Last fall, a woman began a GLP-1. Within a week, she developed severe vulvar itching and labial ulcers.

The patient, who requested anonymity due to the sensitive nature of her condition, questions if the GLP-1s she took somehow triggered these new vulvovaginal issues. While her symptoms are not typical of those being reported in a growing number of case reports and social media posts, her experience points to a lack of research on how the drugs may affect women’s sexual and pelvic health.

The patient is among a growing number of women experiencing effects of GLP-1s on sexual and genital health. As use of the drugs has surged among women over the last few years, Jessica Yih, MD, an assistant professor of urology and the director of women’s sexual health and male infertility at the University of California, Irvine, has heard from patients about a variety of effects. Many women feel “more confident as sexual beings,” Yih said, but for others, the loss of appetite can extend to libido. Some women have experienced unexpected changes in their skin.

“We’re hearing about, in general, sagging skin and vulvar skin changes,” Yih said.

About 1 in 8 US adults report currently using a GLP-1 medication as of November 2025, with 23% using the drugs for weight loss and 45% using the drugs to treat diabetes. Women are more likely than men to use the drugs and report interest in future use for weight loss. But many women may be unprepared for how the drugs can change their anatomy, including in urogenital areas.

“Most people who get these medications are not having their sexual health addressed,” Yih said.

Fat loss in the labia majora can cause the tissue to stretch, making the labia appear more prominent. The excess tissue can also lead to discomfort or pain during sex, Yih said.

While many therapies and nonpharmaceutical interventions can help improve libido and even help some of the other side effects, patients left in the dark may abandon treatments.

“We know that drugs that affect sexual function can profoundly affect people’s ability to use them,” including antidepressant medications like selective serotonin reuptake inhibitors, said Chailee Moss, MD, an ob/gyn at The Centers for Vulvovaginal Disorders in Washington, DC. “If we know that people need to be on these drugs for their health and safety, but it’s causing their libido to tank, then we need to tell them that at the outset so they can look out for it and get help.”

Moss is leading a periodic survey of patients during their first 6 months of using GLP-1s, asking “what they are noticing from a sexual standpoint.” GLP-1s may help regulate the effects of dopamine, helping people curb compulsive behaviors, such as substance use.

But “when they don’t have a baseline problem, if you downregulate that dopamine access in the brain, is it going to diminish a healthy libido?” Moss asked.

Pelvic Health

Chantal Lowry, a physiotherapist who runs a pelvic health clinic in Lisburn, Northern Ireland, has observed a “significant increase” in her patients using GLP-1s. Some of the women have reported vaginal dryness. Many report constipation, which can lead to straining that increases their risk for urinary incontinence and pelvic organ prolapse.

“Most of the symptoms I see are not caused directly by the medication itself but rather by the consequences of rapid weight loss that hasn’t been properly supported,” Lowry said. “If someone is under-fueling, slightly dehydrated, or losing lean muscle without resistance training, it can impact everything from arousal to the feeling of pelvic support and control.”

The pelvic floor can be thought of as “the gatekeeper” for bowel movements, said Jana Richardson, DPT, a pelvic floor physical therapist and the owner and founder of Chicago Pelvic Health in Wheaton, Illinois. Pelvic floor muscles that are “too tight” can lead to constipation, she said.

GLP-1s can also cause constipation — or worsen it — by slowing down the emptying of the stomach. People on the medications may also consume less nutrients that are important for regular bowel movements.

“If they’re already predisposed to having constipation issues, possibly because of a tight pelvic floor, it’s only going to get probably more amplified” with use of a GLP-1, Richardson said.

When strong and coordinated with the abdominals and glutes, pelvic floor muscles work more effectively and help to reduce symptoms of constipation and incontinence, Richardson said.

“Your pelvic floor muscles are the same as any other muscle in your body, in the sense that if you’re not resistance training and working on full body strengthening, you can definitely have weakness in those muscles too,” Richardson said.

Richardson said clinicians who prescribe these drugs should recommend physical therapy and pelvic floor therapy for women. Given the connection between overall strength and pelvic floor function, physicians who prescribe GLP-1s should also ask patients about their level of physical activity and any barriers.

