Sexual health hub
Most trackers give you a score. We read it back to you. Desire, arousal, dryness, pain, UTIs, mood and sleep, over time, in your words. No readiness scores. No selling your data. Your patterns, remembered.
Your tracking data, journals, and check-ins are yours. We don't sell them, train models on them, or surface them to anyone but you.
More than 43% of US women in the PRESIDE survey reported a sexual problem, yet in primary care, female sexual dysfunction is diagnosed and managed less often than erectile dysfunction. After risk-reducing ovary removal, one study found 74% met criteria for sexual dysfunction. The map is crowded at diagnosis and empty after it. This is the after part.
51 and natural is one door. Surgical, POI, treatment-induced, gender-affirming hormone therapy, and long perimenopause misfiled as burnout are the others.
OpenLibrary, community, and tracking that stays yours.
OpenMost apps track you. Nila reads for you.
OpenFor pain days and burnt-out days.
OpenHowever you got to midlife, and whoever you are or aren't having sex with, this hub is for you. Pick the one that sounds most like you.
Most people get here gradually. Desire can flicker with your cycle, dryness or soreness can show up while you still have periods, and sex can hurt some months and not others. Sleep and night sweats often do more to desire than anything else.
Pregnancy is still possible in perimenopause, so contraception still matters until your doctor or specialist says otherwise.
Related symptom guides:
Genital and urinary changes tend to build over time rather than fade, so dryness, burning, urgency or UTIs can arrive five or ten years after menopause. That's common, and it's treatable at any age.
Related symptom guides:
If your periods stopped before 40 (or before 45), you're not too young for these changes, and you deserve the full conversation, including fertility, bone and heart health, and sex.
Testosterone can cause dryness and tissue changes much like menopause. Trans women on estrogen can have their own hormone shifts in midlife. Use the words for your body that feel right; we follow anatomy, not identity.
Sexual health isn't only partnered sex. Pleasure on your own counts. So does a new partner in your 50s, and safer sex: STIs don't stop at menopause, and thinner tissue can tear more easily.
If you're asexual, not interested right now, or happy with less, nothing here needs fixing. Desire only becomes a problem when it bothers you. You can still use this hub for comfort, dryness or UTIs.
Chronic pain, pelvic floor problems, diabetes, MS, and medicines like antidepressants can all change arousal, orgasm and comfort. That's worth naming at an appointment, not working around.
Related symptom guides:
A pelvic floor that's too weak leaks; one that won't let go makes sex, exams and even peeing hurt. Both are common in midlife, and both respond to training, not just kegels.
The pelvic health hub has short voice-guided practices for leaking, urgency and down-training, plus a workbook if you want structure.
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Touch, texture and sensory overload can shift in midlife. If sex or exams feel unsafe, you can go slowly, pause, or say no. Care should work at your pace.
After hysterectomy or ovary removal: the full surgical menopause guide“I went into chemical menopause overnight, then surgical menopause the same day they finally found endo after 18 years. No slow transition. No easing in. Just acute, all-at-once menopause with a body I was still learning. This site is the place I wish I'd had open.”
Cancer treatment and risk-reducing ovary removal (RRSO) can change hormones, anatomy and the nervous system all at once. In one study of 119 people after RRSO, 74% met criteria for sexual dysfunction and 73% for low desire. Among gynecologic cancer survivors, sexual changes are common, and rates run higher after surgery combined with radiation.
That's not in your head. It can be dryness, narrowing, pain, altered arousal, and desire that doesn't match your body yet. After hormone-positive breast cancer, systemic hormone therapy is often off the table, so local options need a careful talk with your oncology team.
Related symptom guides:
Good evidence, but limited sample size. Nila notes where the gaps are so you can ask smarter questions.
Genital and urinary changes of menopause (GSM: dryness, irritation, urgency, recurrent UTIs) affect somewhere between 13% and 87% of people, depending on how studies ask. They tend to continue without treatment rather than fade.
Low-dose vaginal estrogen is the best-supported treatment in the 2025 AUA/SUFU/AUGS guideline, and guidelines recommend it to lower recurrent UTI risk. After hormone-positive breast cancer, decisions are individual. Moisturizers (used regularly), lubricants (for sex), dilators for narrowing, and pelvic floor work are non-hormonal tools. Skip fragranced washes.
Related symptom guides:
Strong evidence from multiple high-quality studies. Nila is confident in these takeaways.
