Arbor, Michigan), Noven Pharmaceuticals, Inc (New York, New York), Novo Nordisk (Bagsvrerd, Denmark), Nuelle, Inc (Mountain View, California), Perrigo Company, PLC (Dublin, Ireland), Radius Health, Inc (Waltham, Massachusetts), Regeneron Pharmaceuticals, Inc (Tarrytown, New York), Roivant Sciences, Inc (New York, New York), Sanofi SA (Paris, France), Sebela Pharmaceuticals, Inc (Roswell, Georgia), Sermonix Pharmaceuticals, Inc (Columbus, Ohio), Shionogi Inc (Florham Park, New Jersey), Sprout Pharmaceuticals (Raleigh, North Carolina), Symbiotec Pharmalab (Indore, India), TherapeuticsMD (Boca Raton, Florida), and Valeant Pharmaceuticals (Laval, Canada). He has also served (within the last year) or is currently serving on the speakers' bureaus of Amgen Inc (Thousand Oaks, California), Eisai, Inc (Woodcliff Lake, New Jersey), Merck (Whitehouse Station, New Jersey), Noven Pharmaceuticals, Inc (New York, New York), Novo Nordisk (Bagsvrerd, Denmark), Shionogi Inc (Florham Park, New Jersey), and Valeant Pharmaceuticals (Laval, Canada). In the last year he has received or is currently receiving grant or research support from AbbVie, Inc (North Chicago, Illinois), Actavis, PLC (Dublin, Ireland), Agile Therapeutics (Princeton, New Jersey), Bayer Healthcare LLC (Tarrytown, New York), GlaxoSmithKline (Brentford, United Kingdom), New England Research Institute, Inc (Watertown, Massachusetts), Novo Nordisk (Bagsvrerd, Denmark), Palatin Technologies (Cranbury, New Jersey), Symbio Research, Inc (Port Jefferson, New York), and TherapeuticsMD (Boca Raton, Florida). Dr Simon is a stockholder (direct purchase) in Sermonix Pharmaceuticals (Columbus, Ohio). The other author did not report any potential conflicts of interest.

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© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.