Menopausal women may be more likely to develop gluteal tendinopathy, which causes chronic hip pain. They may also experience urinary incontinence or prolapse, which can lead to symptoms such as pelvic heaviness, making exercising harder. Use of GLP-1s is highest among adults aged 50-64 years, according to a 2025 survey from the Kaiser Family Foundation. If a patient cannot exercise, they may be more likely to develop pelvic floor dysfunction while taking a GLP-1.

Some effects of GLP-1s in women may also overlap with Genitourinary Syndrome of Menopause (GSM), a combination of vulvovaginal, urinary, and sexual symptoms linked to declining estrogen and androgen, Richardson said.

“A lot of people who are on these drugs are women in the menopausal phase,” Richardson said. “Maybe they’re on a GLP-1 at the same time and they’re developing sexual dysfunction, lack of orgasm, or lack of libido. That could be partly from the GLP-1, but it could also be GSM symptoms.”

Primary care doctors can start the screening process for vulvar tissue changes and pelvic floor health risks among patients using GLP-1s, Yih said.

Asking “Do you have any sexual health or genital health concerns?” can prompt a conversation with patients and lead to a referral for specialty care if needed, she said. 

Sexual Health Effects

GLP-1s change how the body processes fats, which may affect sex hormones.

“Our sex steroids are derived from cholesterol, so if you have a real change in your lipid metabolism, it makes sense to me that you could have changes related to your estrogen and testosterone levels,” Moss said.

GLP-1s have been shown to lower testosterone in women who have polycystic ovarian syndrome (PCOS) or have obesity. But research is lacking on how the drugs affect testosterone levels in women who do not have PCOS or obesity.

Moss prescribes topical medications such as estrogen, prasterone/dhea, or a combination of estradiol and testosterone to treat hormonal imbalances. She hypothesized that, for some patients, these drugs may compensate for hormonal effects related to use of GLP-1s.

Women may have concerns about changes in vulvar appearance with GLP-1 use, sometimes due to the influence of peers and media. The labia minora prominence that can result from fat loss in the labia majora has been dubbed “Ozempic vulva.”

Societal standards and stigmas around labial appearance can affect women’s self-esteem and sexual confidence, contributing to the growing popularity of labiaplasty and other vulvar cosmetic procedures. Vulvar beauty standards — some perpetuated by pornography featuring people with cosmetically altered labia — have become “so ingrained,” Yih said.

But “it can be helpful to understand how broad normal vulvar appearance can be,” Moss said. She often refers patients to online resources, such as the Labia Library, which shows the range of vulvar tissue variation. 

Research Questions

But more research is needed to paint a definitive picture of the effect of the drugs on women’s health. While emerging reports point to detrimental effects, weight loss, especially from abdominal fat, may improve symptoms of stress incontinence or overactive bladder by reducing pressure on the pelvic floor, Richardson said. Researchers from Yale Medicine in New Haven, Connecticut, are currently investigating how GLP-1s may improve urinary incontinence, while an upcoming clinical trial at Hartford Hospital in Hartford, Connecticut, is studying how weight-loss drugs affect pelvic floor health.

Yih recently published a study comparing rates of vulvar hypertrophy and atrophy among patients who were prescribed GLP-1s with a control group. The diagnoses — often used to gain insurance approval for labiaplasty — provided a proxy for possible tissue changes linked to the use of GLP-1s, Yih said. Her analysis  found no statistically significant difference in the two diagnoses between groups.

The finding has “raised a lot of questions, like, how accurately are clinicians diagnosing these conditions?” Yih said.

GLP-1s are often prescribed by telehealth clinics or primary care doctors “who wouldn’t think to ask about vulvar skin or genital concerns or sexual health concerns,” and thus would not make those diagnoses, she said.

While case studies and anecdotal reports inform the development of clinical trials, Moss said potential drawbacks of GLP-1s on urogenital health may be nuanced. GLP-1s may improve overall health for people with obesity, hypertension, and diabetes, helping them overcome sexual dysfunction that can occur with those conditions.

“With these drugs, there may be so many beneficial effects that the big picture is going to be so important,” Moss said. “Because if you’re really improving people’s cardiac status and exercise tolerance, and reducing hypertension, those have tremendous sexual benefits. It’s just hard to know on balance whether the dopamine and hormonal concerns will be outweighed by those benefits.”

The sources declared no financial conflicts of interest.

Sarah Amandolare is a freelance journalist in New York City.