Women's Sexual Health: Libido, Arousal, and What the 2026 Research Shows

Forty-Three Percent of Women Report a Sexual Health Problem. So Why Does Almost Nobody Study It?

Here is a number that should bother you: 43.1% of women of all ages report experiencing a sexual problem. Among those, about 12% describe it as distressing enough to interfere with their lives. A national probability sample of more than 3,000 adults aged 57 to 85 found that sexual dysfunction was more common in women (11.3% to 43.3%) than in men (2.9% to 36.9%). The range is wide because female sexual dysfunction spans multiple overlapping conditions -- low desire, difficulty with arousal, pain during sex, inability to orgasm -- and many women deal with more than one at the same time.

Despite these numbers, research funding tells a different story. Applied mathematician Arthur Mirin analyzed NIH data and found that diseases predominantly affecting women received funding that was a fraction of what was awarded for diseases predominantly affecting men, once you adjust for disease burden. The NIH hasn't even assigned menopause its own identification code for funding tracking -- unlike conditions such as prostate cancer or anorexia -- making it nearly impossible to track how much money goes toward studying something that affects half the world's population.

The disparity goes deeper than dollars. Before the 1993 NIH Revitalization Act, it was both normal and acceptable for drugs and vaccines to be tested only on men. That law forced the inclusion of women in NIH-funded clinical trials, and roughly half of participants in those trials are now women. Progress, yes. But the legacy of exclusion persists: the foundational research that informs how we understand conditions like hypoactive sexual desire disorder (HSDD) was built on decades of data that barely included female bodies.

Consider the treatment landscape. There are more than 30 testosterone products approved by the FDA for men. For women? Zero. The first FDA-approved drug specifically for female sexual desire (flibanserin) didn't arrive until 2015 -- nearly two decades after sildenafil launched for erectile dysfunction. As the White House stated when announcing its Initiative on Women's Health Research in January 2024, "women have been understudied and underrepresented in health research for far too long."

What makes this particularly frustrating is that sexual health problems don't just affect women who happen to be young or partnered. About 60% of women older than 60 remain sexually active, and surveys consistently show that sexuality matters to women across all stages of adulthood. The assumption that older women don't care about sex has functioned as a convenient excuse for not investing in treatments or training doctors to ask the right questions.

Three Breakthroughs That Changed Female Sexual Health in 2025 and 2026

More happened in the past 18 months than in the previous decade. Three developments matter most.

The first arrived in April 2025, when the American Urological Association released the first-ever clinical guideline on genitourinary syndrome of menopause (GSM). Developed in collaboration with the Society of Urodynamics (SUFU) and the American Urogynecologic Society (AUGS), the guideline was endorsed by ISSWSH and The Menopause Society. Before this guideline existed, there was no consensus on how many symptoms or physical signs a patient needed before a doctor could formally diagnose GSM. That ambiguity left millions of women in a diagnostic gray zone where their pain was real but their condition had no official framework.

The second came in November 2025. The FDA convened an expert panel to revisit the warning labels on hormone replacement therapy (HRT) for menopause and concluded that the existing labels -- which had been in place since 2002 -- were based on outdated data from the Women's Health Initiative study. That study used conjugated equine estrogens combined with medroxyprogesterone acetate in women whose average age was 63, well past the typical onset of menopause. Clinicians had argued for years that the risks found in that specific population couldn't be generalized to all forms of hormonal therapy, and the FDA agreed: it announced plans to remove the broad box warning labels from HRT products.

The third breakthrough landed in December 2025, when the FDA approved an expanded indication for flibanserin (Addyi) to treat HSDD in postmenopausal women under 65. The drug had been approved in 2015, but only for premenopausal women. The expansion made it the first and only FDA-approved treatment of its kind for this population. Dr. Rachel S. Rubin, a urologist and sexual medicine specialist, put it plainly: "So many of my postmenopausal patients have carried the weight of frustrating low sexual desire with no FDA-approved option to turn to."

The ISSWSH annual meeting in early 2026 built on this momentum. Researchers presented work spanning sexual dysfunction in cancer survivors, innovative GSM therapies, and the ongoing push to distinguish HSDD from female sexual arousal disorder -- conditions that the Global Consensus Position Statement on testosterone confirms are distinct (Grade B evidence) and require separate diagnostic and treatment approaches. The practical takeaway: a woman who has low desire needs different treatment than a woman who has difficulty with physical arousal, even when the two overlap.

