Why Women’s Sexual Wellness Deserves Real Medical Care

For decades, women entering perimenopause or menopause have heard the same refrains: “It’s just hormonal.” “It’s part of aging.” “You’ll adjust.” But the symptoms—painful intercourse, lost desire, diminished sensation, difficulty achieving orgasm—are far from minor, and according to internal medicine physician and hormone expert Dr. Janette Gray, they’re far from inevitable.

“Pain, low libido, and arousal issues are not things women simply have to accept as they age. These are treatable medical conditions rooted in hormonal changes, not moral failings or personal shortcomings,” she says.

In her San Diego practice, Perfect Balance Health, Dr. Gray has spent more than 25 years treating women navigating hormonal transitions. What she sees again and again is heartbreaking: women blaming themselves for physiological shifts they were never educated about—and too often misdiagnosed for.

Below, VITA breaks down Dr. Gray’s refreshingly honest, science-backed perspective on why women’s sexual health deserves real medical attention, and how reclaiming hormonal balance can transform pleasure, confidence, and relationships.

Why This Narrative Is Harmful—Not “Normal”

“So many women are told painful sex and loss of desire are ‘just part of aging,’” Dr. Gray says. “At what point did we decide women’s suffering is natural?”

She explains that declining estrogen and testosterone—during perimenopause, menopause, and even earlier—create profound physiological changes:

“Estrogen works in the brain to increase desire and maintains supple vulvar tissues that produce lubrication. Testosterone stimulates sexual desire in the brain and increases blood flow and clitoral stimulation. When these hormones drop, the entire sexual cycle is affected.”

The issue, she says, is not psychological—it’s biological.

The Medical System’s Blind Spot

Women’s sexual symptoms have been misclassified for decades, often dismissed as depression or “stress,” with devastating consequences.

“Women are four times more likely to be prescribed antidepressants than treated with hormone replacement therapy for the same symptoms,” Dr. Gray notes. “This stems from flawed research in the early 2000s that led doctors to believe hormones were dangerous—and treatment stopped almost overnight.”

Meanwhile, basics like clitoral atrophy, nerve sensitivity changes, and tissue thinning remain taboo topics in exam rooms.

“If we can’t even name the anatomy, how are women supposed to understand what’s happening to their bodies or advocate for themselves?”

Why Women Feel “Broken”—And Why They’re Not

Dr. Gray hears the same sentence over and over: “I just don’t want sex anymore, and it’s becoming a problem.”

But she is unequivocal: “No woman should ever blame herself for feeling ‘broken.’”

Her holistic approach looks at lifestyle, psychological, and medical factors—but hormonal deficiencies remain the most common, most treatable cause.

“Whether the issue is stress, sleep, trauma, thyroid dysfunction, or actual hormone decline, none of it means something is wrong with who she is as a woman.”

Shame, Dr. Gray says, keeps women silent far longer than necessary.

The Truth About Hormone Therapy

According to Dr. Gray, the fear surrounding hormone replacement therapy is outdated and harmful.

“The Women’s Health Initiative created a myth that HRT causes breast cancer and heart disease. The science simply does not support that. In fact, starting HRT early in menopause can reduce the risk of heart disease, diabetes, Alzheimer’s, and osteoporosis.”

And vaginal estrogen? “It’s completely safe—even for women with active breast cancer.”

Perhaps most importantly for intimacy: “Estrogen and testosterone replacement can restore desire, lubrication, arousal, orgasmic response, and physical comfort. Women deserve to know that.”

How Hormones Shape Confidence, Relationships, and Daily Life

Menopause symptoms don’t stay in the bedroom—they echo through a woman’s entire life.

“When a woman gains weight around her midsection, can’t sleep, feels irritable, and experiences pain during intercourse, her self-esteem and relationships naturally suffer,” Dr. Gray says.

Restoring hormonal balance improves confidence, body awareness, relationship quality, emotional intimacy, and sexual enjoyment.

“Women deserve pleasure, connection, and vitality throughout their entire lives—not just in their 20s and 30s.”

Why Women Are Taught to Tolerate Discomfort

One of Dr. Gray’s biggest frustrations is the gender gap in sexual healthcare.

“There are more than 20 FDA-approved testosterone prescriptions for men and none for women. That tells you everything about how society still views female sexual health,” she explains.

Add to that a cultural fixation on heteronormative, penetration-focused sex:

“Women often feel like bad partners if intercourse is painful—even though vaginal dryness and pain are easily treated with vaginal estrogen.”

Education, she says, is liberation.

If She Could Tell Every Woman One Thing…

Dr. Gray doesn’t hesitate:

“Your sexual wellness is not optional. It is part of your health, your confidence, and your joy—at every age. These symptoms are treatable. You deserve care.”

And for any woman silently struggling:

“Please know: this is not your fault, and you’re not alone. Help exists, and healing is absolutely possible.” —Noa Nichol