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Sexual Dysfunction in Women

Author/s: 
Susan R Davis

The Clinical Problem
Because there is no universal definition of normal sexual function, what constitutes sexual difficulty is determined by a person’s subjective definition of unsatisfactory sexual well-being. The condition is usually described as unsatisfactory interest, arousal, orgasm, or other aspects of sexuality (e.g., sexual self-image), and the symptoms often coexist. The term “sexual dysfunction” is used when at least one of the symptoms is of substantial concern to the affected person. Sexual dysfunction negatively affects mental health, vitality, and social functioning and has an overall effect on quality of life that is of similar magnitude to that associated with chronic back pain or diabetes.

Keywords 
Sexual Dysfunction Estrogen Replacement Therapy Hysterectomy Libido menopause Women's Health

The Women’s Health Initiative Randomized Trials and Clinical Practice

Author/s: 
Manson, J.E., Crandall, C.J., Rossouw, J.E.

Importance: Approximately 55 million people in the US and approximately 1.1 billion people worldwide are postmenopausal women. To inform clinical practice about the health effects of menopausal hormone therapy, calcium plus vitamin D supplementation, and a low-fat dietary pattern, the Women's Health Initiative (WHI) enrolled 161 808 postmenopausal US women (N = 68 132 in the clinical trials) aged 50 to 79 years at baseline from 1993 to 1998, and followed them up for up to 20 years.

Observations: The WHI clinical trial results do not support hormone therapy with oral conjugated equine estrogens plus medroxyprogesterone acetate for postmenopausal women or conjugated equine estrogens alone for those with prior hysterectomy to prevent cardiovascular disease, dementia, or other chronic diseases. However, hormone therapy is effective for treating moderate to severe vasomotor and other menopausal symptoms. These benefits of hormone therapy in early menopause, combined with lower rates of adverse effects of hormone therapy in early compared with later menopause, support initiation of hormone therapy before age 60 years for women without contraindications to hormone therapy who have bothersome menopausal symptoms. The WHI results do not support routinely recommending calcium plus vitamin D supplementation for fracture prevention in all postmenopausal women. However, calcium and vitamin D are appropriate for women who do not meet national guidelines for recommended intakes of these nutrients through diet. A low-fat dietary pattern with increased fruit, vegetable, and grain consumption did not prevent the primary outcomes of breast or colorectal cancer but was associated with lower rates of the secondary outcome of breast cancer mortality during long-term follow-up.

Conclusions and relevance: For postmenopausal women, the WHI randomized clinical trials do not support menopausal hormone therapy to prevent cardiovascular disease or other chronic diseases. Menopausal hormone therapy is appropriate to treat bothersome vasomotor symptoms among women in early menopause, without contraindications, who are interested in taking hormone therapy. The WHI evidence does not support routine supplementation with calcium plus vitamin D for menopausal women to prevent fractures or a low-fat diet with increased fruits, vegetables, and grains to prevent breast or colorectal cancer. A potential role of a low-fat dietary pattern in reducing breast cancer mortality, a secondary outcome, warrants further study.

Keywords 
vitamin D calcium menopause Menopausal women Women's Health

Postpartum Depression-New Screening Recommendations and Treatments

Author/s: 
Tiffany A Moore Simas, Anna Whelan, Nancy Byatt

Perinatal mental health conditions are those that occur during pregnancy and the year following childbirth, whether onset of the condition(s) predates pregnancy or occurs in the perinatal period. Perinatal mental health conditions are the leading cause of overall and preventable maternal mortality and include a wide array of mental health conditions including anxiety, depression, and substance use disorders. Perinatal depression specifically affects 1 in 7 perinatal individuals. While commonly referred to as postpartum depression, it is more accurately called perinatal depression because its onset corresponds with prepregnancy (27%), pregnancy (33%), and postpartum (40%) time frames.

Keywords 
Depressive Disorders Pregnancy Obstetrics and Gynecology Women's Health Postpartum Depression

Women’s health update: A literature review impacting primary care

Author/s: 
Dolan, B. M., Merriam, S., Prifti, C. A., Walsh, J. M.

The authors review studies on key issues in women’s health with potential impact on internal medicine practice. The reviewed articles discuss cardiovascular disease risks, bone health, breast cancer genetics, cervical cancer prevention, depression in the peripartum period, pelvic pain, and emergency contraception.

Keywords 
Women's Health primary care Literature Review Internal Medicine Practice Disease Risks

The Women's Preventive Services Initiative Well-Woman Chart: A Helpful Tool for the Practice of Internal Medicine

Author/s: 
Batur, Pelin, Phipps, Maureen, Qaseem, Amir

The Women's Preventive Services Initiative (WPSI) is a national coalition of 21 professional organizations and patient representatives that develops, reviews, updates, and disseminates evidence-based clinical recommendations for women's preventive health care services, from adolescence into the postreproductive years. The aim of the WPSI is to provide a clinically useful tool for practicing clinicians to help them identify and implement recommended preventive care services. The Well-Woman Chart (WWC) was created to serve as a central reference of the evidence-based reviews and recommendations. The chart provides a quick summary of screening, risk assessment, and counseling recommendations, along with links to obtain further clarification. The topics included are updates to the 2011 Institute of Medicine recommendations, as well as any other topics that were deemed relevant to the well-being of women. A brief summary of preventive services recommended during the pregnancy and postpartum periods are also included, though the WWC is not meant to be a comprehensive guide for perinatal care. We encourage clinicians to familiarize themselves with the contents of the WWC and use this tool to educate others to ensure women receive optimized preventive services.

Keywords 
Pregnancy Well-Woman Exam Women's Health Internal Medicine
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