Women's Health
Sexual Health & Intimacy — Real Care for Real Concerns
Vaginal dryness, pain during sex, low libido, or intimacy changes that came with perimenopause or menopause — these are medical issues with real solutions. A licensed provider can evaluate your concerns privately, same day.
Start a VisitAbout women's sexual health
💜 Your sexual health matters — and it's treatable
Women's sexual health is a legitimate and important part of overall wellbeing, yet it remains one of the most under-discussed areas of medical care. Many women experience changes in desire, comfort, or intimacy at some point in their lives — particularly during perimenopause, menopause, postpartum recovery, or following hormonal changes from medications or other health conditions — and assume these changes are simply something to accept.
They are not. Vaginal dryness, painful intercourse, reduced libido, and difficulty with arousal are clinical conditions that respond to treatment. Evidence-based options exist — from vaginal estrogen and lubricants to FDA-approved medications for low sexual desire — and a licensed provider can evaluate your situation and help you understand what is actually available.
Bringing this up with a provider can feel awkward, even in person. That is one reason telehealth is particularly well-suited for these conversations — you can discuss what is going on from wherever you are most comfortable, privately, without a waiting room.
What we address in this category
Vaginal dryness and genitourinary syndrome of menopause (GSM), low libido and reduced sexual desire (HSDD), painful intercourse (dyspareunia), difficulty with arousal or orgasm, intimacy changes related to perimenopause or menopause, postpartum hormonal effects on sexual health, and medication-related effects on sexual function.
When to seek in-person care first
Pelvic pain unrelated to intercourse, unexplained vaginal bleeding, new or unusual discharge that may indicate infection, a new lump or mass, persistent vulvar ulcers, severe vulvar pain, or skin lesions should be evaluated in person by a gynecologist or primary care provider. If you are concerned about a possible STI, please see our STI Testing & Treatment page.
Conditions we treat
📋 Common women's sexual health concerns
Sexual health concerns in women are often multifactorial — meaning hormones, physical changes, emotional factors, relationship dynamics, and medications can all play a role. Understanding the clinical picture behind what you are experiencing is the first step toward effective treatment.
- 🌡️ Vaginal dryness and genitourinary syndrome of menopause (GSM) Vaginal dryness is among the most common sexual health complaints in women, particularly after perimenopause or menopause. When estrogen levels decline, the vaginal tissues thin, lose elasticity, and produce less natural lubrication — a condition now clinically called genitourinary syndrome of menopause (GSM). GSM causes vaginal dryness, irritation, burning, and pain during or after intercourse. Unlike hot flashes, which often improve with time, GSM typically worsens without treatment. Effective options include local vaginal estrogen (cream, ring, or suppository), hormone-free vaginal moisturizers, and other non-hormonal therapies. GSM is underdiagnosed and undertreated — many women simply do not know treatment exists. See also: Menopause & Hormonal Health.
- 💗 Low libido and reduced sexual desire (HSDD) Hypoactive sexual desire disorder (HSDD) is the most common female sexual dysfunction, affecting women across all age groups. It is defined as a persistent or recurrent lack of sexual desire that causes personal distress. HSDD is not simply a low sex drive — it is a clinical condition with recognized medical treatments. Hormonal factors (low estrogen, low testosterone), medications (particularly SSRIs/SNRIs and hormonal contraceptives), stress, relationship dynamics, and mental health all contribute. Two FDA-approved medications exist specifically for HSDD in premenopausal women — flibanserin and bremelanotide — and a provider can determine whether either is appropriate based on your full health picture.
- 😣 Painful intercourse (dyspareunia) Pain during or after intercourse — dyspareunia — has multiple possible causes including vaginal dryness, GSM, inadequate arousal, vaginismus (involuntary muscle tightening, now more broadly classified as genito-pelvic pain/penetration disorder in current diagnostic terminology), hormonal changes, skin conditions, or infections. Many women quietly endure painful sex for years, not realizing it is a treatable medical condition. The appropriate treatment depends entirely on the cause: vaginal estrogen for GSM-related dryness, pelvic floor physical therapy referral for vaginismus, antifungals for yeast-related irritation, or topical treatments for skin conditions. A provider can evaluate the likely cause based on your history and symptoms and recommend the right starting approach. If you suspect an infection, see our Vaginal & Urinary Infections page.
