Sexual Dysfunction in Perimenopause & Menopause

Let’s Talk About What’s Often Left Unsaid

There is a part of menopause that many women whisper about — or don’t speak about at all.

Loss of desire.

Pain with intimacy.

Difficulty with arousal.

Changes in orgasm.

Feeling disconnected from your body.

Too often, women are told to “try cuddling instead” or “find a new way to be intimate.”

Connection matters.Emotional intimacy matters.Relationships evolve.

But when sexual changes are distressing, dismissing them is not care.

This is one of the clearest examples of the disparity between men’s and women’s health.

If a man experiences erectile difficulties and this causes distress, medical assessment and treatment options are commonly discussed.

For women, the conversation has historically been quieter.

That is slowly changing as awareness and research continue to grow.

How Common Is Sexual Dysfunction in Midlife?

Sexual changes during perimenopause and menopause are common.

Research suggests that around 40–60% of women experience some form of sexual difficulty during midlife, including:

• Reduced sexual desire

• Vaginal dryness

• Pain with intercourse (dyspareunia)

• Reduced arousal

• Difficulty reaching orgasm

Not all women are distressed by these changes.

But when distress is present, it matters.

Persistent low desire that causes personal distress may meet criteria for conditions such as Female Sexual Interest/Arousal Disorder.

The key word is distress.

Sexual well-being is not defined by frequency.It is defined by comfort, connection, and personal well-being.

Why Does Sexual Function Change?

Sexual well-being during menopause is influenced by several factors.

Hormonal changes

During perimenopause and menopause, levels of reproductive hormones fluctuate and gradually decline.

These changes can influence:

• Vaginal tissue elasticity

• Natural lubrication

• Blood flow to genital tissue

• Sexual desire and arousal

A condition known as Genitourinary Syndrome of Menopause (GSM) may occur.This can involve vaginal dryness, irritation, or discomfort with penetration.

Importantly, GSM is common and treatable once recognised.

Sleep, stress and nervous system factors

Chronic sleep disruption, anxiety, and mental load can also affect sexual desire. When the nervous system is under sustained stress, libido often becomes less of a priority for the body.

Relationship and life context

Sexual well-being is also influenced by:

• Relationship dynamics

• Body image changes

• Cultural messages about ageing

• Emotional wellbeing

Sexual health is best understood through a biological, psychological and relational lens.

Evidence-Informed Management Approaches

Management depends on the dominant contributing factors and should always be

individualised following clinical assessment.

Supportive strategies may include:

Treating vaginal discomfort or dryness

Addressing underlying vaginal tissue changes can significantly improve comfort and intimacy for many women.

Managing broader menopausal symptoms

For some women, addressing other menopausal symptoms such as sleep disturbance or hot flushes may indirectly improve sexual wellbeing.

Pelvic floor physiotherapy

Pelvic health physiotherapists can assist with pain, pelvic floor tension, and sexual discomfort.

Psychological or relationship support

Sexual wellbeing is closely linked to emotional and relational factors.

Lifestyle and wellbeing strategies

Improving sleep quality, managing stress, and addressing fatigue can also support libido. In some cases, additional medical treatments may be discussed after careful clinical assessment and shared decision-making.

There is no single solution.There is thoughtful, individualised care.

Journal Club

Female sexual dysfunction in midlife: Contemporary assessment and management considerations. International Journal of Gynecology & Obstetrics (2026)

For this issue, we reviewed a recent article examining sexual dysfunction in perimenopausal and postmenopausal women and how it should be assessed and managed today.

What Was Reviewed?

The article examined:

• The prevalence of sexual dysfunction during midlife

• Biological, psychological and relational contributors

• How clinicians distinguish low desire from pain-related avoidance

• Current management approaches supported by the literature

It brings together contemporary research and international guidance.

Why Does This Matter?

The review reinforces that:

• Sexual difficulties in midlife are common

• Distress, not frequency, defines clinical significance

• Many women are not routinely asked about sexual well-being

• Pain and vaginal dryness are often overlooked contributors

Sexual well-being is an important component of overall quality of life.

What Has Changed?

The literature increasingly emphasises:

• Earlier recognition and management of vaginal symptoms

• More proactive clinician-led conversations about sexual wellbeing

• Greater acknowledgement that sexual health is part of holistic menopause care

What This Does, and Does Not, Mean

This does not mean:

• All women require treatment

• One approach works for everyone

• Sexual frequency defines well-being

It does support:

• Individualised assessment

• Thoughtful, stepwise management

• Validating women’s experiences

Does This Change Clinical Practice?

For clinicians working in menopause care, the paper largely reinforces current best practice.

It highlights the importance of:

• Proactively asking about sexual well-being

• Recognising vaginal symptoms early

• Taking a biopsychosocial approach to management

Perhaps the biggest shift is cultural.

Sexual health during menopause deserves to be taken seriously.

A Gentle 3-Step Check-In

If this topic resonates, you may wish to:

1. Notice whether changes are causing personal distress

2. Consider whether pain, dryness, desire, or arousal is the dominant issue

3. Seek a menopause-informed clinician comfortable discussing sexual health

You deserve to feel heard.You deserve thoughtful discussion of options.

A Final Thought

Sexuality does not expire at menopause.

Desire may change.Bodies change.Context changes.

But silence should not be the default response.

If this part of menopause has felt lonely, confusing, or dismissed, you are not alone.

You’re not alone on this journey, and understanding how different treatments work can support more informed, confident decisions.

If you’d like support or a personalised review, you’re welcome to reach me at: hello@menopauseandme.com.au www.menopauseandme.com.au

Warmly,JennaNurse Practitioner & Menopause Educator

Sources

International Menopause Society. Global Consensus Position Statement on Testosterone Therapy for Women. | Australasian Menopause Society. Genitourinary Syndrome of Menopause Information Sheet. | North American Menopause Society. Management of GSM and sexual dysfunction guidance.

Journal Club feature:

Okomo, U., Oringanje, C., Nwaneri-Ogugbue, M., Inyang, E., Okusanya, B., Okoh, P.-F., Otonkue, M., & Meremikwu, M. (2026). Female sexual dysfunction in midlife: Contemporary assessment and management considerations. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.70761

Important  Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse  Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements –  particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past.  Individual needs and responses vary.