Low-Dose Testosterone for Women: Separating Signal from Noise

Testosterone therapy for women is trending on social media, in book clubs, and in doctor's offices. Dr. Kathleen Jordan, chief medical officer at Midi Health, calls it the "book club effect" -- women who have positive outcomes share them with friends, and providers see those friends arriving for appointments. The enthusiasm is running well ahead of the evidence.

First, some biology. Women produce testosterone in their ovaries and adrenal glands, and it plays a role in sexual desire, arousal, bone density, and muscle maintenance. Think of it less as a "male hormone" and more as a shared chemical with a different volume dial. As Dr. Talia Crawford at Cleveland Clinic puts it, "Part of the confusion with testosterone and estrogen is that we genderize them and call them 'sex hormones,' but in reality, both have important biological functions in both men and women."

Women's testosterone levels decline throughout the reproductive years and drop to about 25% of their peak by midlife. The typical level for an adult woman is around 40 ng/dL (normal range 15 to 70 ng/dL), compared to 193 to 824 ng/dL in men. Women who receive testosterone therapy take roughly one-tenth of the dose prescribed to men.

What does the evidence actually support? The strongest data comes from a 2019 Global Consensus Position Statement, endorsed by 11 international medical societies including the Endocrine Society, the International Menopause Society, and ISSWSH. The consensus found that testosterone therapy at physiological doses produces a beneficial effect on sexual function: an average of one additional satisfying sexual event per month, plus increases in desire, arousal, orgasmic function, pleasure, and responsiveness, along with reduced sexual distress (Level I, Grade A evidence).

One additional satisfying sexual event per month may not sound dramatic on paper. But for a woman who has gone from wanting sex regularly to not wanting it at all -- and feeling distressed about it -- that shift can reshape how she feels about her body and her relationship.

Here is where the evidence gets narrower. The only condition for which testosterone has adequate clinical support is postmenopausal HSDD -- low sexual desire that causes distress and isn't explained by another medical or psychiatric condition. For everything else women report improving on testosterone -- energy, mood, brain fog, body composition -- the Global Consensus found no effect on general wellbeing, cognitive performance, or depressed mood. As Dr. Traci Kurtzer at Northwestern told Time magazine: "We just don't have sufficient data."

And the risks? At physiological doses, the Global Consensus found mild increases in acne and body or facial hair in some women, but not alopecia, clitoromegaly, or voice change (Level I, Grade A). The concern about masculinization is, according to Dr. Jordan, "disproportionate to what really happens" when doses stay in the physiological range.

The bigger worry is what we don't know. No long-term studies on testosterone in women extend beyond about two years, even for HSDD. Whether extended use affects cardiovascular risk or breast cancer risk remains an open question. The Global Consensus was explicit: oral testosterone is not recommended because of adverse effects on lipid profiles, and the recommendations do not apply to pellets, injections, or compounded formulations that produce supraphysiological concentrations.

That last point matters because compounding pharmacies are where many women actually get their testosterone. These pharmacies create custom doses since no FDA-approved product exists for women. But their products aren't regulated for efficacy or consistency. One study found that some compounded products contained more than 20% deviation from the prescribed dose, while others had essentially no testosterone at all. Both the Global Consensus and the National Academies of Sciences, Engineering, and Medicine have recommended against compounded bioidentical testosterone, and pellet implants carry particular risk because, as Dr. Kurtzer explains, "Once they're in your body, you can't alter or adjust the dose. It takes about three to four months for testosterone pellets to metabolize out."

Testosterone Form	Recommended?	Why
Transdermal cream/gel	Yes (preferred)	Safest delivery; avoids liver/lipid effects; dose adjustable
Transdermal patch	Yes	Controlled delivery; fewer side effects than oral
Oral pills	No	Adverse lipid profiles; liver effects (Level I, Grade A)
Pellet implants	No	Supraphysiological levels; dose cannot be adjusted once placed
Injections	No	Very high levels; can cause rage, acne, hirsutism
Compounded formulations	Caution	Not FDA-regulated; significant batch-to-batch variation

Four countries -- the United Kingdom, Australia, New Zealand, and South Africa -- have approved testosterone products specifically for women. The United States has not. Until that changes, American women navigating testosterone therapy are working with off-label prescriptions and a regulatory gap that the medical community has been trying to close for years.

Beyond Dryness: What GSM Actually Is and How to Treat It

Genitourinary syndrome of menopause is one of those conditions that sounds clinical until you hear what it feels like: burning during urination, pain during sex, vaginal dryness so persistent that it interferes with daily comfort, itching that doesn't respond to over-the-counter creams, and recurrent urinary tract infections that keep coming back despite antibiotics. The term was introduced in 2014 to describe the spectrum of symptoms and physical changes resulting from declining estrogen and androgen concentrations during menopause.