- 🔥 Arousal difficulty and difficulty reaching orgasm Changes in arousal and orgasmic function are common, particularly with age, during hormonal transitions, as side effects of medications (especially antidepressants), or following pelvic surgery or certain neurological conditions — the latter of which may require in-person evaluation. While these experiences are widespread, they are rarely discussed openly, and many women assume nothing can be done. Contributing factors include hormonal changes, medication effects, vaginal tissue changes, and other medical or psychological factors. Depending on what is driving your symptoms, options may include addressing underlying hormonal imbalances, adjusting medications where possible, vaginal treatments to improve comfort and lubrication, or referral to a sexual health specialist.
- 🌸 Perimenopause and menopause effects on intimacy The hormonal changes of perimenopause and menopause affect sexual health in multiple ways — declining estrogen causes vaginal dryness and tissue changes, fluctuating hormones affect mood and energy, sleep disruption from night sweats reduces overall wellbeing, and reduced testosterone may lower desire. These changes do not have to define your sex life. Hormone therapy, local vaginal treatments, and non-hormonal options can significantly improve intimate comfort and desire. See our full Menopause & Hormonal Health page for comprehensive menopause management.
- 🤱 Postpartum changes in sexual health After childbirth, hormonal shifts — particularly the drop in estrogen during breastfeeding — can cause vaginal dryness, reduced libido, and pain during intercourse that many new mothers are not warned about. These are biologically normal postpartum changes, but they are also clinically addressable. A provider can discuss appropriate options based on whether you are breastfeeding, your recovery timeline, and your overall health. If you are experiencing postpartum mood changes, see our Postpartum Depression page, as mood and sexual health are closely connected in the postpartum period.
- 💊 Medication effects on sexual health Many commonly prescribed medications reduce libido, impair arousal, delay or prevent orgasm, or cause vaginal dryness. SSRIs and SNRIs (antidepressants), hormonal contraceptives, antihistamines, blood pressure medications, certain antiandrogens, and cancer therapies are among the most common culprits. A provider can review your medications, assess the likely connection to your sexual health symptoms, and discuss whether alternatives or adjunct treatments may be appropriate. Never stop a prescribed medication without speaking to your provider.
Signs worth talking to a provider about
🔍 You do not have to push through this
Many women normalize sexual health concerns as an inevitable part of aging, having children, or taking certain medications. Most are not inevitable, and most are treatable. Here are the experiences that are worth raising with a provider — not because something is wrong with you, but because effective options exist.
| What you might be experiencing | What it may indicate |
|---|---|
| Vaginal dryness or irritationNot enough natural lubrication, discomfort with everyday activities or intercourse | GSM, low estrogen, hormonal contraceptive effect, postpartum |
| Pain during or after intercourseBurning, tearing, rawness, or aching | Dyspareunia from GSM, inadequate lubrication, vaginismus, or infection |
| Low interest in sexLittle to no desire, even when the relationship is healthy | HSDD, hormonal changes, medication side effect, fatigue, stress |
| Difficulty becoming arousedSlower or weaker physical response to sexual stimulation | Hormonal changes, reduced blood flow, medication effect, GSM |
| Difficulty reaching orgasmOrgasms that were once accessible now feel absent or significantly harder | Medication side effect (especially antidepressants), hormonal changes, GSM |
| Intimacy changes since menopause or perimenopauseThings that used to feel good now feel uncomfortable or absent | GSM, declining estrogen and testosterone, mood changes |
| Sexual side effects from medicationChanges began after starting a new prescription | Medication-induced sexual dysfunction — often reversible with adjustment |
If any of these feel familiar, a licensed provider can help you understand what is going on — and what can actually be done about it.
