Abstract
Objective
Menopausal women often experience changes in sexual function, including reduced desire, arousal difficulties, and increased sexual distress, which can impact their overall well-being. Mindfulness-based interventions (MBIs) have emerged as a potential approach to enhancing sexual function and reducing distress, yet their effectiveness remains uncertain. This systematic review aimed to evaluate the effects of MBIs on sexual function, desire, arousal, sexual distress, and satisfaction in menopausal women.
Methods
We searched Science, Scopus, and ScienceDirect for randomized controlled trials (RCTs) published up to February 2025. Studies were included if they evaluated the effects of MBIs on sexual function outcomes in menopausal women. In total, seven RCTs, involving 609 participants from the United States, Iran, India, the Netherlands, and Hong Kong, met the inclusion criteria. Intervention durations ranged from 8 to 12 weeks, with various validated measures used to assess sexual function and related outcomes. Study quality was assessed using Joanna Briggs Institute Critical Appraisal Checklists.
Results
Mindfulness demonstrated positive effects on sexual desire, arousal, and sexual distress in menopausal women. A significant reduction in sexual distress was consistently reported across studies. However, the effects on overall sexual function varied, with some studies showing improvements in satisfaction while others reported inconsistent findings. The heterogeneity in study design, intervention types, and outcome measures contributed to variations in reported effects.
Conclusions
Mindfulness appears to be beneficial in reducing sexual distress and improving aspects of sexual function in menopausal women. However, the variability in study outcomes highlights the need for further high-quality, standardized research to determine the long-term effectiveness and clinical applicability of these interventions. Given the increasing interest in nonpharmacological strategies for menopause-related health concerns, mindfulness may offer a promising complementary approach for sexual well-being in this population.
Keywords: Menopause, mindfulness, sexuality, systematic review
1. Introduction
Menopause, marked by the absence of menstruation for 12 consecutive months, is a normal physiological transition in a woman’s life (Paschou et al., 2024). Menopause is associated with physiological changes, including hot flashes, mood disturbances, sleep disorders, and vaginal dryness, all of which can impact daily life and sexual health (Faubion et al., 2020; Lowdermilk, 2024; Storey & Last, 2021).
Sexual health is a multidimensional phenomenon that persists throughout life. Menopause and aging-related hormonal changes, combined with common medical conditions, can foster a less favorable biological environment for a healthy sexual response (Nappi et al., 2019). During menopause, many women experience decreased sexual desire, arousal, and satisfaction, which may be associated with emotional distress and relationship challenges (Faubion et al., 2020; Nappi & Cucinella 2025).
Women experiencing the genitourinary syndrome of menopause often report that it is negatively associated with their sexual life and satisfaction (Mili et al., 2021). Sexual function components, including satisfaction, intimacy, spontaneity, emotional connection, and sexual activity, may be negatively influenced (Hull, 2017; Nappi et al., 2019). Supporting sexual health before, during, and after menopause is essential for healthy aging and a high quality of life (WHO, 2024).
Mindfulness-based interventions (MBIs) are psychological approaches that help individuals consciously direct their attention to the present moment and observe their experiences without judgment (Kabat-Zinn, 2015). These interventions typically incorporate techniques such as breath awareness, body scanning, and slow, intentional movement to increase awareness of stress, anxiety, and negative thought patterns, encouraging conscious rather than automatic responses. Most commonly delivered as 8-week group programs, MBIs include guided meditations, home practice assignments, and exercises that promote mindfulness in daily life. These practices have been shown to support mental well-being by enhancing emotional regulation, self-compassion, and psychological flexibility (Kabat-Zinn, 2021; Segal et al., 2018; Treves et al., 2024; Zhang et al., 2021). In addition to their general psychological benefits, MBIs also play a role in sexual health management, particularly during menopause (Paschou et al., 2024). In the context of sexuality, mindfulness aims to mitigate emotional distress, improve body image, and enhance sexual satisfaction. Studies have suggested that MBIs are associated with a lower sexual dysfunction incidence in women (Sood et al., 2022; Smedley et al., 2021).
This systematic review was conducted to evaluate the existing evidence on the effects of mindfulness-based interventions on sexuality in menopausal women. The objective was to synthesize the current literature and provide clinically relevant evidence.
2. Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed, and the review was registered in the PROSPERO database (CRD42024619219). Two independent researchers (E.A. and G.Ü.S.) performed title and abstract screening, full-text assessment, and quality evaluation. Disagreements were resolved by consulting a third researcher. To minimize bias, study selection, data extraction, and quality assessment were conducted independently by two researchers using Rayyan online software (https://www.rayyan.ai). No deviations from the predetermined protocol occurred.
2.1. Eligibility criteria
The research question was structured using the PICOS framework, which defines the key components of a systematic review. In this study, the population (P) consisted of menopausal women; the intervention (I) involved any form of mindfulness-based practice; the comparison (C) group received no intervention; the outcomes (O) focused on the effects of the intervention on sexuality-related variables; and the study design (S) was limited to randomized controlled trials (RCTs).
Studies were included if they involved menopausal women—experiencing either natural or surgical menopause—and applied any mindfulness-based intervention (e.g., mindfulness-based stress reduction [MBSR], mindfulness meditation). To be eligible, studies had to assess specific dimensions of sexual health—such as sexual function, sexual distress, or sexual quality of life—using an RCT design, and be published in Turkish or English with full-text availability.
2.2. Search strategy
A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and ScienceDirect from January to February 2025. Two independent researchers (E.A. and G.Ü.S.) executed the searches using a predefined strategy incorporating MeSH terms and keywords:
((“menopause”[Title/Abstract] OR “Menopause”[Mesh] OR “climacteric”[Mesh] OR “perimenopause” OR “postmenopause” OR “menopausal”) AND (“Mindfulness”[Mesh])) AND (“Sexuality”[Mesh] OR “sexual*”[Title/Abstract] OR “Libido”[Mesh] OR “Orgasm”[Mesh] OR “Dyspareunia”[Mesh]).
Additionally, the reference lists of selected studies were manually screened for potential eligible articles.
2.3. Selection of articles and data extraction
Study selection and data extraction were performed using Rayyan software. After duplicate removal, two independent researchers (E.A. and G.Ü.S.) screened titles and abstracts, followed by full-text evaluation of eligible studies. Articles that met inclusion criteria proceeded to data extraction. Any discrepancies were resolved through consensus.
A structured data extraction tool was used to collect information on study characteristics, including:
Study title, publication year, and location.
Study design and sample size.
Intervention type, content, and follow-up duration.
Outcome measures (Table 1).
Table 1.
Study characteristics.
| Study and year | Country | Population | Duration of MBIs | Scale | Construct related to sexual health | Major relevant findings | Quality rating |
|---|---|---|---|---|---|---|---|
| Thomas et al. 2023 | United States | Age range: Women participating in the study are 45 years and older. Total number of participants: In total, 81 women were screened, and 61 were included in the study. Among these participants, 31 were randomly assigned to the mindfulness intervention group, while 30 were allocated to the education group. Participation and retention: Among the 31 women in the mindfulness group, 18 attended at least one session, whereas 23 out of the 30 women in the education group participated in at least one session. Of the 41 women who attended any sessions, 37 (90%) completed a minimum of five sessions. Inclusion criteria: Participants were required to report low libido, experience a certain level of sexual distress, and have difficulties during sexual intercourse. |
Mindfulness intervention: The intervention was structured as a 2-hour group session conducted once per week. Each session dedicated at least 30 minutes to mindfulness practice. Participants were encouraged to engage in daily 60-minute mindfulness exercises at home using guided audio recordings. Mode of delivery: virtual (online) group-based sessions Setting: home-based (participants attended online) Duration: 6 weeks, with one session per week (90 minutes) Structure: • Weekly 2-hour group sessions (total of 2 hours per session, including 30 minutes of mindfulness practice) • Daily 60-minute mindfulness exercises at home (home practice) Frequency: once per week Protocol type: researcher-adapted program |
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No significant change in sexual function (FSFI) was observed in the mindfulness group (p = 0.101). However, a significant reduction in sexual distress levels (FSDS-R) was recorded (p = 0.021). In the health education group, no significant changes were detected in either measure. |
10/13 |
