Postmenopausal hypoactive sexual desire disorder: ongoing challenges

Hypoactive sexual desire disorder (HSDD) is the most common sexual dysfunction among women, and its pathogenesis is closely linked to an imbalance in the brain's excitation-inhibition system and underlying hormonal deficiencies. While HSDD is not an inevitable result of aging, postmenopausal women face unique sexual health risks arising from the interplay of endocrine changes and age-related effects. References were identified through systematic searches of PubMed, EMBASE, and the Cochrane Library using relevant search terms. Searches spanned publications from 2000 to June 2025, supplemented by key older studies identified from reference lists. Studies were screened for originality, clinical relevance, and alignment with the definition of HSDD in postmenopausal women; no language restrictions were applied. Despite the high prevalence of HSDD in postmenopausal women, clinical underdiagnosis and undertreatment remain widespread. Structural barriers-including inadequate provider training, limited treatment access, and underdeveloped policies/regulations-and broader societal barriers, encompassing interconnected factors like sexual and gender diversity, racial disparities, cultural contexts, discrimination, and stigmatization, persist. Future research should broaden study population diversity, resolve diagnostic criterion controversies, strengthen health care provider training, improve access to treatment resources, and advance policy reforms and targeted public education. These efforts aim to address systemic barriers, ultimately enhancing healthcare access and outcomes for postmenopausal women affected by HSDD.