Start a VisitHow online care can help
💻 Private, clinical support without a waiting room
Sexual health is one of the most common areas where patients say they avoided seeking care because the conversation felt too uncomfortable in a traditional clinical setting. Telehealth removes that barrier. You speak with a licensed provider from wherever you are most comfortable, with the same clinical rigor as an in-person visit.
Many of the most effective treatments for vaginal dryness, low libido, and intimacy discomfort are prescription medications — vaginal estrogen, FDA-approved HSDD treatments, hormonal therapy, or topical treatments — that a provider can prescribe after a full evaluation. A telehealth visit is a convenient way to receive a clinical evaluation and discuss treatment options, including prescription therapy when appropriate, without requiring a specialist referral or a weeks-long wait.
| What online sexual health care can do | What may need in-person evaluation |
|---|---|
| Evaluate vaginal dryness, GSM, and low libido | Pelvic examination for unexplained pain or bleeding |
| Prescribe local vaginal estrogen (cream, ring, suppository) | Vaginismus requiring pelvic floor physical therapy |
| Discuss and prescribe systemic hormone therapy where appropriate | Gynecological evaluation for new or unexplained symptoms |
| Prescribe FDA-approved HSDD medications when clinically appropriate | STI testing (see our STI Testing & Treatment page) |
| Review medications affecting sexual function and discuss options | Imaging or lab work for complex hormonal evaluation |
| Recommend referral to sexual health specialist or therapist when indicated |
- 🔒 A private conversation. You discuss your symptoms with a licensed provider — not a form, not a chatbot. What you share is confidential and treated with the same care as any other medical concern.
- 🩺 A clinical evaluation, not generic advice. Your provider reviews your full health picture — hormonal history, current medications, life stage, and symptoms — before making any recommendation.
- 🏪 Your prescription at your pharmacy. If medication is appropriate, it may be sent to your preferred pharmacy. No specialty enrollment, no required membership.
- ⏰ Same-day appointments may be available. You do not need a referral to discuss sexual health concerns with a licensed provider.
Treatment options
💊 Evidence-based treatments for women's sexual health
Treatment depends entirely on what is driving your symptoms. Your provider will assess your full clinical picture — including hormonal status, medications, and health history — before making a recommendation. The good news is that for the most common concerns, effective treatments exist.
- 💧 Local vaginal estrogen — first-line for GSM and vaginal dryness Low-dose vaginal estrogen (available as a cream, suppository, or ring) delivers estrogen directly to vaginal tissues with very low systemic absorption compared with systemic hormone therapy, restoring thickness, lubrication, and elasticity. It is highly effective for vaginal dryness, irritation, and painful intercourse from GSM. Because systemic absorption is very low, many providers consider local vaginal estrogen appropriate even for women who cannot use systemic hormone therapy. Decisions remain individualized, particularly for women with a history of estrogen-sensitive cancers, and should be made in consultation with their full healthcare team. Your provider will assess your history before prescribing. This is different from systemic hormone therapy — see our Menopause & Hormonal Health page for full HRT discussion.
- 🌿 Non-hormonal vaginal moisturizers and lubricants For women who prefer or require hormone-free options, vaginal moisturizers (used regularly, not just during intimacy) help maintain vaginal tissue hydration and reduce chronic dryness. Water-based and silicone-based lubricants reduce friction and discomfort during intercourse. These are available OTC but your provider can advise on which formulations are most effective and appropriate for your situation.
- 💗 FDA-approved medications for low sexual desire (HSDD) Two FDA-approved medications specifically address hypoactive sexual desire disorder in premenopausal women. Flibanserin (Addyi) is a daily oral medication that works on neurotransmitter pathways involved in sexual desire — it requires careful review of current medications and alcohol use due to interaction risks outlined in FDA prescribing guidance. Bremelanotide (Vyleesi) is a self-administered injection used before anticipated sexual activity. Neither is appropriate for every patient, and your provider will determine eligibility based on your full health history. For carefully selected postmenopausal women with HSDD after evaluation, testosterone therapy may be discussed as an off-label option.
