Restoring Sexual Desire After Surgical Menopause: Update on Assessment and Management

Loss of sexual desire is a common problem among surgically menopausal women that often results in personal distress and diminished quality of life. Various physiological, psychosocial, and interpersonal factors may contribute, but the hormonal changes induced by the removal of the ovaries should not be overlooked. Postoperative declines in testosterone often result in loss of sexual desire, and estrogen deficiency may aggravate the situation, leading to vaginal atrophy, dryness, and pain during intercourse. Physicians' direct questioning about sexual function is an essential step in establishing a dialogue before and after surgery. When complaints of low sexual desire are present, a thorough sexual, medical, and psychosocial history is needed to help delineate underlying causes and establish a diagnosis. Hypoactive sexual desire disorder (HSDD) may be diagnosed in women with a persistent lack of interest in, desire for, or receptivity to sexual activity that causes personal distress. An integrated treatment approach may be most successful. Recent evidence suggests that testosterone therapy is effective in restoring sexual desire in surgically menopausal women with HSDD. Additional clinical trials are needed to define the efficacy and tolerability of the different testosterone therapies and establish long-term safety, ensuring appropriate use in clinical practice.