Pain is common, and it's not something you have to push through. It can be entry pain, deep pain, burning after, or bladder urgency after sex. Common contributors: dryness and a pH shift, pelvic floor holding after surgery or radiation, low estrogen, bracing from anxiety, and less time for arousal.
Small things help: more time for arousal, an unclenched jaw, breathing out longer than in (in for 4, out for 6), water-based or silicone lube, changing angle, pausing. If pain is new or severe, or comes with bleeding, get seen the same day.
Related symptom guides:
Good evidence, but limited sample size. Nila notes where the gaps are so you can ask smarter questions.
Desire lives in brain, body and context. After abrupt menopause, estrogen, progesterone and testosterone fall fast. Sleep is broken, mood is buzzy, confidence feels thinner.
The PRESIDE survey of 31,581 US women found 43.1% reported a sexual problem and 22.2% felt distressed about sex. Distressing problems peaked at midlife, 14.8% at ages 45 to 64. Desire that was frequent can feel distant. That's grief and physiology, not failure. Tracking patterns, not scores, helps you see what shifts it.
Related symptom guides:
Good evidence, but limited sample size. Nila notes where the gaps are so you can ask smarter questions.
A 2025 study of primary care records found female sexual dysfunction was diagnosed and managed less often than erectile dysfunction. You may need to open the door.
Bring your symptom pattern from Nila, the body map with spots circled, the treatments you've tried, and what matters to you. Plain words work: “I have pain at entry after chemo.” “I've had UTIs every month since menopause.” “Desire is gone and it's distressing.”
Related symptom guides:
Good evidence, but limited sample size. Nila notes where the gaps are so you can ask smarter questions.
Menopause doesn't happen to just one person in the house. It happens to the partner who doesn't know what to say, too. So we made space for them.
Every Premium membership includes a companion seat: your person gets their own private Premium account, with no card needed and no access to anything you log. No awkward “can you download this?” conversation. You share the seat. They get tools, understanding and their own space. We charge for one. We built for two.
Bacterial vaginosis, yeast and UTIs come back by nature. Few tools track recurrence. We do.
Saved only on this device. No account sync, no analytics. Clearing your browser removes it.
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Saved only on this device. No account sync, no analytics. Clearing your browser removes it.
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Some devices became HSA/FSA eligible in 2022. Being FDA-registered as a low-risk device isn't the same as being cleared or proven. FDA has said no energy-based vaginal rejuvenation device (laser or radiofrequency) is cleared or approved for menopause symptoms, incontinence or sexual function, and their safety and effectiveness aren't established.
MV.Health (MysteryVibe)
Claim outpaces the data. Common online, thin in the literature. We name it as such so you can decide.
Joylux
Claim outpaces the data. Common online, thin in the literature. We name it as such so you can decide.
Lioness
Emerging or limited evidence. Useful context, but treat conclusions as provisional.
Ferly (app)
Claim outpaces the data. Common online, thin in the literature. We name it as such so you can decide.
HelloGina (app)
Claim outpaces the data. Common online, thin in the literature. We name it as such so you can decide.
Not yet reviewed: Joylux vSculpt, Womanizer and We-Vibe. No paid placements, no affiliate links, and makers can't buy a grade.
Low desire that causes distress (hypoactive sexual desire disorder, HSDD) is common after menopause. One large survey found it in about 9% after natural menopause and up to 26% in younger people after surgical menopause. Until recently, both approved medicines, Addyi (flibanserin) and Vyleesi (bremelanotide), were only for premenopausal use.
On December 15, 2025, FDA expanded Addyi to people under 65 regardless of menopause status, the first oral option for HSDD after menopause. It isn't a performance drug. Vyleesi is still approved for premenopausal use only. There's no FDA-approved testosterone for women, and off-label prescribing comes with access barriers. Non-drug supports matter too: sleep, pain care, sex therapy and time.
2015
Addyi approved for premenopausal HSDD.
2019
Vyleesi approved for premenopausal HSDD.
December 15, 2025
Addyi expanded to under-65s regardless of menopause status.
Strong evidence from multiple high-quality studies. Nila is confident in these takeaways.
Related symptom guides:
Your tracking data, journals, and check-ins are yours. We don't sell them, train models on them, or surface them to anyone but you. How we handle data
Educational information, not medical advice. More sources in the research library.