- 🌡️ Systemic hormone therapy — for broader menopause and intimacy symptoms When vaginal dryness and low libido coexist with hot flashes, night sweats, mood changes, and sleep disruption from perimenopause or menopause, systemic hormone therapy (estrogen with or without progestogen) addresses multiple symptoms at once, including vaginal changes and sexual function. Systemic hormone therapy is prescribed primarily for menopausal symptoms such as hot flashes and night sweats — improvements in sexual function often occur as part of that broader symptom relief rather than as a standalone sexual health indication. Full discussion is covered in our Menopause & Hormonal Health page. Your provider will assess your medical history and risk factors to determine whether systemic therapy is appropriate for you.
- 💊 Medication review and adjustment If a current medication is contributing to your sexual health concerns — particularly an antidepressant, hormonal contraceptive, or blood pressure medication — your provider can discuss whether an alternative within the same therapeutic class may have a more favorable sexual side effect profile. This requires a thoughtful clinical conversation rather than simply stopping the medication. Never discontinue a prescribed medication without provider guidance.
- 🔗 Referral to specialist or sexual health therapist Some aspects of sexual health — particularly vaginismus, complex relationship dynamics, or significant psychological contributors to desire or arousal concerns — benefit from specialist input. Pelvic floor physical therapy is highly effective for vaginismus and post-surgical pain. Therapists with expertise in sexual health can address psychological and relational dimensions that a prescribing provider cannot. Your MyPhysician360 provider can help you understand when and who to see.
A note on flibanserin (Addyi) and alcohol
Flibanserin carries an FDA boxed warning regarding alcohol use and important medication interactions. Current prescribing recommendations around alcohol are nuanced — your provider will review the most current guidance and determine whether flibanserin is appropriate for your situation, including any interactions with other medications you take.
Ready to find out what options are right for you? A licensed provider can evaluate your situation today.
Start a VisitWhat to expect
🗓️ Your visit, start to finish
Sexual health visits are confidential, clinical, and designed to be comfortable. Your provider is there to understand your situation and help — not to judge it.
|
1
Share your concerns
Complete a short intake covering your symptoms, how long you have been experiencing them, your hormonal and reproductive history, current medications, and what matters most to you about this visit. You can be as specific or as general as you are comfortable. |
2
Speak with your provider
A licensed provider listens to your full picture, asks follow-up questions, and discusses the likely contributing factors. This is a real clinical conversation. You will not be rushed and your concerns will be taken seriously. |
3
Receive a personalized plan
Your provider explains what they believe is driving your symptoms, what treatment options are appropriate for your situation, and what to expect. If prescription treatment is appropriate, they discuss it fully before prescribing. |
4
Your prescription, your pharmacy
If prescription treatment is appropriate, it may be sent to your selected pharmacy. Medication availability varies. Some treatments may require follow-up labs or monitoring. |
What to expect from treatment timelines
Local vaginal estrogen: most women notice improvement in vaginal comfort within 2 to 4 weeks, with continued improvement over 3 months. Vaginal moisturizers and lubricants: immediate comfort improvement, ongoing benefits with consistent use. Flibanserin: effect on desire typically takes 4 to 8 weeks of daily use to evaluate. Systemic hormone therapy: improvements in sexual function and other menopause symptoms typically begin within weeks and continue to build over several months. Your provider will set realistic expectations for your specific treatment.
Supporting your sexual health
🌿 What else matters alongside treatment
Prescription treatment addresses the underlying clinical issues, but sexual health is also influenced by broader wellbeing, relationship context, and everyday habits. These factors do not replace medical treatment — but they support it.
