Sexual function and practical solutions with Lauren Streicher, MD

Lauren Streicher, MD, a clinical professor of Obstetrics and Gynecology at Northwestern University's Feinberg School of Medicine, highlighted the importance of addressing postmenopausal sexual dysfunction with practical, patient-centered solutions during her presentation at The Menopause Society 2024 Annual Meeting in Chicago, Illinois. One key issue she addressed is acquired orgasmic dysfunction, which affects more than half of women by age 50.

"Fifty-five percent of women by age 50 are no longer able to have an orgasm," Streicher explained. "This is a consequence of not only hormonal changes, but aging, and very often vascular changes in the clitoris or nerve endings that are desensitized." She emphasized the multifaceted nature of the problem, which is influenced by hormonal shifts, aging, and changes in vascular and nerve health.

In terms of treatment, Streicher is focused on providing practical solutions. "You have to increase vascularization," she advised. "Sometimes it might be a topical vasodilator. Sometimes it might be something more systemic. Very often we talk about increasing stimulation by something as simple as a vibrator." Although no FDA-approved treatments currently exist for postmenopausal orgasmic dysfunction, Streicher encourages clinicians to explore off-label options and creative approaches to help their patients. "Unfortunately, we have no FDA-approved options to offer our patients, so what we are left with is having to either use things off label or, quite frankly, get a little creative."

Streicher also stressed the importance of understanding that sexual dysfunction is often a "downstream consequence of other symptoms." For women in perimenopause or early postmenopause, issues like sleep deprivation, vasomotor symptoms, and genital urinary syndrome of menopause (GSM) can significantly impact sexual function. "That may be why she has no libido, that may be why she can't have an orgasm, that may be why she's having sexual pain," Streicher explained. Addressing these underlying issues may resolve some cases of sexual dysfunction, but if not, additional treatments may be necessary.

Streicher's approach is centered on finding practical, individualized solutions for women experiencing sexual dysfunction. Whether through increasing stimulation, using topical or systemic treatments, or addressing other menopausal symptoms, she encourages clinicians to remain proactive and informed, even in the absence of FDA-approved treatments.