Growing evidence indicates that sexual desire during menopause reflects a dynamic biopsychosocial transition rather than a uniform decline, with implications for clinical assessment, counseling, and management. Clinicians should move beyond symptom-focused care toward integrated models that address biological, psychological, and relational determinants of sexual health in perimenopausal and postmenopausal populations.

Women’s health has historically been underexplored, particularly during menstruation, pregnancy, childbirth, and menopause. Although research has advanced the understanding of pathophysiology and symptom burden, attention is shifting toward quality of life, including sexual health and desire.

Myth Shift

Speaking with El Médico Interactivo, a Medscape Network platform, Lola González and Estela Buendía, psychologists and sexologists at Borobil Centro Sexológico y de Atención a la Pareja in Bilbao, Spain, said, “The main challenge lies not only in the presence of symptoms and their treatment but in the fragmentation of therapeutic approaches, which often medicalize the experience without integrating life context, subjective meaning, and the relational dimension of female sexuality.”

Emerging evidence has challenged these persistent misconceptions. A 2025 study published in Menopause by researchers at the Kinsey Institute, Bloomington, Indiana, reported that most postmenopausal women continue to experience orgasms with a similar frequency and quality as younger women. In a survey of 1500 women in the US, those in perimenopause and postmenopause were more likely to report improved orgasm quality over the previous decade.

However, findings from a large study published in The Lancet Obstetrics, Gynaecology, & Women’s Health indicated that sexual difficulties and sexuality-related distress experienced by middle-aged women remain common. “While our study revealed that low desire and low arousal were the most frequent sexual difficulties, participants with a low sexual self-image had the highest likelihood of associated distress,” said Susan R. Davis, AO, MBBS, PhD, consultant endocrinologist, professor, and head of the Women’s Health Research Program at Monash University in Melbourne, Australia.

These findings showed a dual pattern. Sexual concerns are common and linked to physiologic changes; however, the capacity for satisfying sexual function remains possible in many individuals.

Therapy Options

Pharmacologic strategies continue to evolve. Testosterone therapy at physiologic doses is used for menopausal sexual desire, although the benefits and risks remain uncertain. An international consensus published in The Journal of Clinical Endocrinology & Metabolism concluded that the only evidence-based indication for testosterone therapy in women is the treatment of hypoactive sexual desire disorder, with moderate benefit. Evidence does not support its use for other symptoms or disease prevention.

Other approaches are still being investigated. Observational data suggest that cannabis may facilitate orgasm in postmenopausal women due to its well-known vasodilatory and anti-inflammatory mechanisms. A 2024 review in The Journal of Sexual Medicine reported the widespread use of cannabis in this population, although evidence remains limited.

A 2025 study from Cornell University, Ithaca, New York, for biomarkers in menopause identified stepwise dysregulation across physiologic systems linked to loss of sex hormones and proposed deconvolution methods to better characterize age-related transitions. These findings may support more personalized approaches to menopausal care, including sexual health.

Psych Care

Experts emphasize that sexual desire should not be addressed solely from a biological perspective. Research has often focused on younger populations, hormonal parameters alone, and frequency of sexual activity-based outcomes rather than subjective experience or satisfaction.

“This has generated unrealistic normative standards that can lead to the pathologization of healthy experiences of fluctuating desire, even in the absence of clinically significant distress,” González and Buendía said.

Cognitive-behavioral therapy has emerged as a leading nonpharmacologic intervention for alleviating sexual concerns during this period. Evidence presented at the 2024 meeting of The Menopause Society in Chicago indicated that cognitive-behavioral therapy may be among the safest and most effective strategies for addressing sexual concerns during menopause.

“While pharmacology has a role, scientific evidence supports psychologic and sexologic interventions, where sex therapy plays a central role,” they added. “Within this framework, cognitive-behavioral therapy is a valuable tool for managing anticipatory anxiety and erotic self-demand.”

New Factors

Emerging research has highlighted additional modifiable factors. A 2025 study published in Nature suggests that probiotics may improve sexual function and quality of life during menopause.

Sleep plays a key role in this phase. Data from the Journal of Psychosomatic Research (2023) revealed a negative association between insomnia severity and sexual satisfaction, with insomnia linked to higher rates of sexual dysfunction in women.

Digital therapeutics are gaining traction. A randomized clinical trial published in Behaviour Research and Therapy validated the efficacy of eSense, a digital platform for women with sexual interest arousal disorder. The platform delivers evidence-based cognitive-behavioral therapy and mindfulness through self-guided modules, offering a more accessible and lower-cost alternative to in-person care.

In conclusion, “Female sexuality in perimenopause and postmenopause is not ‘in decline’ but rather ‘in transformation.’” “The challenge for modern medicine is to update conceptual frameworks, incorporate emerging evidence, and recognize sexual desire as an integral part of women’s health throughout their life course,” González and Buendía said.

The study authors reported having no conflicts of interest.

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.