A large number of biological, psycho-relational and sociocultural factors are related to women’s sexual health and they may negatively affect the entire sexual response cycle, inducing significant changes in sexual desire, arousal, orgasm and satisfaction during the entire reproductive life span [2]. Natural menopause is associated with a high rate of sexual symptoms, with a variable prevalence across studies depending on several factors (for example, sample, design, symptomatology, sociocultural background) [3]. Age and menopausal transition may impair the integrity of multiple biological systems involved in the normal sexual response. On the other hand, several intrapersonal and interpersonal issues may also may affect feminine identity and quality of relationships which are equally important for expressing sexual feelings and behaviors [4,5].

 

Levels of sex hormones, mainly low levels of estradiol, are relevant for the lack of sexual awareness and vaginal receptivity in naturally menopausal women [6]. Even diminished levels of androgens, as more frequently occur in surgically menopausal women, have a negative impact on desire and sexual responsiveness [7]. However, sex hormones do not seem to correlate with the presence of female sexual dysfunction [8] because the sexual behavior of midlife and older women is highly dependent also on other factors such as general physical and mental well-being, quality of relationships and life situation. In addition, it is likely that, in routine practice, we do not use assays that are sensitive enough to detect small differences among groups of women or, alternatively, sex hormones play a role in the sexual function of menopausal women through other actions (i.e. intracrinology) [9]. It is important to underline that the data from Moghassemi and colleagues [1] are in line with many other reports in which desire and arousal disorders are the more prominent diagnoses worldwide [10,11]. Being aware that culturally dependent lifestyle factors significantly contribute to sexual attitudes across menopause, we believe that it is crucial to collect data from different countries in order to help clinicians to tailor strategies in line with women’s real needs. On the other hand, the evidence, that the rate of female sexual dysfunction is not so different among countries with extremely diverse cultures, underlines the importance of the organic impairment of sexual response at menopause and this deserves further attention for the better care of women.