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Sexual Dysfunction in Menopause — Dyspareunia and Libido Changes
A 57-year-old postmenopausal woman reports painful intercourse, vaginal dryness, and low sexual desire. Outline evaluation and management.
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If severe hypoactive sexual desire disorder (HSDD): consider transdermal testosterone in select cases (off-label, monitor levels)
First-line: vaginal estrogen or DHEA for GSM; lubricants/moisturizers if mild
Sexual dysfunction common: dyspareunia from GSM, reduced libido from low estrogen/androgen
Reassess symptoms, adverse effects, partner issues regularly
Address psychosocial, relational, mood, medication factors; consider sex therapy
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