Your 61-year-old female patient complains of dyspareunia. On pelvic examination, you note atrophic vaginitis. The clinician should explain that these are most likely:
A. Signs of vaginismus
B. Postmenopausal symptoms
C. Signs of estrogen deficiency
D. B and C
ANS: B
There are no special examinations to be done for sexual dysfunction, although hormonal assessment may be helpful. A thorough gynecological examination is adequate to determine whether there is a physical cause for the problem. Decreases in libido and sexual response are not uncommon with aging, although it is an erroneous stereotype to assume that sexual desire or functioning automatically declines with age. In the aging client, lubricating agents may be helpful to deal with decreased or uncomfortable stimulation due to loss of lubrication. Decreased estrogen can cause atrophic vaginitis and thus decreased lubrication, leading to dyspareunia. Serum for free testosterone can be drawn if loss of libido is a problem in the postmenopausal woman.
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