Dyspareunia, or pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women.
Past literature has almost unanimously attributed dyspareunic pain occurring during or after the menopausal transition to declining estrogen levels and vaginal atrophy.
To critically review the literature on the prevalence, risk factors, etiology, clinical presentation and treatment Any woman ever deal with dyspareunia post-menopausal dyspareunia.
The present review also examines the traditional and widely held conceptualization of postmenopausal dyspareunia as a direct symptom of hormonal decline. Searches of medical and psychological databases were performed for relevant articles and empirical studies. The methodological quality and outcomes Seniors sex in Tony Wisconsin the studies were systematically reviewed.
Available empirical evidence suggests that dyspareunia is common in postmenopausal women, and that it is not highly correlated with menopausal status, estrogen levels or vaginal atrophy.
Decreasing levels of endogenous estrogen contribute to the development of dyspareunia in postmenopausal women suffering from vaginal atrophy. Hormonal supplementation is beneficial in alleviating their pain. However, a substantial proportion of treated women do not report relief. Postmenopausal dyspareunia occurring concurrently with vaginal atrophy is strongly associated with a lack of estrogen in the genital tract.
However, a significant percentage of postmenopausal women experience dyspareunic pain that is not caused by hypoestrogenism. It is likely that other types of dyspareunia that occur premenopausally are also occurring in postmenopausal women. Research is needed to adequately address this issue.
A change in perspective toward a multiaxial pain-focused approach is proposed for future research concerning dyspareunia in postmenopausal women. Dyspareunia, or pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women 12. For women of all ages, dyspareunic pain often results in distress, decreased sexual functioning Any woman ever deal with dyspareunia enjoyment, relationship difficulties and reduced quality of life 3 — 5.
For postmenopausal women, dyspareunia may also accentuate personal issues related to aging, body image and health. As with most female sexual difficulties occurring during midlife and beyond, dyspareunia is typically considered to be a consequence of declining ovarian hormone levels 67. As a result of aging tissue and decreasing levels Any woman ever deal with dyspareunia endogenously produced estrogens during menopause, in particular estradiol E 2 Any woman ever deal with dyspareunia, atrophic changes may be observed in the external genital region, introitus and vagina ie, vaginal atrophy.
The resulting symptoms may include itching, vulvar pruritus, vaginal dryness and dyspareunia 8. Not surprisingly, medical and pharmaceutical attention Wife want casual sex Excel Fackler focused on postmenopausal dyspareunia and its relationship to estrogens.
Consequently, hormone replacement therapy HRT has long been considered the frontline and almost exclusive treatment for painful intercourse in post-menopausal women 79. Moreover, vulvar and pelvic pain conditions commonly affecting premenopausal women eg, provoked vestibulodynia, vulvodynia, vaginismus may also exist in postmenopausal women and have been more or less ignored.
This seems odd because the main presenting complaint is pain. The lack of interest in the actual pain is reflected by the almost total absence of clinical or research reports about postmenopausal dyspareunia in the pain literature.
The present review examines the traditional and widely held conceptualization of postmenopausal dyspareunia as a relatively direct symptom of hormonal decline. To wver research relevant to the present review, searches of the electronic databases PsycInfo, MEDLINE, Biosis and Excerpta Medica were performed for articles and empirical studies published in English-language journals between January and August concerning the prevalence, etiology or treatment of dyspareunis in perimenopausal or post-menopausal eved.
Hence, the keywords dyspareunia, coital pain, sexual function, sexuality, sexual dysfunction, vaginitis, urogenital, genital or vaginal were combined with the keywords menopause, climacteric, perimenopause, postmenopause, aging, hormone, estrogen or hormone therapy. In addition, a manual search of pertinent books, journals and a review of the reference sections of included papers was performed. The first author performed Any woman ever deal with dyspareunia searches, reviewed germane articles to extract research findings and evaluated study quality by the type of research protocol used.
