Menopause: Management of typically ignored but increased risk factors for dysparaneua, HIV, and other STDS

Postmenopausal women face a number of sexually related challenges that are typically not discussed by their health care providers. For example, nearly one half of postmenopausal women report experiencing vaginal dryness or dyspareunia (i.e., pain or discomfort) during intercourse. Due to a decrease in estrogen, subsequent thinning of the vaginal lining, and lengthening of the sexual response cycle, penetrative intercourse often becomes painful. Most postmenopausal women are typically unaware of normative hormonal related-changes, as well as options for treatment. This chapter will review age-related changes in the sexual response cycle, increased risk factors for HIV and other STDs, and available interventions for treatment of vaginal dryness and dyspareunia. Evidence-based interventions include prescription vaginal lubricants, different types of over the counter vaginal lubricants including those safe for use with latex condoms, masturbation, and cognitive-behavioral therapy. Because fewer than 1 in 4 women over the age of 50 report discussing their sexual health with a physician, specific strategies to effectively engage postmenopausal women in a discussion of their sexual functioning also are provided.