Physical health factors that affect sexual wellbeing:
- →Regular physical activity improves circulation, energy, and body confidence — all of which support sexual health and arousal
- →Adequate sleep is foundational — chronic sleep disruption from night sweats or other causes significantly reduces libido and emotional availability for intimacy
- →Stress management matters more than most people realize — cortisol and chronic stress directly suppress sexual desire pathways
- →Avoiding smoking improves genital blood flow, which supports arousal and vaginal tissue health
- →Staying adequately hydrated supports general mucosal health, including vaginal tissue
Practical self-care for vaginal dryness and intimacy comfort:
- →Use a vaginal moisturizer regularly (2 to 3 times per week), not only before intercourse — consistent use rebuilds and maintains tissue hydration over time
- →Choose lubricants appropriate for your situation: water-based lubricants are safe with all contraceptive methods; silicone-based last longer and are better for intercourse but should not be used with silicone toys
- →Avoid scented soaps, douches, and perfumed products in the vaginal area — the vagina is self-cleaning and fragrances disrupt its natural pH and are a common irritant
- →Wear breathable cotton underwear, particularly if vulvar irritation is an issue
- →Regular sexual activity — including self-stimulation — supports vaginal tissue health by promoting blood flow and natural lubrication
Emotional and relational factors:
- →Open communication with a partner about what has changed and what feels good now is consistently cited in research as one of the most important factors in sexual satisfaction — particularly during and after menopause
- →Sexual desire in women is often more context-dependent than spontaneous — arousal may build in response to intimacy rather than preceding it, which is normal and not a sign of dysfunction
- →If anxiety, depression, or past trauma are contributing to your sexual health concerns, these deserve their own attention — a therapist with expertise in sexual health can be a valuable part of your care
A note on what is normal
Sexual desire naturally varies over a lifetime and is not linear. Life stress, health changes, relationship transitions, and hormonal shifts all affect desire and arousal at different points. The distinction between normal variation and a treatable condition is whether the change is causing you personal distress. If it is — regardless of what someone else might consider "normal" — it is worth discussing with a provider.
Care connected to your pharmacy
🏪 Your prescription. Your pharmacy. Your privacy.
When prescription treatment is appropriate, your provider may send it electronically to the pharmacy you already use — filled by the pharmacist who already knows you, with the same confidentiality as any other prescription.
- ✓When prescription treatment is appropriate, it may be sent electronically to your selected pharmacy
- ✓Pick up at your neighborhood pharmacy or any major chain
- ✓Home delivery available by request at many local pharmacies
- ✓No required memberships to access our telehealth services
- ✓If we cannot treat you online, you will not be charged
Frequently asked questions
❓ Women's sexual health — your questions answered
The questions women most often have before this kind of visit.
Can I get vaginal estrogen prescribed through telehealth?
Yes. Local vaginal estrogen — cream, suppository, or ring — can be prescribed through a telehealth visit after a clinical evaluation of your symptoms, health history, and risk factors. It is one of the most effective treatments for vaginal dryness, GSM, and painful intercourse related to hormonal changes. Because it acts locally with minimal systemic absorption, many providers consider it appropriate for a broader range of women than systemic hormone therapy. Your provider will determine what is right for your specific situation.
Is low libido a real medical condition, or just something I need to accept?
Low libido that causes you personal distress — meaning it bothers you, not simply that your desire does not match some external standard — is a recognized medical condition called hypoactive sexual desire disorder (HSDD). It is the most common female sexual dysfunction. It has identifiable contributing factors and FDA-approved treatments for premenopausal women. It is not something you simply have to accept, and bringing it up with a provider is an entirely appropriate medical conversation.
Can I get flibanserin (Addyi) prescribed online?
Flibanserin is an FDA-approved daily oral medication for HSDD in premenopausal women. It can be evaluated and prescribed through a telehealth visit. However, it has important requirements: it is only FDA-approved for premenopausal women, has important interactions with alcohol and other medications, as described in current FDA prescribing guidance, and interacts with several common medications. A provider will carefully review your full health picture, current medications, and eligibility before prescribing. Bremelanotide (Vyleesi), a self-administered injection used as-needed, is another option your provider may discuss.
My antidepressant is affecting my sex life. What can I do?
