Simon J A, Davis S R, Althof S E, Chedraui P, Clayton A H, Kingsberg S A, Nappi R E, Parish S J, Wolfman W
a IntimMedicine Specialists; George Washington University , Washington, DC , USA.
b Women's Health Research Program , School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia.
Climacteric. 2018 Oct;21(5):415-427. doi: 10.1080/13697137.2018.1482647. Epub 2018 Jul 10.
Sexual well-being frequently declines following the menopause transition and can be associated with significant personal and relationship distress. This distress is the hallmark of female sexual dysfunction (FSD). FSD is highly prevalent in postmenopausal women. The prevalence of sexual problems increases with age, but conversely this is associated with decreasing distress with advancing age. This pattern has been seen across multiple international populations with varied cultural norms. While the etiology of FSD is multifactorial, the physiological changes of sex hormone insufficiency and postmenopausal symptoms, such as dyspareunia, are primary factors contributing to FSD at midlife. The International Menopause Society is working to increase awareness of FSD and to provide a framework for practitioners to address sexual medicine concerns. This White Paper aims to review the process of care for female sexual well-being following menopause, from initially approaching the discussion of FSD, to identifying clinical signs and symptoms, and ultimately determining the best available biopsychosocial therapies. As with most processes of care, the first step is often the most difficult. Health-care practitioners need to broach the topic of sexuality in the clinical setting. Lack of information on, comfort with, and biases about the topic of sexuality after menopause are significant hurdles that the International Menopause Society addresses in this document. Each member of the Writing Group remains committed to continued advocacy for the validity of FSD as a diagnosis, the need for therapies for women to be both available and included in health insurance coverage, and continued therapeutic research to provide evidence-based solutions.
绝经过渡后，性健康状况常常下降，并可能伴有严重的个人困扰和人际关系困扰。这种困扰是女性性功能障碍（FSD）的标志。FSD在绝经后女性中非常普遍。性问题的患病率随年龄增长而增加，但相反，这与年龄增长导致的困扰减少有关。这种模式在具有不同文化规范的多个国际人群中都有出现。虽然FSD的病因是多因素的，但性激素不足和绝经后症状（如性交困难）等生理变化是导致中年女性FSD的主要因素。国际绝经学会正在努力提高对FSD的认识，并为从业者提供一个解决性医学问题的框架。本白皮书旨在回顾绝经后女性性健康的护理过程，从最初开始讨论FSD，到识别临床体征和症状，最终确定最佳的生物心理社会治疗方法。与大多数护理过程一样，第一步往往是最困难的。医疗从业者需要在临床环境中探讨性话题。绝经后关于性话题的信息不足、不自在以及偏见是国际绝经学会在本文件中要解决的重大障碍。写作小组的每个成员都致力于继续倡导将FSD作为一种诊断的有效性，为女性提供可用治疗方法并将其纳入医疗保险覆盖范围的必要性，以及继续进行治疗研究以提供基于证据的解决方案。
