As women approach their early 50s, they typically undergo a significant life change known as menopause, with the average age in the United States being around 51. But the journey to menopause begins before that during a stage called perimenopause, a time marked by hormonal shifts.

During perimenopause, women might encounter a range of experiences, from night sweats and irregular periods to moments of brain fog, weight fluctuations, and restless nights. It's a unique and sometimes challenging phase that varies for each individual.

It's a journey that's not always talked about openly, but it's crucial for women to acknowledge these changes and seek support.

Symptoms occur one to two weeks before menstrual period and include symptoms of depression, irritability, and rage.

Vaginal dryness is a common symptom that can occur in women of all ages. This is often due to long-term use of birth control pills, pregnancy or breast feeding.

GSM occurs in women who are menopausal. Women vary in their degree of symptoms from it, but it is common that they complain of vaginal dryness and pain with sexual activity. Other women are also bothered by dryness during exercise or sitting. They will often complain of “itching” or recurrent yeast infections.

Women need to speak up about GSM as it has a negative impact on sexual functioning, daily living but also increases risk for urinary tract infections, vaginal infections and pelvic organ prolapse.

HSDD isn't just about a decrease in sexual desire—it's a real and personal struggle for many women. It goes beyond a mere lack of interest; it's about feeling a profound disconnection from the desire for intimacy.

Dyspareunia is the general description for pain with sexual activity. There are many causes including issues with the musculoskeletal system, hormonal/endocrine system and nervous system.

Vaginismus is the involuntary contraction of the pelvic floor muscles which do not allow for anything to be inserted into the vagina.

Female Sexual Arousal Disorder (FSAD) is the inability for a woman to display both physical and emotional signs of being “turned on” in response to sexual stimulation.

Persistent Genital Arousal Disorder (PGAD) is persistent or recurrent unwanted or intrusive feelings of genital arousal not associated with sexual interest, thoughts or fantasies.

Female Orgasm Disorder describes a persistent or recurrent delay in or the absence of orgasm following sexual arousal and adequate sexual stimulation.

Provoked Vestibulodynia is the most common form of vulvodynia is pain at vaginal opening in response to pressure (both sexual and non-sexual). Symptoms are often describes as “burning”, “cutting” and “sharp”.

Pelvic floor dysfunction involves disruption to the functional anatomy of the pelvic floor. It is the inability to correctly relax or contract the pelvic floor muscles which contribute to a variety of genitourinary and bowel complaints as well as sexual pain.

Interstitial cystitis is a chronic condition that mimics urinary tract infection due to symptoms of bladder pressure, bladder pain and sometimes pelvic pain. Often times women have IC “flares” secondary to sexual activity.

Bacterial vaginosis is thought to be an imbalance of normal vaginal bacteria to “bad” bacteria. It is a common condition and treatment is available however some women develop chronic BV which is embarrassing and has negative impacts on self-esteem and sexual functioning.

Yeast infections are caused by several yeast species. They are common after antibiotic use. Some people develop chronic yeast infections. Yeast infections are over-diagnosed and need expert evaluation if having recurrent symptoms.

Recurrent UTIs that are specifically related to sexual activity are very bothersome to patients. A woman will commonly avoid sexual activity to prevent infections.