Kingsberg S A
Department of Reproductive Biology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Ohio 44106, USA.
Int J Fertil Womens Med. 1998 Mar-Apr;43(2):122-8.
Most men and women remain sexually active into mid-life and beyond. However, sexual functioning in peri- and postmenopausal women, and their partners, is widely variable. Somatic symptoms, psychological issues, partner's physical, psychological, and relationship status are all important to one's perceived quality of life, and may greatly affect sexuality. These wide-ranging influences complicate assessment, diagnosis, and subsequent management of sexual problems. A number of factors influence sexual functioning in menopausal women. There are age-related changes that are unrelated to menopause, which include changes in drive, body image, and general health status. Beliefs about menopause and sexuality impact sexual functioning in women. Changes in relationship status and the physical health of a partner may also influence sexuality. Physiologic changes, directly related to menopausal hormone changes, often impact sexual functioning, both directly and indirectly. Health care providers can play an important role in treating sexual problems and enhancing sexuality in aging patients. Effective evaluation will result in accurately determining the source(s) of an individual's or a couple's sexual dysfunction. Treatment may include the following: basic education about sexuality and sexual functioning, normalizing sexual activity in aging adults, medical management of symptoms or problems that are interfering with sexual desire or activity (such as HRT for vaginal atrophy or in reduction of hot flashes), referral for treatment of the partner's physical or psychological problem, and/or sex therapy to treat a sexual dysfunction or to manage a chronic physical problem that requires a change in a person's or couple's typical sexual repertoire. This paper includes a detailed case history of a couple to illustrate the concepts mentioned above.
大多数男性和女性在中年及以后仍保持性活跃。然而，围绝经期和绝经后女性及其伴侣的性功能差异很大。躯体症状、心理问题、伴侣的身体、心理和关系状况对个人的生活质量感知都很重要，并且可能极大地影响性功能。这些广泛的影响使性问题的评估、诊断及后续管理变得复杂。有许多因素影响绝经后女性的性功能。存在与绝经无关的年龄相关变化，包括性欲、身体形象和总体健康状况的变化。关于绝经和性的观念会影响女性的性功能。关系状况的变化和伴侣的身体健康也可能影响性功能。与绝经激素变化直接相关的生理变化通常会直接或间接地影响性功能。医疗保健提供者在治疗性问题和增强老年患者的性功能方面可以发挥重要作用。有效的评估将准确确定个人或夫妻性功能障碍的根源。治疗可能包括以下方面：关于性和性功能的基础教育、使老年人的性活动正常化、对干扰性欲或性活动的症状或问题进行药物治疗（如使用激素替代疗法治疗阴道萎缩或减轻潮热）、转诊治疗伴侣的身体或心理问题，和/或进行性治疗以治疗性功能障碍或管理需要改变个人或夫妻典型性模式的慢性身体问题。本文包含一对夫妻的详细病史以说明上述概念。
