By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living
Sexual health is one of the most under-discussed aspects of women’s wellness.
Many women experience changes in libido, vaginal comfort, and sexual satisfaction throughout life — but too often, these changes are dismissed as “normal aging” rather than treatable physiologic changes.
At Beyond Health, we view sexual health as a vital component of longevity, metabolic wellness, and quality of life. Sexual function is not merely hormonal; it reflects vascular, neurological, psychological, and relational well-being.
Understanding why these changes occur — and how modern medicine can help — allows women to take control of this important part of their healthspan.
1. Libido Through the Female Lifespan
Libido (sexual desire) is a complex interplay of hormones, neurotransmitters, vascular health, and emotional connection. It fluctuates naturally with age, reproductive stage, stress, and health status.
Reproductive Years
During the 20s and 30s, libido tends to be higher due to robust levels of estrogen, progesterone, and testosterone. These hormones enhance vaginal lubrication, clitoral sensitivity, and sexual motivation.
Pregnancy and postpartum, however, often cause temporary declines in libido due to hormonal shifts, exhaustion, and altered body image.
Perimenopause
Starting in the 40s, estrogen and testosterone begin to decline. This leads to:
Menopause and Beyond
After menopause (defined as 12 months without a period), estrogen levels fall by 80–90%, and androgen levels continue to decline gradually.
The result is often a cluster of symptoms known as Genitourinary Syndrome of Menopause (GSM) — a condition that affects up to 50% of postmenopausal women (Portman & Gass, Menopause, 2014).
2. Understanding Genitourinary Syndrome of Menopause (GSM)
GSM is a comprehensive term that replaces “vulvovaginal atrophy,” reflecting a broader understanding of how estrogen deficiency affects multiple tissues in the lower genitourinary tract.
Common GSM Symptoms
These symptoms are not simply inconveniences — they can severely impact intimacy, mood, and quality of life.
Pathophysiology
Estrogen maintains vaginal tissue thickness, elasticity, and vascularity. When estrogen declines:
This environment fosters dryness, discomfort, and increased infection risk — but these changes are reversible with appropriate treatment.
3. Pain With Sex (Dyspareunia): Why It Happens
Pain during intercourse is one of the most common and distressing symptoms of GSM.
Dyspareunia can arise from multiple factors:
Category | Examples |
Hormonal | Low estrogen or androgens → tissue thinning, dryness |
Mechanical | Vaginal narrowing, pelvic floor dysfunction |
Inflammatory | Recurrent infections, skin conditions (lichen sclerosus) |
Psychological | Fear, anxiety, prior pain conditioning |
Medication-related | SSRIs, antihistamines, chemotherapy, anti-estrogens |
Over time, pain can create a feedback loop — fear of pain leads to avoidance, decreased arousal, and further tissue deconditioning.
Breaking this cycle requires addressing both the physical and psychological components, often through local therapy, pelvic floor work, and hormonal restoration.
4. Hormones, Libido, and Vaginal Health
Estrogen
Estrogen is the primary regulator of vaginal health.
It promotes:
Estrogen therapy — especially local (vaginal) formulations — can restore pH, thickness, and lubrication within weeks, dramatically reducing pain and dryness.
Testosterone
While often overlooked, androgens play a key role in female sexual function.
Testosterone influences:
Postmenopausal women typically experience 50% lower testosterone than during reproductive years. Carefully monitored replacement therapy may improve libido and satisfaction (Islam et al., JAMA Intern Med, 2019).
DHEA (Dehydroepiandrosterone)
DHEA is an adrenal hormone that can be converted into estrogen and testosterone within tissues.
Vaginal DHEA (prasterone) has been shown to:
Studies show daily 6.5 mg vaginal DHEA is safe and effective for GSM (Labrie et al., Menopause, 2016).
5. Treatment Options for GSM and Libido Changes
1. Local Vaginal Estrogen
Benefits:
2. Systemic Hormone Replacement Therapy (HRT)
3. Vaginal DHEA (Prasterone)
4. Non-Hormonal Lubricants and Moisturizers
5. Pelvic Floor Physical Therapy
6. Behavioral and Lifestyle Optimization
6. Addressing Libido Holistically
Low libido is rarely just hormonal — it reflects a combination of:
At Beyond Health, our approach is comprehensive:
We combine evidence-based medicine with personalized interventions — from vaginal estrogen and DHEA to pelvic floor therapy referral and behavioral support — to restore sexual function as part of whole-body health.
7. Beyond Health’s Perspective
Sexual function is an essential marker of health and vitality.
Loss of libido or painful intercourse should never be dismissed as “just aging.”
At Beyond Health, we view these symptoms as biological feedback, signaling the need for tissue restoration, hormone balance, and improved vascular and metabolic support.
Our approach integrates:
Because sexual health isn’t vanity — it’s vitality.
Conclusion
Changes in libido, vaginal comfort, and sexual satisfaction are common — but they are not inevitable.
With modern evidence-based therapies, women can restore vaginal health, relieve pain, and reclaim desire at any stage of life.
Vaginal estrogen, DHEA, and tailored hormone therapy are safe, effective, and life-enhancing when prescribed responsibly.
When paired with physical therapy, metabolic health, and lifestyle optimization, they form a comprehensive blueprint for longevity and fulfillment.
At Beyond Health, our mission is to ensure that women not only live longer — but live better, with strength, confidence, and connection at every stage.
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