♀️What happens when estrogen leaves the building? Join Dr. Mary Claire Haver, MD, and Dr. Kathleen Jordan, MD, in conversation about this topic at the Livelong Women’s Health Summit on April 17& 18 in San Francisco.

Sexual health is still treated as a “quality of life” issue — something to address after the so-called real medical concerns are handled. Dr. Jessica Shepherd, MD, MBA, FACOG, says that’s a problematic outlook, though: “Sexual health is not optional — it is integrative data. Sexual function reflects how well multiple systems are aging together: vascular, neurologic, hormonal, metabolic, musculoskeletal, and psychological.”

When a woman reports satisfying sexual relationships, studies consistently see outcomes that show:

“That’s not coincidence — it’s physiology,” added Shepherd. “Sexual response requires healthy blood flow, intact nerve signaling, hormonal balance, emotional safety, and energy availability. When sexual health declines, it’s often an early warning sign that one or more systems are under strain, sometimes years before disease is formally diagnosed.”

⚡ In other words, sexual health doesn’t sit outside longevity. It reflects it.

Sexual arousal depends on microvascular function — the health of the smallest blood vessels — which often deteriorates earlier than large-vessel disease detected by standard cardiac tests. Vaginal dryness, reduced arousal, or difficulty achieving orgasm can reflect early endothelial dysfunction, sometimes years before heart disease is diagnosed.

“Traditional heart risk assessments often miss women,” says Shepard. They’re based on male symptom patterns and don’t adequately account for hormonal loss or microvascular disease. In many women, sexual symptoms appear before chest pain, she adds.

That makes sexual health an underutilized, and highly sensitive, cardiovascular signal, often appearing before abnormalities show up on standard tests.

Sexual health is also a window into nervous system balance and long-term resilience. 

Chronic stress shifts the body into sympathetic dominance — the fight-or-flight state that suppresses sexual arousal. Elevated cortisol disrupts estrogen, testosterone, and thyroid signaling, while increasing inflammation and insulin resistance. Over time, this leads to blunted desire, reduced genital blood flow, difficulty with arousal and orgasm, and increased pain sensitivity.

“Sexual dysfunction under chronic stress is a sign the body is surviving, not thriving,” says Shepard. “It reflects depleted resilience and reduced capacity to recover from physiologic challenges — key markers in longevity science.”

Too often, pain during sex, dryness, or loss of desire is dismissed as ‘just aging.’ That normalization teaches women to ignore early signs of tissue degeneration, inflammation, hormonal insufficiency, pelvic floor dysfunction, and, in some cases, autoimmune or metabolic disease. It also reinforces a deeper message: that women’s discomfort is expected and acceptable.

“Aging should not mean shrinking, numbing, or tolerating pain,” Shepard says. “When we normalize these symptoms, we delay care — and long-term outcomes worsen.”

“These connections are missed because healthcare is fragmented,” says Shepherd. “Libido gets siloed as ‘gynecologic,’ pain as 'pelvic,' mood as 'mental health,' and fatigue as 'stress.’ Sexual health lives at the intersection of systems, and our healthcare model isn’t designed to treat intersections.

To work toward a better future, Shepard suggests clinicians routinely ask questions like:

These questions normalize conversation, reveal system-level dysfunction, and create opportunities for early intervention rather than late-stage treatment.

When women view sexual changes as data rather than inconvenience or failure, they’re more likely to seek root-cause evaluation, demand integrated and hormone-literate care, and address stress, sleep, nutrition, and emotional health as interconnected drivers of aging.

The most powerful shift you can make today is this: sexual health is not indulgent — it’s informative. And women are deserving of sexual pleasure.

Conversations like this are exactly why we’re hosting the Livelong Women’s Health Summit.

The Summit is where these conversations continue — live, with clinicians and researchers who are pushing women’s health forward. We’d love to see you there.

💸Use the code TIFFANY for a discount on your ticket.

We’re inviting thoughtful, engaged women to become Livelong Ambassadors — sharing our work, contributing to conversations, and helping bring better health information to more women.

👉 Apply to become a Livelong Ambassador

As part of the Livelong Women’s Health Summit, we’re selecting a group of vendors whose work supports women’s long-term healthspan — from hormonal and pelvic health to recovery, resilience, and vitality.

If your work aligns with thoughtful, evidence-led women’s health care, we’d love to explore a partnership.

👉 Learn more about partnering with Livelong

Many of the conversations that matter most in women’s health — sexual health, stress, hormonal shifts, resilience — are still treated as optional. The Livelong Women’s Circle is our private community for women who want to engage with these topics more openly, ask better questions, and learn alongside clinicians and experts.

If this issue resonated and you want a space to keep the conversation going, Circle is where it continues.

👉 Join the Livelong Women’s Circle

We asked, you answered: How confident do you feel that your heart risk has been fully assessed?

The majority of you answered “very confident.” So glad to hear you have providers you trust and feel good about this aspect of aging! If you answered otherwise and want us to dig into a specific issue in the future email [email protected] and let me know.

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