It affects a staggering number of women. According to the 2025 AUA guideline, GSM affects up to 87% of postmenopausal individuals. The symptoms can be as debilitating as other chronic conditions -- research has found that GSM symptoms impact women's quality of life to a similar extent as arthritis, COPD, asthma, or irritable bowel syndrome.

The 2025 AUA/SUFU/AUGS guideline laid out a treatment hierarchy that finally gives both patients and doctors a structured framework. The options, in order of escalation:

Treatment	What It Does	Best For
Lubricants and moisturizers	Temporary symptom relief; restores moisture	Mild dryness; adjunct to hormonal treatments
Vaginal estrogen (local)	Restores vaginal tissue; reduces UTI frequency	Moderate to severe symptoms; recurrent UTIs
DHEA/prasterone (vaginal)	Converts to estrogen and testosterone locally	Moderate-to-severe dyspareunia (painful sex)
Ospemifene (oral)	Selective estrogen receptor modulator	Women who prefer oral over vaginal treatment

What the guideline explicitly does not support: energy-based treatments like CO2 or Er:YAG laser devices marketed as "vaginal rejuvenation." The AUA considers these investigational and not supported by current evidence outside of clinical trials. The FDA has separately warned against using energy-based devices cleared for general gynecologic purposes for vaginal rejuvenation or menopause symptoms.

The removal of the broad box warning on HRT in November 2025 was equally significant for GSM treatment. For over two decades, the warning -- based on the WHI study's findings in a specific population of older women -- had scared both patients and physicians away from vaginal estrogen. Data accumulated since then tells a different story: women who initiate HRT within 10 years of menopause onset show reduced cardiovascular risk, a 35% reduction in the risk of Alzheimer's disease, and a 50% to 60% reduction in the risk of bone fractures. Local vaginal estrogen, which produces minimal systemic absorption, carries even less risk than systemic formulations.

Dr. Sameena Rahman, a clinical assistant professor at Northwestern Feinberg School of Medicine, captured what the label change means in practice: "My counseling is now going to shift from a place of fear to a place of clarity." That single sentence summarizes two decades of unnecessary suffering caused by a warning label that didn't match the evidence.

The Doctor Who Doesn't Ask: What the Training Gap Costs Women

You can have effective treatments, clear guidelines, and FDA approvals. None of it matters if the doctor sitting across from you never brings up sexual health.

The data on how often that conversation happens is bleak. In one survey, 73% of women said their primary care providers asked about sexual health only a few times or almost never. The REVIVE survey found that only 19% of menopausal women were asked by their doctors about sexual health. Even among OB/GYNs -- the specialists most closely connected to reproductive health -- a survey found that while two-thirds routinely asked about sexual activity, only 40% asked about sexual concerns and just 29% asked about sexual satisfaction.

The gap between "are you having sex?" and "is sex working for you?" is where most women fall through.

Why don't more doctors ask? The research points to a training deficit that starts in medical school. The time devoted to sexual health education in medical schools has dramatically decreased, and a 2016 review found that sexual medicine objectives were included in only a few residency programs. A 2025 study of 167 medical residents at Belgium's largest medical school found widespread dissatisfaction with training in sexual history taking, with the most prominent barrier being a lack of skills and knowledge. A survey of 150 physician assistants found that menopause training was inadequate across PA programs.

What the Surveys Show	Percentage
Women whose PCPs rarely/never ask about sexual health	73%
Menopausal women asked about sexual health (REVIVE)	19%
OB/GYNs who ask about sexual activity	67%
OB/GYNs who ask about sexual concerns	40%
OB/GYNs who ask about sexual satisfaction	29%
HSDD patients who delayed help, believing no treatment existed	40%

The consequences of not asking are measurable. Among women in an HSDD registry, 40% reported delaying or foregoing professional help because they didn't believe a treatment existed. Two-thirds of participants in the Women's EMPOWER survey were only somewhat familiar or completely unaware of effective treatments for their symptoms. Women aren't avoiding care because they don't want help. They're avoiding it because no one told them help was available, or because the one time they brought it up, they felt dismissed.

Research confirms the flip side: patients are significantly more inclined to disclose sexual dysfunctions when prompted by their healthcare providers. Physicians who are comfortable discussing sexuality are more likely to uncover problems -- including issues that go beyond sexual dysfunction. The barrier isn't patient reluctance. It's provider silence.

