| 101 Room 518 | Société Francophone de Médecine Sexuelle Sunday, July 10, 2005 Time: 9:00 AM-12:00 PM |
Impact sexuel des crises hormonales de la ménopause : quel traitement après la mise au banc de l'hormonothérapie.
Bitzer, Johannes *,1, 1 University Basel, Basel, Switzerland, Suisse
ABSTRACT- Clinical decision making will have to follow a structured evaluation of the individual patients sexual problems. 1. How does the patient rate her personal distress caused by the sexual disfunction ? Impact on mood, self-image, self confidence, relationship and identity 2. To what extend do steroid hormones (estrogens, androgens) contribute to this problem ? Self observation of the patient of changes around menopause, previous experiences with steroid hormone treatment, eventually hormone measurements and evaluation of other possibel pathogenetic factors. 3. What is the risk profile of the patient regarding applications of oestrogens, oestrogen progesterons and androgens ? Familiy history, proven genetic factors, previous risks and diseases, age From this analysis several groups of patients emerge: a) High distress, high impact of hormonal factors on the individual sexual dysfunction, low risk index. In this group longterm steroid treatment for sexual dysfunction is indicated and safe. b) High distress, other somatic or psychosocial factors strongly contributing to the problem, low risk profile. In these patients a trial of hormonal therapy in the context of other interventions is possible. c) High distress, other somatic and psychosocial factors strongly impacting on the sexual disfunction, high risk profile In these patients interventions focussing on other factors should constitute first line treatment. d) High distress, hormonal factors predominant in the pathogenesis, high risk profile. The clinical decision depends on the specific risk profile. - Women with high risk from mamma carcinoma or established disease should not receive combined oestrogen progesteron therapy. It seems however safe to use local oestriol for women with sexual pain disorder preferably estriol preparations.
Key words: hormones, sexual dysfunction, WHI, indications, contraindications