Female Sexual Dysfunction in Postmenopausal Women: A Systematic Review and Meta-Analysis

Abstract

Introduction: Female sexual dysfunction (FSD) is highly prevalent among postmenopausal women, with multifactorial influences including biological, psychological, and sociocultural determinants. Despite extensive research on individual aspects of FSD, a comprehensive, cross-cultural synthesis of these factors remains limited. This review aims to address this gap by examining international evidence on the prevalence of FSD and the sociodemographic, clinical, psychological, and cultural factors shaping postmenopausal sexuality. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Literature was searched in PubMed, Scopus, Web of Science, CINAHL, and EMBASE for studies published between 2000 and 2026. Twenty-three eligible original studies were included, excluding those involving hormone therapy or participants with diagnosed mental health conditions such as major depression, anxiety, or psychosis. These exclusions were applied to avoid potential confounding effects. Methodological quality was assessed using Joanna Briggs Institute tools. Random-effects meta-analyses were performed using StatsDirect software to account for heterogeneity. Results: The analysis included 11,892 postmenopausal women across 23 studies. FSD affected 61.24% (95% CI: 46.15%– 75.29%; Effect Size: 0,612407) of participants, while severe symptoms associated with the climacteric were reported in over 30% (95% CI: 22.59%–39.95%; Effect Size: 0,309362). Higher risk was associated with older age, unemployment, living in urban areas, low education, and high parity. Urogenital and somatic symptoms, together with depressive and anxious manifestations and negative body image, were significantly associated with reduced sexual function. Cultural and societal beliefs further shaped women’s experiences and perceptions of sexuality. Conclusions: FSD in postmenopausal women is a widespread and multifaceted issue, requiring recognition of physical, psychological, and cultural contributors. A biopsychosocial perspective is essential to fully address its impact. Policy Implications Healthcare systems should implement culturally sensitive, woman-centered strategies that integrate sexual education, empowerment, and psychosocial support. Policies must promote equitable access to sexual health services, multidisciplinary care, and interventions that normalize menopause while reducing stigma and disparities.