Sexual health concerns are extraordinarily common for women during perimenopause, menopause, and post-menopause—yet they remain significantly under-discussed. Research published in peer-reviewed literature indicates that up to 40–70% of midlife women report changes in sexual desire, arousal, lubrication, orgasm, or comfort, with Genitourinary Syndrome of Menopause (GSM) alone affecting more than half of postmenopausal women. These changes often begin during perimenopause—sometimes years before a woman’s final menstrual period—and can persist long after. Importantly, sexual health during midlife is influenced not only by hormonal shifts, but also by neurological, vascular, psychological, relational, and lifestyle factors. In other words, this is not rare, and it is not “just in your head”—it is a common, physiologically grounded experience that deserves informed, evidence-based support.

1. The Impact of Perimenopause & Menopause on Sexual Function

Sexual function is an important contributor to a woman’s quality of life, yet many women experience changes as they transition through perimenopause into menopause. Scientific research shows:

  • Many women report declines in sexual desire, arousal, lubrication, orgasm, satisfaction, and increased pain during and after menopause. These changes are multifactorial, driven by hormonal shifts, psychosocial factors, relationship variables, and physical changes in genital tissues.
  • Longitudinal data demonstrate that sexual functioning begins to decline about 20 months before the final menstrual period (FMP) and continues afterward — underscoring that the transition itself, not just the absence of periods, can influence sexual health.

2. Evidence-Based Medical Approaches

Hormone Therapy & GSM

Genitourinary Syndrome of Menopause (GSM) — including vaginal dryness and discomfort — impacts more than 50 % of midlife and older women and significantly affects sexual activity and comfort.

  • Consensus expert panels (including Dr. James A. Simon and others) emphasize that tissues relevant to sexual function are both estrogen- and androgen-responsive, and this is clinically relevant for managing GSM and related sexual concerns.
  • Systematic reviews find that systemic hormone therapy may offer a small benefit for overall sexual function, possibly by alleviating genitourinary symptoms and improving comfort during sexual activity — though effects on sexual function overall are modest and individualized.

Holistic & Lifestyle Factors

Exercise and physical activity appear to positively influence postmenopausal women’s sexuality and ameliorate psychological symptoms related to menopause, likely through mood enhancement, improved cardiovascular health, and increased body confidence.

3. Perspectives from Leading Practitioners

Dr. Rachel Rubin, MD

Dr. Rubin is a clinician-researcher focused on sexual medicine. Her work highlights that:

  • We need to understand biopsychosocial contributors to sexual dysfunction and broaden clinical approaches.
  • Treatments such as vaginal estrogen and DHEA (prasterone) can be effective first-line therapies for conditions like GSM, helping improve lubrication, reduce discomfort, and support sexual arousal.

Her emphasis on evidence-based, patient-centered care helps destigmatize sexual health conversations and supports women in optimizing wellbeing throughout midlife.

Dr. Kelly Casperson, MD

While direct peer-review citations of Dr. Casperson’s research aren’t indexed on PubMed, her clinical insights — especially through educational platforms — focus on:

  • The importance of targeted vaginal therapies such as localized estrogen to address GSM and associated sexual pain.
  • Integrating pelvic floor health and functional genital care into comprehensive menopausal symptom management.

(These clinical themes are widely supported by menopause care guidelines and patient outcomes discussions in emerging clinical practice.)

4. How Chiropractic Care Can Support Sexual Health

While chiropractic care is not a primary treatment for sexual dysfunction itself, evidence and clinical practice indicate that:

  • Central Nervous System Regulation: Chiropractic adjustments help optimize nervous system communication. Because sexual response involves coordinated neurological, vascular, and musculoskeletal pathways, improved neurological function can support better pelvic floor coordination, sensation, and overall comfort.
  • Stress Reduction: Chronic stress — which many women experience during midlife transitions — can dampen sexual desire and arousal. Chiropractic care promotes parasympathetic activation and reduces sympathetic dominance, fostering relaxation and improved mood.
  • Pelvic Alignment & Function: Subtle biomechanical dysfunction in the lumbar or sacral spine can affect pelvic floor muscle function and proprioception, which in turn may influence comfort and responsiveness during sexual activity.
  • Holistic Care Integration: When combined with lifestyle strategies (e.g., exercise, nutrition, pelvic floor physical therapy), chiropractic support contributes to a whole-body approach to sexual wellbeing.

5. Practical Tips for Women Today

✔ Talk openly with your clinician about symptoms — sexual health is a normal part of overall wellbeing.
✔ Consider regular physical activity — evidence shows structured exercise improves sexual health measures.
✔ Explore evidence-based treatments like localized hormone therapies when appropriate.
✔ Address stress and nervous system balance — holistic care approaches, including chiropractic care, may support global wellbeing that underpins sexual health.

With vitality,
Dr. Brew & the Vitality Chiropractic Center Team

Cultivating Vitality – one person, one mind, one life at a time.