genetically determined declining DHEAS and T (Fig. 2) (9, 10, 15, 16). In parallel, sexual desire declines with age (17, 18). Decreased sexual desire with ‘‘reverse adrenarche’’has long been associated with clinical disruptions (Table 2) of endogenous androgen decline. Examples include oophorectomy, oral estrogen therapy, adrenal insufficiency, corticosteroid adrenal suppression, and hypopituitarism (19–21). Aging afflicts sexual endocrinology in other ways. Engagement in a secure and attractive relationship, a safe place, good health, and no drugs remain as core issues. Declining estrogens. Estradiol secretion, chaotic during peri- menopausal years, declines to very low levels after menopause. Estrogen withdrawal increases tissue fragility, increases vaginal and urinary infections, irritation, dryness, urogenital pain, and susceptibility to vaginal tissue trauma (1). Declining estrogen impairs sexual desire indirectly in that it induces vulvovaginal atrophy leading to sexual pain and trauma during intercourse (1). Finally, neuroendocrine estrogen depletion adversely affects sexual response
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Perimenopausal and Postmenopausal Years Female aging is associated with genetically determined
declining DHEAS and T (Fig. 2) (9, 10, 15, 16). In parallel, sexual desire declines with age (17, 18). Decreased sexual desire with ‘‘reverse adrenarche’’has long been associated with clinical disruptions (Table 2) of endogenous androgen decline. Examples include oophorectomy, oral estrogen therapy, adrenal insufficiency, corticosteroid adrenal suppression, and hypopituitarism (19–21). Aging afflicts sexual endocrinology in other ways. Engagement in a secure and attractive relationship, a safe place, good health, and no drugs remain as core issues. Declining estrogens. Estradiol secretion, chaotic during peri- menopausal years, declines to very low levels after menopause. Estrogen withdrawal increases tissue fragility, increases vaginal and urinary infections, irritation, dryness, urogenital pain, and susceptibility to vaginal tissue trauma (1). Declining estrogen impairs sexual desire indirectly in that it induces vulvovaginal atrophy leading to sexual pain and trauma during intercourse (1). Finally, neuroendocrine estrogen depletion adversely affects sexual response by acting through the central nervous system and expressed as mood swings, hot flushes, irritability, memory lapses, and insomnia (1).
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