Sexual health encompasses physical, emotional, and relational wellbeing in the context of intimacy — and it is affected by the same hormonal, anatomical, and psychological factors that gynecology addresses in every other domain. Yet sexual health concerns are among the least likely to be raised by patients and among the least likely to be asked about by clinicians. The result is that low libido, painful sex, reduced arousal, and intimacy difficulties after menopause, childbirth, or illness are managed in silence by millions of women who do not know that clinical evaluation and effective treatment are available to them.
The conditions covered in this cluster — low libido, dyspareunia, sexual changes after menopause, and the impact of vaginal dryness on intimacy — all have identifiable physiologic contributors that a gynecologic evaluation can assess and address. They also have psychological and relational dimensions that benefit from acknowledgment and, when appropriate, from referral to sexual health specialists. The goal at Lapeer Women’s Health is a clinical conversation that takes sexual health seriously as a component of overall health — not as a side topic that gets five minutes at the end of an appointment.
Each of the following is covered in depth on its dedicated page. Together they reflect the full range of sexual health concerns that gynecologic evaluation can meaningfully address.
Low Libido in Women
Low sexual desire is the most common sexual complaint among women and one of the least addressed in clinical settings. It has hormonal, psychological, relational, and medication-related contributors that each benefit from different management approaches. Identifying which factors are present — and which are primary — is the foundation of effective management. Learn more →
Painful Sex — Dyspareunia
Pain during intercourse has multiple distinct causes including vulvodynia, genitourinary syndrome of menopause, endometriosis, pelvic floor dysfunction, and ovarian cysts. Each requires different treatment, and the evaluation that identifies the specific cause is the prerequisite for effective management. Pain with sex is not something to be accepted or worked around — it is a clinical signal that warrants evaluation. Learn more →
Sexual Health After Menopause
Menopause affects sexual health through multiple overlapping mechanisms — genitourinary atrophy producing pain and dryness, hormonal changes reducing desire and arousal response, and mood changes affecting interest and intimacy. Each mechanism has specific and effective management options. Sexual health after menopause is not simply diminished — it is changed in ways that respond well to targeted treatment. Learn more →
Vaginal Dryness and Sex
Vaginal dryness from any cause — menopause, breastfeeding, hormonal contraception, or cancer treatment — directly affects sexual comfort and function. When dryness makes intercourse painful, the resulting avoidance affects relationships and quality of life in ways that extend well beyond the physical symptom. Effective treatment restores comfort and is available at every age. Learn more →
STI Testing for Women
Sexually transmitted infection screening is a component of comprehensive women’s health care that is recommended at different intervals based on age, sexual activity, and risk factors. Understanding which tests are recommended, how often, and what positive results mean is part of informed sexual health care. Learn more →
Sexual Health at Every Age
Sexual health concerns change across the lifespan — from the hormonal contraception conversations of the reproductive years, through the libido and lubrication changes of perimenopause, to the intimacy and comfort considerations of postmenopause. Understanding what is normal and what warrants evaluation at each stage is the foundation of proactive sexual health care. Learn more →
Most sexual health concerns are appropriately addressed through a scheduled appointment. Contact our office promptly if you experience:
- New vulvar sores, blisters, or ulcers — these warrant prompt evaluation to exclude herpes or other STIs
- Significant pain or swelling in the vulvar area suggesting a Bartholin gland abscess
- Vaginal bleeding after intercourse that is new or unexplained — postcoital bleeding warrants evaluation
Female sexual function involves an interplay of hormonal, vascular, neurologic, psychological, and relational factors. Gynecologic evaluation addresses the physiologic contributors that are most amenable to clinical intervention.
Hormonal Contributors
Estrogen, testosterone, and progesterone each play roles in female sexual function. Estrogen maintains the vaginal and vulvar tissue health that allows comfortable intercourse, supports the vasocongestion response that produces lubrication, and contributes to genital sensitivity. Testosterone, produced by the ovaries and adrenal glands, supports sexual desire, arousal, and response. Declining levels of both hormones during perimenopause and menopause — and the abrupt loss of ovarian testosterone in surgical menopause — produce changes in desire, arousal, and physical comfort that have hormonal management options. The evaluation at Lapeer Women’s Health assesses the hormonal contribution to sexual health concerns as a specific component of the history and examination.
Anatomic and Tissue Contributors
Genitourinary syndrome of menopause, vulvodynia, pelvic floor dysfunction, and surgical changes from prior gynecologic procedures all produce anatomic or tissue-level changes that directly affect sexual comfort and function. These are the contributors most directly addressed by gynecologic evaluation — they are identifiable on examination and treatable through specific interventions that restore tissue health and anatomic function.
Medication and Medical Condition Contributors
Antidepressants — particularly SSRIs — are among the most common causes of medication-related low libido and delayed or absent orgasm in women. Antihypertensives, hormonal contraceptives, and medications for other chronic conditions also affect sexual function. Chronic conditions including diabetes, thyroid dysfunction, cardiovascular disease, and autoimmune conditions produce sexual health impacts through hormonal, vascular, and neurologic mechanisms. Reviewing medications and chronic conditions as potential contributors is part of the sexual health evaluation at Lapeer Women’s Health.
Psychological and Relational Contributors
Anxiety, depression, relationship conflict, history of trauma, and body image concerns all significantly affect sexual desire, arousal, and satisfaction. These factors are acknowledged and, when significant, addressed through coordination with mental health and sexual health specialists. The gynecologic evaluation identifies the physiologic contributors; comprehensive care acknowledges that the physiologic does not exist in isolation from the psychological and relational dimensions of sexual health.
Sexual health evaluation at Lapeer Women’s Health is led by Dr. Ramona D. Andrei, MD, PhD, FACOG — in a clinical environment where sexual health concerns are treated as legitimate medical concerns deserving thorough evaluation and specific management.
A Conversation That Takes the Concern Seriously
The evaluation begins with a thorough history that reviews the specific nature and timeline of the sexual health concern, its relationship to hormonal changes and life events, relevant medication history, and the impact on quality of life and relationships. Sexual health concerns are not rushed through or minimized — they receive the same clinical attention as any other gynecologic concern.
Examination and Testing
Physical examination assesses vulvar and vaginal tissue health, pelvic floor tone, and anatomic contributors to pain or discomfort. Hormonal testing — estradiol, testosterone, thyroid function, and other markers when clinically indicated — provides objective data to complement the history. Vaginal testing excludes infectious contributors when relevant.
Individualized Management and Referral
Treatment recommendations address the specific identified contributors. Local estrogen for atrophy. Testosterone discussion for desire concerns. Pelvic floor therapy for pain and dysfunction. Medication review and adjustment when medications are contributing. Coordination with sexual health specialists, pelvic floor physical therapists, or mental health providers when the full scope of concerns extends beyond gynecologic management alone.
Many women carry sexual health concerns for years without raising them with their gynecologist — because they assume the concerns are normal, because they feel embarrassed, or because prior attempts to raise the topic were met with dismissiveness or inadequate time. At Lapeer Women’s Health, these concerns are a legitimate and valued part of the gynecologic conversation.
If low libido, painful intercourse, intimacy changes after menopause or childbirth, or any other sexual health concern is affecting your quality of life or your relationship, it is worth bringing to a clinical evaluation that takes it seriously. Dr. Ramona D. Andrei and the team are here for that conversation — at both our Lapeer and Rochester Hills offices, without a referral required.
Sexual Health for Women
Our team at Lapeer Women’s Health provides comprehensive sexual health evaluation at both our Lapeer and Rochester Hills offices. No referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.