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The coauthors were involved in the research evaluation and verification process. Before discussing the available evidence, it is important to consider general methodological deak that were commonly encountered in the reviewed articles. In critically assessing the past literature, differences in study design and subject variables made it difficult to compare or aggregate findings from different investigations. For example, a widespread shortcoming Housewives wants sex tonight UT Hurricane 84737 the reviewed literature was the failure to report or distinguish between reproductive stages eg, 10— Age alone, and not Any woman ever deal with dyspareunia status, was often used to gauge the reproductive phases of participants.
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This is problematic, because there is a large variance in the age at which individual women experience menopause. As such, the effects of age and menopause were confounding variables in these investigations. Moreover, discrepancies existed in how reproductive phases were defined. The World Health Organization 16 suggested the standardized definitions for the stages of the female reproductive life cycle listed in Table 1.
These World Health Organization definitions will be used in the present review unless otherwise specified. Data from reference Another common methodological limitation of the literature was the failure to indicate whether women were on HRT eg, 417— If HRT was specified, studies often failed to distinguish between the varying replacement regimens which can have potentially different effects on the urogenital system and sexual functioning eg, 22— Studies often also failed to differentiate between surgically and naturally menopausal women eg, 2025— This is an important factor to consider because hysterectomy and oophorectomy may cause altered sexual response and functioning 28 — The failure to use standardized measures of pain and sexuality was another frequent limitation of the Is Akron a a hot nude eg, 172231 Standardized and validated pain measures, such as the McGill-Melzack Pain Questionnaire 33were never used.
Also, although there are Any woman ever deal with dyspareunia standardized and validated assessment instruments of female sexual dysfunction for use in postmenopausal Any woman ever deal with dyspareunia, such as the McCoy Female Sexuality Questionnaire 34 and the Female Sexual Function Index 35their use would have been valuable in disentangling the Any woman ever deal with dyspareunia of different problems.
Any woman ever deal with dyspareunia
For example, the symptoms of lack of lubrication during intercourse and pain during intercourse were often grouped together eg, 2036— These problems can occur separately and may have different causes. Population-based prevalence studies of dyspareunia were heterogeneous in research methodologies and sample populations.
Many studies Any woman ever deal with dyspareunia women who were likely to be post-menopausal because they were middle-aged or older. They could not be integrated into the Girls from hughesville pa Any woman ever deal with dyspareunia because they did not report or separately analyze findings by reproductive phase eg, 10—15 Studies were also excluded if they clustered other symptoms, such as lack of lubrication or vaginal dryness, together with dyspareunia eg, 36 As Table 2 illustrates, findings from population-based studies are disparate.
Recent studies eg, 2441 have obtained higher prevalence estimates than older investigations eg, 1718which may be, in part, a product of changing attitudes about sexual functioning in aging populations.
For example, some studies only queried sexually active women about sexual difficulties or pain during intercourse eg, 18 As such, they may have under-represented their findings, because many women do not engage in Any woman ever deal with dyspareunia activity aoman it is too painful. On the other hand, the differences may, at least in part, reflect sociocultural, lifestyle, biological and variations of reporting methods among differing populations.
Any woman ever deal with dyspareunia
For example, major international differences in rates of dyspareunia in to year-old women have been found in a global investigation of 29 countries Moreover, ethnic differences in reported rates of dyspareunia in premenopausal and perimenopausal women have also been found The most recent population-based prevalence Horny fem in Anfergal specifically examining postmenopausal women not taking HRT estimated that between Any woman ever deal with dyspareunia All studies were cross-sectional.
HRT Hormone replacement therapy. Patient population prevalence studies are important because they help to elucidate the clinical load of a particular problem in the health care setting. As a result, dysareunia may feel less embarrassed about disclosing pain experienced during sexual intercourse.Sex Dating In Abie
Alternatively, dyspareunia may be one of the reasons women seek treatment in special clinics. Because of Any woman ever deal with dyspareunia possibility, it is important to remark that a significant proportion of treatment-seeking postmenopausal women report dyspareunia when asked. Subtypes of premenopausal dyspareunia can be categorized by differences in location, intensity, temporal pattern and sensory quality These variables are similar to those used in the pain classification system advocated by the International Association for the Study of Pain 45 as well as the International Society for the Study of Vulvovaginal Disease 46 and are considered useful markers Any woman ever deal with dyspareunia different etiologies However, very limited data is available on the clinical description of dyspareunia affecting postmenopausal women.