Sexual side effects — reduced libido, difficulty with arousal, and delayed or absent orgasm — are among the most common reasons people stop antidepressants. This is a very appropriate topic to raise with a provider. Options may include switching to an antidepressant with a more favorable sexual side effect profile (such as bupropion or mirtazapine), adjusting the dose or timing, or adding a medication to counteract the sexual side effects. The right approach depends on your mental health situation and your current medication. Never stop an antidepressant without speaking to your provider — the mental health implications are significant.
Sex has been painful since menopause. Is that normal, and can it be treated?
Painful intercourse after menopause is extremely common but not something you simply have to endure. The most frequent cause is genitourinary syndrome of menopause (GSM) — thinning and drying of vaginal tissues from declining estrogen. GSM responds well to local vaginal estrogen, which is safe and effective for most women. Unlike hot flashes, GSM does not improve on its own with time — it typically gets worse without treatment. A provider can confirm the likely cause and recommend appropriate treatment.
I'm breastfeeding and experiencing vaginal dryness and low libido. Is there help?
Yes. The low estrogen state of breastfeeding causes vaginal dryness and reduced libido for many women — it is a hormonal effect, not a permanent condition. Non-hormonal vaginal lubricants and moisturizers are a safe first step. Low-dose local vaginal estrogen is sometimes considered by providers for breastfeeding women, but this decision is individualized and based on shared decision-making between you and your provider — it is not appropriate for every situation. Discuss your specific circumstances fully. Vaginal dryness and libido often improve naturally as estrogen levels recover when breastfeeding decreases or ends.
Do I need a referral to discuss sexual health with a telehealth provider?
No referral is needed. A MyPhysician360 telehealth visit is a direct path to a clinical evaluation of your sexual health concerns. If your situation would benefit from a specialist — a gynecologist, pelvic floor physical therapist, or sexual health counselor — your provider will help you understand why and who to see.
Will what I share during a sexual health visit be kept private?
Yes. Your visit and everything you share during it is protected health information under HIPAA — the same legal privacy protections that apply to any medical visit. Your provider is there to evaluate your situation clinically. The conversation is confidential.
Is this visit HSA or FSA eligible?
Yes. MyPhysician360 consultations are HSA and FSA eligible. Your visit cost is reimbursable through your Health Savings Account or Flexible Spending Account, making this accessible through your existing health benefits even without insurance.
Helpful resources
📚 Learn more about women's sexual health
Authoritative resources on women's sexual health from medical and patient advocacy organizations.
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💜 Clinical overview Women's sexual health: an overview of common concerns and treatment American College of Obstetricians and Gynecologists (ACOG) Visit ACOG |
🌡️ Menopause and sexual health Genitourinary syndrome of menopause (GSM): symptoms and treatment The Menopause Society (formerly NAMS) Visit The Menopause Society |
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💗 Sexual desire and HSDD Understanding low sexual desire in women ISSWSH (International Society for the Study of Women's Sexual Health) Visit ISSWSH |
🩺 General sexual health Women's sexual health: talking about your needs Mayo Clinic Visit Mayo Clinic |
You deserve to feel good. Let's talk about what's possible.
A licensed provider can evaluate your sexual health concerns privately, same day. No referral needed. No required membership. Your prescription, if appropriate, may be sent to your pharmacy.
HSA & FSA eligible | No required membership | No charge if we can't help
Medical disclaimer & sources: The information on this page is for general educational purposes only and does not constitute medical advice. Sexual health concerns may have multiple contributing factors. Not all conditions described are appropriate for telehealth management alone. Flibanserin (Addyi) carries an FDA boxed warning regarding alcohol interaction. All prescription medications discussed require evaluation by a licensed provider and are subject to individual clinical eligibility. Content informed by the American College of Obstetricians and Gynecologists (ACOG), The Menopause Society, the International Society for the Study of Women's Sexual Health (ISSWSH), and current FDA prescribing guidance. A licensed MyPhysician360 provider will review your complete health history before prescribing any medication. MyPhysician360 services are available in most states. Services are not currently available in Mississippi or Alaska.