Sexuality in premature ovarian insufficiency

Abstract

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.

摘要

自发性早发性卵巢功能不全（POI）患者的性行为值得关注, 因为其年纪尚轻, 而且这种改变一生的诊断具有令人痛苦的影响。生物医学和社会心理因素共同决定了性功能的显著变化。过早的激素缺乏导致症状性外阴阴道萎缩, 并使控制性反应的调控中枢和外周回路紊乱从而导致性欲减退。对POI短期和长期后果的情感和认知的调整可能进一步决定其对性的消极态度。从更年期症状到生育问题, 从健康风险到可能的治疗方案, 在生活的各个方面向POI女性提供建议是至关重要的。生物心理社会视角是控制性行为症状的最佳方法, 包括个体化的激素治疗和重点咨询。缺乏针对自发性卵巢功能不全（POI）进行专门研究的药物治疗方法, 临床判断指导治疗方法的选择, 根据最新指南, 治疗必须至少持续到自然绝经的平均年龄。还需要进一步的研究来更好的描述POI女性的特征, 并了解包括性激素、认知行为和性干预在内的新型治疗策略的有效作用。

Keywords:

• Premature ovarian insufficiency
• female sexual function
• female sexual dysfunction
• estrogens
• androgens
• counseling
• psychosexual therapy

Conflict of interest

R. E. Nappi had past financial relationships (lecturer, member of advisory boards, and/or consultant) with Boehringer Ingelheim, Ely Lilly, Gedeon Richter, HRA Pharma, Pfizer Inc., Procter & Gamble Co., TEVA Women’s Health Inc, and Zambon SpA. At present, she has an ongoing relationship with Bayer HealthCare AG, Endoceutics, Exceltis, Merck Sharpe & Dohme, Novo Nordisk, Palatin Technologies, Shionogi Limited, and Theramex. The other authors do not declare any conflict of interest.

Additional information

Funding

Nil.