Women's Sexual Health & Libido
No woman should be told to push through painful sex. Sexual health is the most predictably under-treated dimension of women’s care. Painful intercourse, declining libido, vaginal dryness, recurrent UTIs, and the slow disappearance of desire are normalized, dismissed, or simply never asked about. And women learn to stop bringing them up. Nova was built, in part, for this conversation.
What We Treat
The presentations Nova sees regularly include:
- Painful intercourse (dyspareunia), often a downstream effect of genitourinary syndrome of menopause (GSM), but not exclusively.
- Vaginal dryness, irritation, and recurrent UTIs. The GSM cluster.
- Low libido / hypoactive sexual desire disorder.
- Arousal difficulties, including the longer arousal time many women experience in perimenopause and menopause.
- Desire discrepancy. The partnered conversation where one person’s libido has shifted and the other’s hasn’t.
- Loss of clitoral or vulvar sensitivity.
- Post-cancer sexual health, including after estrogen-receptor-positive breast cancer.
- Sexual health concerns after childbirth or postpartum.
If any of these resonate, the most important first step is hearing the answer your provider may not have given you: this is treatable.
Why It's So Often Missed
A primary care visit isn’t built for this conversation. Seven minutes doesn’t leave room for it. An OB-GYN focused on screening and reproductive care often won’t open it. Many providers were trained in a model where menopausal sexual health was simply not a clinical priority.
The result: an enormous number of women in perimenopause, menopause, and postmenopause living with conditions that are treatable with inexpensive, effective, well-studied interventions. And quietly accepting that this is what middle age feels like.
It is not what it has to feel like.
What Nova Does
The approach depends on what’s driving the symptoms. The toolkit Nova draws on includes:
- Vaginal estrogen. Highly effective for GSM, painful intercourse, vaginal atrophy, and recurrent UTIs. Considered safe even after estrogen-receptor-positive breast cancer, in most cases.
- Systemic hormone therapy. When appropriate, addresses sexual health symptoms alongside the broader menopausal picture.
- Testosterone optimization in women. A meaningful intervention for libido in many perimenopausal and menopausal women. And one of the primary providers doesn’t offer.
- Pelvic floor referral and coordination for cases where pelvic floor dysfunction is contributing.
- Lifestyle, nutrition, and stress physiology, because libido is also a downstream effect of sleep, energy, and nervous system state.
- Peptide-based interventions for arousal and tissue health, when clinically appropriate.
- Direct, evidence-based conversation about desire, partnership, and the parts of this that are physiology and the parts that are something else.
Dr. Chris Di Giorgio
Dr. Chris Di Giorgio, a board-certified cardiologist and former Chief of Cardiology at Hackensack Meridian Mountainside Medical Center, brings a prevention-focused approach to cardiovascular and metabolic health. His expertise includes insulin resistance, inflammation, cholesterol management, longevity medicine, and identifying cardiovascular risk long before disease develops.
Dr. Jennifer Knight
Women’s health at Nova is led by Dr. Jennifer Knight, a double board-certified physician and certified menopause specialist with advanced training in integrative and longevity medicine. Whether you’re navigating hormonal changes, unexplained symptoms, or simply want to optimize your health, our goal is simple: understand the whole story, identify the root causes, and create a personalized plan that helps you feel your best.
Who This Is For
- Women in perimenopause or menopause whose sexual health has changed and want it addressed seriously.
- Couples in midlife navigating a desire discrepancy who want clinical help making sense of it.
- Women who have been told painful sex is just something they have to live with.
- Breast cancer survivors with GSM who have been told they can’t use any form of estrogen. And who deserve a more nuanced conversation.
- Women who haven’t brought this up with anyone because no one has made it easy to.
Frequently Asked Questions
Is vaginal estrogen safe?
Yes. For most patients, vaginal estrogen has an exceptionally strong safety profile. It works locally, with minimal systemic absorption. The Menopause Society and current professional guidelines consider vaginal estrogen safe even for many breast cancer survivors. We’ll work through your individual case carefully.
Will I need a referral?
What's "GSM"?
Can hormone therapy actually restore libido?
Is this conversation going to be awkward?
You deserve a sex life that doesn't hurt. And one that you actually want.
If sexual health has been a quiet, untreated part of your life, let’s change that.