Dr. Rachel Pope, who presented at the ISSWSH 2026 meeting, noted that women with conditions like lichen sclerosis can go for years without being diagnosed, partly because providers aren't trained to look for them. The pattern repeats across GSM, HSDD, and other conditions: by the time a woman finds a knowledgeable provider, she has often spent years assuming her symptoms were inevitable or unimportant.

Six Questions to Bring to Your Next Appointment

Waiting for your doctor to bring up sexual health may mean waiting indefinitely. Based on the evidence and expert guidance reviewed in this article, here are specific questions worth raising at your next visit.

1. "Could my symptoms be related to GSM?" If you're postmenopausal and experiencing vaginal dryness, pain during sex, urinary urgency, or recurrent UTIs, ask specifically about GSM. The 2025 AUA guideline gives your doctor a clinical framework for diagnosis and treatment that didn't exist before.

2. "Am I a candidate for vaginal estrogen?" The removal of the broad HRT box warning in November 2025 means your doctor can now discuss local vaginal estrogen without the same regulatory baggage. Local vaginal estrogen has minimal systemic absorption and is recommended as a treatment for GSM symptoms and recurrent UTIs.

3. "I've noticed a change in my desire for sex. Could this be HSDD?" HSDD is a clinical diagnosis, not just "normal aging." It should be assessed through thorough clinical evaluation guided by ISSWSH or ICD-11 diagnostic criteria. A biopsychosocial approach is ideal -- meaning your doctor should consider medical, psychological, and relationship factors rather than jumping straight to a prescription.

4. "Is testosterone therapy appropriate for my situation?" If you're postmenopausal and low desire is your primary concern, transdermal testosterone may be an option. Ask about expected timelines: improvement typically takes about four weeks, with maximum results around 12 weeks. If nothing changes by six months, the recommendation is to stop and explore other causes.

5. "How will you monitor me if I start testosterone?" Baseline testosterone levels should be checked before starting therapy, with follow-up testing within four to six weeks and then every six months. The goal isn't to hit a target number -- it's to make sure levels don't climb too high.

6. "Can you refer me to a sexual medicine specialist?" Not every primary care provider or OB/GYN has training in sexual medicine. ISSWSH maintains a Find a Provider directory specifically for this purpose. A specialist can offer evaluation and treatment options that a general practitioner may not be equipped to provide.

Frequently Asked Questions

Is low libido a normal part of aging, or a medical condition?

It depends on whether it causes you distress. A gradual shift in desire over time is common and doesn't require treatment if it doesn't bother you. But when low desire causes personal distress -- not just your partner's dissatisfaction -- and isn't explained by another condition (medication side effects, depression, relationship conflict), it may qualify as HSDD. The distinction matters because HSDD is a diagnosable condition with treatment options, not an inevitable consequence of getting older.

Is testosterone safe for women?

At physiological doses (typically transdermal cream or gel), clinical trials of up to two years show it is well-tolerated with mild side effects like occasional acne or body hair growth. The unknown is long-term safety beyond two years, particularly regarding cardiovascular and breast cancer risk. The Global Consensus Position Statement, endorsed by 11 medical societies, supports its use specifically for postmenopausal HSDD when properly monitored. Pellets, injections, and high-dose compounded formulations carry higher risk and are not recommended.

What's the difference between HSDD and general low libido?

HSDD is clinically defined as low sexual desire that causes significant personal distress and is not better explained by another medical condition, psychiatric disorder, medication, or relationship problem. General low libido might have a clear cause (stress, exhaustion, a new medication) or might not bother you. HSDD is the specific diagnosis that qualifies for pharmacological treatment like flibanserin or testosterone therapy.

Should I ask my doctor about GSM, or wait for them to bring it up?

Ask. The data is clear that most providers will not initiate this conversation, and many women spend years managing symptoms they assume are untreatable. The 2025 AUA guideline and the removal of the HRT box warning give your doctor a stronger evidence base than ever before. If your provider dismisses your concerns, consider seeking a specialist through ISSWSH's provider directory.

Are vaginal laser treatments effective for menopause symptoms?

The 2025 AUA guideline classifies energy-based treatments (CO2 and Er:YAG laser) as investigational and not supported by current evidence for GSM outside of clinical trials. The FDA has also warned against their use for vaginal rejuvenation or menopause symptoms. Evidence-based alternatives include vaginal estrogen, DHEA, and non-hormonal moisturizers.