Goldstein Irwin, Alexander Jeanne Leventhal
J Sex Med. 2005 Sep;2 Suppl 3:154-65. doi: 10.1111/j.1743-6109.2005.00131.x.
The decline in circulating estrogen levels in peri- and postmenopause has a wide range of physiological effects, including atrophy of tissues in the urogenital tract. Vaginal atrophy is an important contributor to postmenopausal sexual dysfunction.
To provide a framework for clinical evaluation and clinical management of sexual dysfunction secondary to vaginal atrophy.
Conduct a brief overview of literature on evaluation and treatment of vaginal atrophy, augmented with the authors' clinical observations and experience.
Estrogen decline disrupts many physiological responses characteristic of sexual arousal, including smooth muscle relaxation, vasocongestion, and vaginal lubrication; genital tissues depend on continued estrogen and androgen stimulation for normal function. An upward shift in vaginal pH as the result of vaginal atrophy alters the normal vaginal flora. Reduced lubrication capability and reduced tissue elasticity, in addition to shortening and narrowing of the vaginal vault, can lead to painful and/or unpleasant intercourse. At the same time, diminished sensory response may reduce orgasmic intensity. Other contributors to peri- and postmenopausal sexual dysfunction include reduced androgen levels, aging of multiple body systems, and side-effects of medications. Workup of sexual health problems starts by taking a comprehensive sexual, medical, and psychosocial history, followed by complete physical examination and laboratory evaluation. Clinical management includes measures to preserve and enhance overall health, adjustment of medication regimes to reduce or avoid side-effects, and topical or systemic hormone supplementation with estrogens and/or androgens.
No single therapeutic approach is appropriate for every woman with peri- or postmenopausal sexual dysfunction; instead, treatment should be based on a comprehensive evaluation and consideration of medical and psychosocial contributors to the individual's dysfunction. Further research is required to establish optimal regimens of hormonal and nonhormonal agents, including dosages/dosage forms and duration of treatment, for specific subtypes of sexual dysfunction.
围绝经期和绝经后循环雌激素水平下降具有广泛的生理影响，包括泌尿生殖道组织萎缩。阴道萎缩是绝经后性功能障碍的重要原因。
为阴道萎缩继发的性功能障碍的临床评估和临床管理提供一个框架。
对阴道萎缩评估和治疗的文献进行简要综述，并结合作者的临床观察和经验。
雌激素下降会破坏性唤起的许多生理反应，包括平滑肌松弛､血管充血和阴道润滑；生殖组织依赖持续的雌激素和雄激素刺激才能正常发挥功能。阴道萎缩导致阴道pH值升高，改变了正常的阴道菌群。润滑能力降低和组织弹性降低，再加上阴道穹窿缩短和变窄，可导致性交疼痛和/或不适。同时，感觉反应减弱可能会降低性高潮强度。围绝经期和绝经后性功能障碍的其他原因包括雄激素水平降低､多个身体系统衰老以及药物副作用。性健康问题的检查首先要全面了解性､医学和社会心理病史，然后进行全面的体格检查和实验室评估。临床管理包括维护和增强整体健康的措施､调整药物治疗方案以减少或避免副作用，以及局部或全身补充雌激素和/或雄激素。
对于每一位患有围绝经期或绝经后性功能障碍的女性，没有单一的治疗方法是合适的；相反，治疗应基于对导致个体性功能障碍的医学和社会心理因素的全面评估和考虑。需要进一步研究以确定针对特定性功能障碍亚型的激素和非激素药物的最佳治疗方案，包括剂量/剂型和治疗持续时间。
