a Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences , University of Pavia , Pavia , Italy.
Climacteric. 2019 Jun;22(3):289-295. doi: 10.1080/13697137.2019.1575356. Epub 2019 Mar 22.
Sexuality in women with spontaneous premature ovarian insufficiency (POI) deserves attention because of the young age and the distressing impact of such a life-changing diagnosis. Biomedical and psychosocial factors work in concert to determine significant changes of sexual function. Early hormonal deprivation gives origin to symptomatic vulvovaginal atrophy and contributes to hypoactive sexual desire disorder modulating central and peripheral circuitries, which regulate sexual response. Emotional and cognitive adjustment to the short-term and long-term consequences of POI may further determine negative attitudes toward sexuality. It is essential to counsel POI women on every aspect of their life, from menopausal symptoms to fertility concerns, from health risks to potential therapeutic solutions. The biopsychosocial perspective is the best approach to manage sexual symptoms, including tailored hormone therapy and focused counseling. Pharmacotherapies specifically investigated in spontaneous POI conditions are lacking and clinical judgment has to guide the choice of treatment, which must be continued at least until the average age at natural menopause according to the most recent guidelines. Further studies are needed to better characterize POI women and to understand the effective role of novel therapeutic strategies, including androgens and cognitive-behavioral and sexual interventions.
自发性卵巢早衰（POI）女性的性生活值得关注，因为她们正值年轻，且这种改变人生的诊断会带来痛苦的影响。生物医学和社会心理因素共同作用，决定了性功能的显著变化。早期的激素剥夺会导致症状性外阴阴道萎缩，并导致低反应性性欲障碍，从而调节调节性行为的中枢和外周回路。对 POI 的短期和长期后果的情绪和认知调整可能进一步导致对性行为的负面态度。至关重要的是，要对 POI 女性进行生活各方面的咨询，包括更年期症状、生育问题、健康风险和潜在的治疗方法。从生物心理社会的角度来管理性功能障碍，包括针对性激素治疗和有针对性的咨询，是最佳方法。在自发性 POI 情况下专门研究的药物治疗方法缺乏，临床判断必须指导治疗选择，根据最新指南，治疗必须至少持续到自然绝经的平均年龄。需要进一步的研究来更好地描述 POI 女性，并了解新型治疗策略的有效作用，包括雄激素和认知行为及性干预。
