Monash University researchers have released a landmark study and called for urgent guidance and therapy.
Almost half of women in midlife experience poor sexual wellbeing, according to a large Monash University-led study.
The research, believed to be the largest of its kind and published in The Lancet Obstetrics, Gynaecology & Women’s Health, found that women in early perimenopause were twice as likely to experience desire and arousal dysfunction compared to those in premenopause.
“Our study suggests approximately 50% of women at midlife had poor sexual wellbeing; one in four participants had a sexual dysfunction and one in four participants had sexually related distress without an identified sexual dysfunction,” the authors wrote.
“It also demonstrates a meaningful increase in the likelihood of eFSD [estimated female sexual dysfunction] in the early perimenopause. However, best practice guidelines for FSD [female sexual dysfunction] in perimenopause are scarce.
“Additionally, regulator-approved treatments for FSD are restricted to desire dysfunction and confined to either premenopausal or postmenopausal women. Given the observed prevalence of eFSD in perimenopausal women, best practice guidelines and treatment options for perimenopausal women are much needed.”
The study involved 5468 Australian women aged 40-69 years and explored the prevalence of sexual difficulties and sexually related personal distress.
Participants were excluded from this analysis if they were pregnant, breastfeeding or using medications that would affect sex hormone levels or menopausal vasomotor symptoms, or if menopausal status could not be ascertained
Of the participants, 2583 reported sexually related personal distress, with one in four women experiencing a diagnosable sexual dysfunction and another one in four reporting distress without an identifiable dysfunction.
Senior author Professor Susan Davis AO, head of the Monash University Women’s Health Research Program, said the findings highlighted early perimenopause as a critical time of change for women’s sexual wellbeing and underscored the need for targeted therapeutic options.
“The importance of sexual wellbeing to overall health is often overlooked,” she said.
“One cannot dismiss the impact that sexual health has, not only on a woman’s intimate relationship, but most importantly on a woman’s general wellbeing.”
FSD, as classified by the International Classification of Diseases, includes difficulties with desire, arousal, orgasm, and non-specified dysfunctions that cause personal distress. FSD is associated with poorer quality of life, higher rates of depression and increased emotional and relationship stress.
The study found low sexual desire (13.3%), impaired arousal (13.1%) and poor sexual self-image (12.8%) were the most common dysfunctions.
“Although our study revealed low desire and arousal to be the most prevalent sexual difficulties, participants with poor sexual self-image had the greatest likelihood of having associated distress,” Professor Davis said.
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First author Dr Yuanyuan Wang, also from Monash University’s School of Public Health and Preventive Medicine, said that after accounting for factors such as ancestry, partner status, body mass index, vaginal dryness, depression, medication use and experiences of psychological or sexual abuse, sexual difficulties tended to increase with age while distress decreased.
“This resulted in the greatest likelihood of estimated FSD in participants aged 55-59 years, suggesting increasing age could be a key contributing factor,” Dr Wang said.
Professor Davis said the two-fold increase in desire, arousal and self-image dysfunction among early perimenopausal participants highlights a vulnerable stage in women’s health that is currently underserved.
“Best practice guidelines for FSD in perimenopause are scarce, and regulator-approved treatments are restricted to desire dysfunction and limited to either premenopausal or postmenopausal women,” she said.
“Given the observed prevalence of FSD in perimenopausal women, evidence-based guidelines and treatment options for this group are much needed.”
The Lancet Obstetrics, Gynaecology & Women’s Health, November 2025