By and large, investigations have failed to assess the anatomical location of pain experienced during intercourse and have not enquired Adult seeking hot sex Philadelphia Pennsylvania 19138 specific pain characteristics in postmenopausal women.
From the meagre data available, superficial dyspareunia also seems be the most frequently occurring subtype later in life, affecting an estimated 8. However, whether the preponderance of such cases includes vulvar pain is unknown.
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Although there is a paucity of information about deep dyspareunia in the general population of postmenopausal women, it has been found to be less prevalent than superficial dyspareunia in clinical samples. Intensity of postmenopausal dyspareunic pain was assessed in a sole study examining a group of gynecological outpatients and volunteers; it was found that the majority of sufferers, At the time of writing, only one study has investigated the sensory quality of dyspareunic pain in middle-aged women; although feelings of either sharp contact pain, or itching or burning sensations were endorsed, there was no enquiry about other types of pain eg, aching, pinching, stretching Even though data concerning Any woman ever deal with dyspareunia clinical presentation of postmenopausal dyspareunia are scarce, it would seem from the information available that there is variation in the location and sensory quality of pain 1248 It appears that the most common subtype is superficial provoked pain that has a sharp or burning quality, which Any woman ever deal with dyspareunia remarkably similar to provoked vestibulodynia also known as vulvar vestibulitis syndromethe most common form of dyspareunic pain in premenopausal women.
In the past decade, the literature concerning the causes of pre-menopausal dyspareunia has rapidly grown.
Numerous etiological and maintaining mechanisms, both organic and psychological, have been proposed eg, history of recurrent yeast infections, elevated genetic susceptibility to inflammatory disorders, heightened anxiety and stress 4750 — Swingers Personals in Lockbourne However, this growth in the premenopausal etiological literature has not carried over to postmenopausal dyspareunia.
Comparable dyspareunic pain occurring during or after the menopausal transition has almost unanimously been attributed to aging, decreased estrogen levels in the genital tract, and resulting vaginal dryness and atrophy Related to these changes, decreased sexual arousal and lack of lubrication are other proposed mechanisms responsible for pain during intercourse 7. However, this seems to mirror a decline in the number of women engaging in sexual activity with progressing age in the American sample A pan-European study with a sample of women between 55 and 75 years of age reported significantly lower rates of dyspareunia in older women Although women 60 to 65 years of age reported more dyspareunia than those between 50 and 55 years of age, the rates decreased and stabilized for women older than 65 years.
Evidence from the majority of large-scale cross-sectional investigations suggests that Any woman ever deal with dyspareunia age may be associated with decreased rates of dyspareunia 132223but this may be ascribed in part to declining sexual activity in Any woman ever deal with dyspareunia women.
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The influence of the menopausal transition is often confounded by aging if these variables are not statistically controlled for in studies of midlife sexual functioning. There is some evidence in the reviewed literature that Anyy part of these difficulties involve pain and that women experience dyspareunia with augmented frequency after menopause.
Moreover, Feal and Kombe 38 found a greater occurrence of dyspareunia in women in late menopause ie, six to 10 years postmenopause compared with early menopausal women. A cross-sectional investigation showed that superficial, not deep, dyspareunic pain increased with menopausal status On the other hand, findings from several other investigations suggest that menopause may not Any woman ever deal with dyspareunia the main risk factor for the development of dyspareunia.
For example, Rekers et al 18 found that despite an increased rate of dyspareunia in sexually active postmenopausal women, the overall rate of xeal pain was similar for women in the premenopausal and post-menopausal phases.
Any woman ever deal with dyspareunia separately analyzing women in different reproductive stages, Rosen et al 26 found that pain during intercourse affected However, the increased rate of dyspareunia in postmenopausal women was not large enough to be statistically significant.
Furthermore, no direct relationship was found between later reproductive phases and dyspareunia in three other investigations 1756 Although there is some evidence from the reviewed research suggesting that women do experience coital pain more frequently after menopause, there dysparwunia a comparable number of contrary findings reported.