Formation of Sexual Dysfunctions in Women at the Stage of Menopausal Transition - (Romashchenko O, Grygorenko V, Melnykov S, Biloholovska V, Yakovenko L)

The authors assessed women in perimenopause and early menopause using standardized clinical evaluations. These included measures of sexual desire, arousal, lubrication, orgasm, satisfaction, and pain during intercourse. Hormonal status — especially changes in estrogen — was evaluated alongside psychological factors such as anxiety, mood changes, and stress. Social and relationship variables were also considered.

Key Findings

The study found that changes in sexual experience become significantly more common during the menopausal transition, and that they are rarely shaped by a single factor.

Physically, declining estrogen levels were strongly associated with vaginal dryness, reduced elasticity of vaginal tissues, thinning of the vaginal epithelium, and increased discomfort during sexual activity. These changes directly affected arousal, lubrication, and overall sexual satisfaction.

Neurological and vascular changes related to estrogen decline also contributed to reduced genital blood flow and diminished sensitivity — which can affect arousal and orgasm even in women who still report sexual interest.

Psychological factors played a major role. Women experiencing anxiety, depressive feelings, sleep disturbance, and heightened stress were significantly more likely to report low desire and reduced sexual satisfaction. The study emphasized that fear of discomfort and previous difficult sexual experiences during menopause often led to avoidance of intimacy, which further reinforced those patterns over time.

Relationship dynamics were another important contributor. Reduced communication with partners, feelings of embarrassment, and lack of understanding from partners amplified sexual difficulties and emotional distress.

How Intimacy Shifts During the Menopausal Transition

The authors describe these changes as a gradual process rather than a sudden event. Hormonal shifts initiate physical changes, which can then lead to anticipatory anxiety, reduced desire, and avoidance. Over time, this cycle can become entrenched even as hormone levels stabilize.

Importantly, the study highlights that many women misinterpret these changes as a normal and unavoidable loss of sexuality — rather than as experiences shaped by physiology and psychology that are worth discussing with a knowledgeable provider.

What Does This Mean for Me?

The findings have significant implications for wellbeing and quality of life.

Changes in sexual experience during menopause were associated with reduced self-esteem, increased emotional distress, strained partner relationships, and lower overall life satisfaction. The authors note that when these changes go unaddressed, they can weigh on mood and contribute to social withdrawal.

The research points to the value of recognizing these changes early — during perimenopause, not years later when the patterns are already entrenched. A purely physical or purely psychological approach was found to be insufficient on its own.

The authors describe a more integrated approach: one that takes into account hormonal wellbeing, vaginal tissue health, psychological factors, and partner communication. Their view is clear — sexual wellbeing deserves to be central to menopausal care, not an afterthought.

In a Nutshell...

Intimacy changes during the menopausal transition are common, multifactorial, and biologically driven — but they are not inevitable, and they are not something to simply accept in silence. Hormonal shifts initiate physical changes that interact with psychological and relational factors to shape sexual experience in midlife. Early recognition and an integrated, whole-person approach can prevent long-term distress and preserve both intimacy and quality of life for women navigating this stage.