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Case History

image A 53-year-old woman mentions in passing that her interest in sex has fallen since her periods stopped a year ago. She and her 55-year-old partner, with whom she has been in a stable relationship for 25 years, are unhappy about this.

What do you do?

How do you assess the situation?

What is your management plan?


image Sexual problems are frequent in menopausal women.1 Ageing and length of the relationship with a partner are known to affect sexual function of both sexes. The longitudinal Melbourne Women's Midlife Health Project found a highly significant negative effect of ageing on frequency of sexual activity, sexual interest (libido), and aspects of sexual responsiveness, sexual arousal, enjoyment, and orgasm.2 Furthermore, a number of studies have found an additional decrement in aspects of sexual function in midlife, coinciding with the menopause.

What do you do?

The problem has been mentioned at the end of the consultation and it would be advisable to find out if this is something she wants to discuss with you further. She may want to come alone initially and then with her partner. Before the next consultation it would be prudent to review the medical and social histories of both partners, if available, for any long-standing underlying problems.

How do you assess the situation?

The aim of the consultation is to try and identify the main problem, whether it be male or female:

  • decreased or absent sexual desire (loss of libido) in either partner

  • arousal disorders

  • lack or loss of orgasm

  • painful intercourse

  • vaginismus

  • erectile dysfunction

  • premature or retarded ejaculation

  • sexual violence

  • others, such as fear of a sexually transmitted disease, gender confusion and paraphilias (abnormal sexual activity that is socially prohibited)

There are now international definitions and classifications of the various types of female sexual dysfunction (Table 30.1).3

Table 30.1Consensus classification system of female sexual dysfunction

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