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A new study presented at the 25th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America (SMSNA) has shed light on a largely understudied aspect of menopause: the impact of menopause on female genital sensory pathways and its potential contribution to sexual dysfunction. While the hormonal effects of menopause have been widely researched, this study focuses on the integrity of somatic afferent pathways responsible for genital sensation, such as the dorsal and perineal nerve branches of the pudendal nerve.

The research highlights the use of genital quantitative sensory testing (QST) to assess the function of these pathways in menopausal patients with sexual dysfunction. The study's objective was to evaluate sensory thresholds for vibration, cold, and warm sensations in two cohorts of menopausal women: those with genitourinary syndrome of menopause (GSM) and those with persistent genital arousal disorder or genito-pelvic dysesthesia (PGAD/GPD), conditions in which neurologic impairment is more documented.

Methods and testing

The study involved a chart review of 30 menopausal patients who presented to a sexual medicine clinic between January 2022 and May 2024. These women had little to no prior menopause management involving systemic or local sex steroid hormone treatments. The research divided patients into two groups: 16 with GSM alone and 14 with concomitant PGAD/GPD. Quantitative sensory testing was conducted at the time of the patients' first visit using a biothesiometer and a thermal sensitivity tester to measure their vibratory, cold, and warm perception thresholds. The results were compared to a non-genital control location, with abnormal results defined as values that were ≥ 2 standard deviations from the control.

Key findings

The study revealed significant abnormalities in genital sensation across both patient groups. In those with GSM alone, 63% had abnormal vibratory perception, 44% had abnormal cold perception, and 68% had abnormal warm perception. The findings were similarly high in the PGAD/GPD group, with 71% showing abnormal vibratory perception, 43% demonstrating abnormal cold perception, and 71% exhibiting abnormal warm perception.

Overall, the prevalence of abnormal sensory results ranged between 44% and 71%, depending on the type of sensation tested. These findings suggest that sensory impairment is common in menopausal women with sexual dysfunction and may play a role in their symptoms, particularly in conditions like PGAD/GPD where neurologic disease is often a factor.

Conclusions

The study emphasizes the importance of understanding sensory pathway changes in menopause and their potential impact on sexual health. According to the authors, genital sensory impairment could be a contributing factor to menopause-related sexual dysfunction, which has historically been attributed mainly to hormonal changes. The researchers advocate for neurogenital testing to be included as part of baseline assessments for menopausal women presenting with sexual concerns.

With the findings presented at this year's SMSNA meeting, the researchers hope to raise awareness among clinicians about the importance of evaluating sensory pathways and considering these impairments when developing treatment plans for menopausal patients with sexual dysfunction. The study opens the door for further research on the subject, which could lead to new diagnostic tools and therapies that address the neurogenic aspects of menopause-related sexual health issues.

Reference:

Goldstein SW, Weinberger JM, Goldstein I. Quantitative Sensory Testing of the Clitoris, Vulva and Vestibule in Menopausal Patients With Sexual Dysfunction. Online Poster. Presented at: 25th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America. Scottsdale, Arizona. October 17-20, 2024.