Validate the importance of sexual function for overall quality of life, as this legitimizes seeking treatment and making lifestyle changes to improve happiness and well-being.
Actively manage lifestyle and chronic conditions like diabetes and cardiovascular issues, as poor metabolic and vascular health are strongly linked to sexual dysfunction in both men and women.
For post-menopausal women with disruptive hot flashes and night sweats, consider combined estrogen-progesterone therapy (or estrogen alone if no uterus) as it is the most effective treatment for symptom relief and is safe at low doses for short-term use.
Understand that modern bioidentical, lower-dose, transdermal hormone replacement therapy (HRT) has a much safer breast cancer profile than previously thought, with re-analysis of older studies showing minimal absolute risk and no increase in mortality.
Prioritize hormone replacement therapy for bone health and fracture prevention, as the risk of death from fractures later in life significantly outweighs the risk of death from breast cancer due to hormones.
Seek treatment for vaginal dryness and discomfort, as it is one of the most treatable and manageable sexual health conditions with clear therapeutic options available.
For vaginal dryness, pain with sexual activity, or genitourinary symptoms, use a multi-pronged approach including lubricants during sex, regular vaginal moisturizers, dilators for tightness, vibrators for enhanced stimulation, and consistent sexual activity.
If breastfeeding and experiencing vaginal dryness, difficulty, pain, or low sexual function for six months or more without menses, consult a doctor as these symptoms are treatable and similar to post-menopausal changes.
Be aware that combined hormonal contraception, especially ultra-low dose estrogen pills, can cause pain, mood issues, and lower free testosterone, impacting sexual desire and function. Discuss these potential effects with your doctor.
Seek informed consent about all contraception options and their potential impact on sexual health from your doctor, rather than just accepting a prescription, to make choices that align with your overall well-being.
Prioritize treating depression, as improving mental health often leads to better sexual function; if sexual dysfunction persists, discuss switching antidepressant medications with your doctor.
For anorgasmia, explore various stimulation techniques (clitoral, vaginal, vibrators, nipple stimulation) and learn what works best for your body, then communicate these preferences effectively to your partner.
Utilize recommended books (e.g., ‘For Yourself,’ ‘Becoming Orgasmic,’ ‘The Joy of Sex’) and websites like OMGSYES.com to learn about female sexual anatomy and effective stimulation techniques for achieving orgasm.
If experiencing performance anxiety or spectatoring during sex, consider sensate focus therapy, which gradually reintroduces sexual and partner communication in a non-threatening way.
Seek psychological therapy if deep-seated issues like sexual trauma, genital aversion, PTSD, or strong religious/cultural prohibitions are interfering with sexual quality of life.
For post-menopausal women with distressing low desire, testosterone can be prescribed off-label using one-tenth of the male transdermal dose, prioritizing transdermal products and monitoring levels to stay within the physiologic range.
Apply topical testosterone to a relatively hairless area like the buttock, outer thigh, or back of the calf, avoiding washing for a couple of hours and ensuring no transfer to children or partners.
Women of reproductive age using testosterone therapy must be on reliable contraception to prevent pregnancy, as testosterone use during pregnancy is not recommended.
For pre-menopausal women with distressing low desire, after addressing other factors, consider Flibanserin (Addyi), a daily 100mg bedtime pill that is FDA-approved and can improve desire and sexual events in 4-12 weeks.
For pre-menopausal women with distressing low desire, consider Bremelanotide (Vyleesi), a self-injected on-demand treatment taken 45 minutes before sexual activity, which stimulates dopaminergic pathways to increase desire and arousal. Limit use to four times a month to reduce hyperpigmentation risk.
Consider intravaginal DHEA (Intrarosa) as an option for vulvovaginal atrophy and associated pain, especially post-menopause, as it has good efficacy and safety data with minimal systemic absorption.
For women considering hormone replacement therapy, opt for transdermal estrogen products (patches or gels) over oral formulations to potentially lower the risk of venous thromboembolism.
When using systemic estrogen with an intact uterus, a progesterone-coated IUD (like Mirena) can be considered as an off-label but clinically supported alternative for endometrial protection.
Assess and manage lifestyle factors such as body weight, exercise, sleep, and relationship stress, as they can significantly influence the experience and distress of menopausal symptoms and overall sexual health.
Avoid warming liquids and scented products for vaginal care, as the sensitive tissue can be irritated by chemicals in these products.
Do not use oral DHEA for low sexual desire, as studies have not convincingly demonstrated its efficacy or safety for this indication.
To find specialized care for sexual health concerns, look for ‘sexual medicine specialist,’ ‘menopause specialist,’ ‘pelvic floor physical therapist,’ or ‘sex therapist’ using ‘find a provider’ websites from relevant professional societies.
Men experiencing erectile dysfunction should undergo a cardiovascular assessment, as ED can be a mirror to small vessel cardiovascular or cerebrovascular disease.