Couplepause: A New Paradigm in Treating Sexual Dysfunction During Menopause and Andropause

摘要

Background: At midlife and beyond, both men and women face organic changes that can affect sexual functioning. For women, ovarian exhaustion causes estrogen deficiency, leading to genitourinary syndrome of menopause, which may include vaginal dryness, irritation/itching, inadequate lubrication, and dyspareunia. Hypoactive sexual desire disorder also can result from biopsychosocial factors. For men, erectile dysfunction prevalence increases with age, and some men develop testosterone deficiency. Aim: In this narrative review, we summarize the literature on how menopause and andropause can affect the sexual health of both the patient and partner and describe a new paradigm ("couplepause") for addressing the sexual health needs of the aging couple as a whole. Methods: We combined a literature review conducted using PubMed with insights garnered from our own clinical experiences. Outcomes: We reviewed publications relating to couples-based approaches to sexual dysfunction, male perceptions of female sexual dysfunction, female perceptions of male sexual dysfunction, interactions between male and female sexual dysfunctions, sexual dysfunction and midlife changes in homosexual couples, and impact of pharmacologic treatments for sexual dysfunctions on the couple's sexual health. Results: Both members of a couple may experience age-related changes concurrently and interdependently. In such cases, it is unhelpful, and sometimes detrimental, to treat the symptoms for only one member of the couple without also treating the other. Therefore, as an evolution of the couple-oriented approaches of Masters and Johnson and others, we introduce the concept of couplepause and the need for a new diagnostic and therapeutic paradigm that addresses the sexual health needs of the aging couple as a whole rather than treating the individual patient in isolation. Conclusion: Taking a couple-oriented approach to evaluate and manage couplepause in the latter half of life can dramatically and simultaneously help both members of the couple to improve sexual satisfaction and intimacy.