Effects of hormone replacement therapy on sexual psychophysiology and behavior in postmenopause.

Investigators continue to define the exact relationship between sexual function and changes in hormonal status during menopause. The availability of different preparations that could replace estrogens and androgens has led to many studies of the use of hormone replacement therapy (HRT) for sexual dysfunction. Dyspareunia due to vaginal dryness appears to be most responsive to estrogen replacement therapy (ERT) via restoration of vaginal cells, pH, and blood flow. Progestins, to a certain extent, can oppose these changes and lead to a recurrence of dryness and dyspareunia. ERT has also been reported to enhance sexual desire in a significant percent of women. Although treatment with ERT has been shown to be efficacious for many women, there are others whose sexual difficulties remain unresponsive. There also appears to be a significant subgroup of women whose sexual difficulties respond initially to ERT but who subsequently revert to their initial problems, especially when the problem has been loss of libido. For these women, the addition of androgen has proved helpful.