For decades, declining sexual desire in menopause was treated as inevitable, almost "part of the package" of getting older. That idea no longer holds up: female sexuality after 50 has a well-studied physiological basis, and —this is a genuine novelty— for the first time there is an approved oral treatment specifically for low sexual desire in postmenopausal women.
What's changing (and why)
Desire, arousal, orgasm, satisfaction and pain are the five dimensions that define female sexual function, and menopause can affect each of them differently. The decline in oestrogen, progesterone and also testosterone —the latter with a real, if less well-known, role in female desire— explains much of these changes.
What the evidence says
- Pain during intercourse (dyspareunia) is one of the most cited symptoms of vaginal atrophy and dryness in menopause; in clinical samples, studies report figures ranging from 11% to over 45%.
- A 2025 study of more than 900 women aged 40 to 79 found that regular sexual activity (in the past 3 months) is associated with a lower likelihood of vulvar pain, dryness and irritation — one more reason not to avoid it out of fear of pain, but to treat the underlying cause.
- In December 2025, the FDA approved an expanded indication for flibanserin for low sexual desire in postmenopausal women under 65 — the first and only oral treatment approved specifically for this indication.
The map of options, by symptom
- Dryness and pain (dyspareunia): local vaginal oestrogen therapy — the best-supported treatment for this specific symptom.
- Low sexual desire: systemic hormone therapy (oestrogen ± testosterone) or, since late 2025, oral flibanserin in eligible women.
- Pelvic function and sensitivity: pelvic floor physiotherapy, Kegel exercises.
- Complex or multifactorial cases: vaginal DHEA, regenerative treatments (PRP, laser) — with growing but still developing comparative evidence.
An important message
Many women never mention their sexual difficulties at the gynaecology appointment, and many practitioners don't actively ask either — a 2025 systematic review documented precisely that communication gap as a real barrier to getting help. Naming the symptom, even if it feels uncomfortable at first, is the first step toward treatment.
A note
This content is for informational purposes and does not replace a medical consultation. Flibanserin and hormone therapy require individual assessment and prescription.
- Paschou SA, Athanasiadou KI, Hafford-Letchfield T, et al. (2024). Sexual health and wellbeing and the menopause: An EMAS clinical guide. Maturitas, 189, 108055.
- Kao A, Binik YM, Kapuscinski A, Khalifé S (2008). Dyspareunia in postmenopausal women: A critical review. Pain Research & Management, 13(3), 243-254.
- The Menopause Society (2025). More sex, less pain and irritation for perimenopausal and postmenopausal women. Menopause.
- Medscape (2025). FDA Expands Flibanserin Approval to Postmenopausal Women With Hypoactive Sexual Desire Disorder.
- Calvin A, Cina S, Byrskog U, Erlandsson K, Borneskog C (2025). Women's experiences of their sexuality during their menopausal transition and the support offered to them by healthcare providers: A systematic review and meta-synthesis. European Journal of Midwifery, 9.