I concur with the points Barbara Levy, MD, raises in her article, “Break the silence: discussing female sexual dysfunction” [March], especially the need for physicians to raise the subject. In fact, I post an open letter in my office that informs patients of my willingness to provide sexual counseling, as it was a formal part of my OBG residency training. However, I insist that their male partners also participate. Perhaps because of this, very few have sought therapy.
It is important to note that of the patients who do seek counseling, perimenopausal women (ages 40 to 50+) most frequently report having decreased libido compared with other age groups.
Gary Steinman, MD
DR. Levy responds:
I agree with Dr. Steinman that decreased libido is a common complaint among perimenopausal women. However, testosterone levels actually begin their decline much earlier. Another group who frequently report diminished libido are women in their 30s, particularly those who are new mothers. Whether it is the abrupt change in lifestyle, the stress of motherhood, or declining testosterone levels that precipitate this often dramatic alteration in sexual function, remains to be elucidated. The key point is that without our direct solicitation, many women suffer these symptoms in silence.