According to the recently released ICD-11, female sexual dysfunction can be a result of a lack of desire (hypoactive sexual desire dysfunction or HSDD), sexual arousal dysfunction, or orgasmic dysfunction.

HSDD can now be diagnosed even if the patient is on a SSRI, says Professor Sue Davis, Director of the Monash University Women’s Health Research Program and the Specialist Women’s Health Clinic at Alfred Health.

“Traditionally, if a woman on a SSRI had symptoms of HSDD she was said to not have the disorder. That’s now been disqualified. She has the disorder but it’s up to us to identify any contributing factors,” says Professor Davis.

For a patient with low sexual desire, Professor Davis says taking them off the pill can lift testosterone levels and improve libido. The pill reduces testosterone levels in middle aged to older women by up to 50%.

Prof Susan Davis AO will be giving a lecture on managing sexual health in postmenopausal women, during the 6th December Healthed webcast. Sign up for free here.

“Testosterone increases at ovulation. In a 46 year old it’s worth a trial off the pill to see what happens if ovarian function resumes over a 10-12 week period, but you will need to discuss other contraception options,” Professor Davis says.

GPs should also be aware of vaginal atrophy, which occurs in 56% of postmenopausal women, yet only 6% receive oestrogen therapy.

“Every woman should be considered a candidate for this intervention. Even if a patient is not sexually active, vaginal oestrogen can be incredibly effective in reducing asymptotic urinary tract infections, bacteria, and to treat incontinence,” says Professor Davis.

“Vaginal moisturisers are an option but they’re expensive, and vaginal lubricants are only effective at the time of sexual activity. There are other therapies that may be available in Australia in the future and they include Ospemifene and vaginal DHEA.”

If the patient is showing signs of HSDD and has associated distress, Professor Davis says testosterone treatment can improve libido and self esteem.

“We’ve shown testosterone treatment is safe in women not on concurrent oestrogen therapy. It should not be used to treat low mood or depression, or to prevent any condition, such as breast cancer,” she says.

“Do not use a measurement of testosterone to diagnose androgen deficiency. There is no such condition in women. You only use it to diagnose androgen excess and to monitor overuse if you put a patient on testosterone.”

Once a patient is taking testosterone, Professor Davis recommends checking blood levels after three weeks to ensure the patient is not using the therapy excessively, and to then monitor levels every six to 12 months.

“Actually see them face to face to make sure that there’s no evidence of hyperandrogenism,” she says.

Prof Susan Davis AO will be giving a lecture on managing sexual health in postmenopausal women, during the 6th December Healthed webcast. Sign up for free here.