by Frances Bushrod, Ph.D
Younger women who undergo hysterectomy and oophorectomy experience a premature menopause, the symptoms of which are normally treated with oestrogen replacement therapy. However, after such surgery testosterone production also decreases to around half the pre-operative level; this has been associated with the serious loss of sexual desire termed Hypoactive Sexual Desire Disorder (HSDD).
In an effort to alleviate this condition a testosterone patch, Intrinsa, was developed by Procter and Gamble Pharmaceuticals to be prescribed for surgically menopausal women up to the age of 60 years who are also receiving ERT. Recently approved by the EMEA for use in the EU, though not yet approved by the FDA, the patch was studied in clinical trials in women who had experienced surgically-induced menopause. The studies demonstrated a 74% increase in sexual satisfaction in the group using the patch compared with the placebo group. Frequent side-effects, encountered by more than 10% of users, included some extra hair-growth on the chin or upper lip as well as irritation at the site of the patch, but participants in the trial did not consider these sufficiently serious to discontinue therapy. So what is the problem?
Firstly some more serious side-effects are fairly common, including hair loss, acne, migraine, sleep disturbances, voice effects (deepening or hoarseness), breast pain, abdominal pain and weight gain. There is also a possible link with breast cancer which is being investigated further. And unfortunately, but inevitably, studies from several countries are now reporting results from trials using the testosterone patch in older women with 'HSDD' who had actually gone through a natural menopause. Apart from the fact that this is an off-label use of the drug (clinical trials prior to regulatory approval only tested Intrinsa on younger, surgically menopausal women), one has to question whether older, post-menopausal women are genuinely suffering from a condition that should be treated. Various studies actually demonstrate that it is the norm, rather than the exception, for 'sexual dysfunction' in women to increase with age. A recent comprehensive US study involving over two thousand women from 30 to 70 years old found that 52.4% of naturally menopausal women (the average age at which women experience menopause is 52) had low sexual desire. Other studies from Sweden, Switzerland and Italy reported the condition in 52%, 53% and 79% of post-menopausal women respectively. And a study from Nigeria found that nine years post-menopause, 70% of women had ceased sexual activity altogether.
Sadly in today's over-sexualised Western society it is dogmatically asserted, by healthcare professionals as well as by lay people that, in spite of many studies to the contrary, it is normal (and healthy) to enjoy an active sex life to a ripe old age. Lack of sexual desire in the elderly has thus become a condition which must be treated, unpleasant side-effects notwithstanding. Googling Viagra yields 63 million hits; currently 'testosterone patch' yields a quarter of a million hits, including many sites through which Intima can be purchased without a prescription.
A minority of elderly women still want an active sex life. But can we not accept that the majority may now find sexual activity irrelevant, not because they are unhealthy and in need of treatment, but because there are so many more useful and interesting things for them to do?
