Sexual Dysfunction in Postmenopausal Women

Objectives: This narrative review synthesizes current evidence on the prevalence and key biological, psychological, and social determinants of sexual dysfunction in postmenopausal women, with a focus on regional variations in middle-income countries. Methods: A structured literature search was conducted across Google Scholar. Studies published since 2003 examining prevalence or predictors of sexual dysfunction in postmenopausal women were included. Inclusion required longitudinal, cross-sectional, or interventional design with full-text access. Studies were screened using PRISMA criteria, and 21 were ultimately included for synthesis. Results: Prevalence of sexual dysfunction among postmenopausal women ranged from 35.9% to 96.6%, varying by geography, methodology, and sociocultural context. In Iran, estimates ranged from 49% to 80%, with the most affected domains being desire and arousal. Key biological factors included estrogen and androgen deficiencies, surgical menopause, and chronic illnesses such as diabetes and cardiovascular disease. Psycho-emotional factors like depression and anxiety were consistently associated with dysfunction, while physical inactivity and negative self-perception further compounded risk. Social determinants—such as education, income, spousal relationship quality, and healthcare access—were variably associated, reflecting cultural and systemic disparities. Protective factors included positive sexual attitudes, supportive partnerships, and routine medical care. However, findings on hormone therapy, parity, and lifestyle behaviors like alcohol use were inconsistent across studies. Conclusion: Sexual dysfunction in postmenopausal women is complex and multidimensional. Addressing it requires an integrative, culturally sensitive approach involving clinical assessment, public education, and healthcare provider training to enhance sexual well-being and overall quality of life in older women.