[Psychosexual problems in menopause].

BACKGROUND

A case-control study about the evaluation of sexual disturbances during menopause considering the ways in which these are caused by neuro-endocrine disequilibrium, or by a psycho-social crisis during menopause. In addition, there is an evaluation of the efficacy of hormonal replacement therapy on sexual disturbances.

METHODS

Two groups of 44 menopausal women. The first group was transdermically treated with 50 micrograms/day of estradiol for three weeks in a one month period with the association of MAP 10 mg administered orally for 10 days. The other group received a placebo. Both groups were studied for a period of six months with quarterly check-ups. We have identified the crucial symptoms using a series of interviews which consisted of questions regarding the classic symptoms of menopause. The intensity of such symptoms was classified on a five point scale. Specific questions were asked regarding the frequency of sexual intercourses and the presence and intensity of sexual desire. The same questions were consecutively asked to the subjects at three month intervals.

RESULTS

The presence of crucial symptoms was distributed as follows: hot flashes and perspiration in 65%, anxiety in 60%, symptoms of depression in 50%, paraesthesia and asthenia in 40%, insomnia in 35%, varying degrees of memory loss in 30%, vaginal dryness and dyspareunia in 15% of the subjects in both groups (control and sperimental). Sexual desire was diminished or very diminished in 48%, unchanged in 31% and increased in 11.5%. The frequency of sexual intercourse was diminished or very diminished in 56.5%, unchanged in 25% and absent in 18.5%. For the vasomotor disorders, patients participating in the first group demonstrated only a slight persistence in 15% by the end of six cycles. Similar results were found with symptoms of insomnia. Only 10% of the patients mentioned slight symptoms of anxiety or depression. All of the patients with vaginal dryness and dyspareunia showed a total remission of the symptoms. Subjects participating in the control group noted a slight increase in vasomotor disturbances, while psychological symptoms decreased slightly. Vaginal dryness and dyspareunia remained unchanged. At the end of treatment, only a modest percentage of the subjects, from both groups, mentioned an increase in the frequency of sexual desire and intercourse.

CONCLUSIONS

These results shows that the lack of estradiol is not the most important factor in deciding sexual behavior. Also, for the group of patients complaining symptoms connected to vaginal atrophy, only a small increase in sexual interest and practice was verified once the normal trophism of tissue was reestablished. The same data obtained from the control group is probably a result of a certain mental condition caused by the "pharmacological effect".