| John et al. 2022 | United States | Number of participants: In total, 50 women were included in the study. Group Assignment: Participants were randomly assigned to one of two groups: 25 to the mindfulness intervention group and 25 to the general health education control group. Age range: 45–60 years Menopausal status: The study targeted women in the menopausal period. Inclusion criteria: Participants were required to have a Kupperman Index score of 15 or higher. |
Duration: The intervention lasted for 8 weeks, with participants attending one session per week. Mode of delivery: face-to-face, group-based mindfulness-based cognitive therapy (MBCT) Setting: clinical environment (hospital or healthcare center) Session length: 8 weeks, one session per week (60 minutes) Frequency: Once per week Protocol type: researcher-adapted (brief MBCT) |
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A significant improvement in sexual function was observed following the mindfulness-based intervention. Before the intervention, the sexual function score was 3 ± 1.08 in the mindfulness group and 2.84 ± 1.267 in the control group. After the intervention, the score in the mindfulness group decreased to 0.9 ± 0.21, indicating a statistically significant change (p < 0.001). Similarly, a significant improvement was maintained during the follow-up period (p < 0.001). These findings suggest that the mindfulness intervention has a positive impact on sexual function. |
13/13 |
| Mojtehedi et al. 2022 | Iran | Number of participants: In total, 132 postmenopausal women were included in the study. Study groups:
Age range: 50–60 years Menopausal status: All participants were in the postmenopausal period. Inclusion criteria: Participants were required to experience menopause-related issues such as sexual dysfunction, anxiety, and depression. |
Mindfulness intervention: The intervention was conducted over 8 weeks, with weekly sessions. Mode of delivery: mindfulness-based intervention (MBI) Setting: conducted in the training rooms of Tabriz health centers Duration: 8 weeks, with one session per week Frequency: once per week Protocol type: no protocol reference; likely researcher-designed |
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A significant increase in the total FSFI score was observed in the group that received the combination of mindfulness intervention and aromatherapy (95% CI: 5.6–10.3, p < 0.001). Notably, substantial improvements were reported in the sexual desire and arousal subscales. | 13/13 |
| Yazdani Aliabadi et al. 2021 | Iran | Number of participants: A total of 66 postmenopausal women were included in the study. Study groups: Intervention group: received mindfulness-based stress reduction (MBSR) training. Control group: did not receive any intervention. Age range: 47–62 years Menopausal status: All participants were in the postmenopausal period. Inclusion criteria: Participants were assessed for menopause-related quality of life. |
MBSR program:
Protocol type: standard MBSR protocol |
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A significant improvement was observed in the sexual subdomain of the MENQOL questionnaire in the mindfulness group (p < 0.05). No significant change was detected in the control group’s sexual subdomain scores. | 10/13 |
| Enjezab et al. 2019 | India | Number of participants: In total, 50 perimenopausal women were included in the study. Study groups: Intervention group: received mindfulness-based cognitive therapy (MBCT) training. Control group: did not receive any intervention. Age range: 45–55 years Menopausal status: All participants were in the perimenopausal period. Inclusion criteria: Women in the perimenopausal period Women not using hormone replacement therapy Women without psychiatric disorders |
MBCT Program: The program was conducted over 8 weeks, with weekly sessions lasting one hour. Mode of delivery: face-to-face, group-based MBCT Setting: clinical environment Duration: 8 weeks, with one session per week Frequency: once per week Protocol type: standard MBCT protocol |
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A significant improvement was observed in the sexual subdomain of the MENQOL questionnaire in the MBCT group (p < 0.05). No significant change was reported in the sexual subdomain scores of the control group. | 10/13 |
| van Driel et al. 2018 | Holland | Number of participants: In total, 65 women carrying the BRCA1/2 gene mutation were included in the study. MENQOL was completed by 53 participants. Study groups: Intervention group: received mindfulness-based stress reduction (MBSR) training. Control group: did not receive any intervention. Age range: mean age of 47.7 ± 5.2 years Menopausal status: All participants were women who experienced menopausal symptoms after risk-reducing salpingo-oophorectomy (RRSO). Inclusion criteria: Women carrying the BRCA1/2 gene mutation Women experiencing at least two moderate to severe menopausal symptoms after RRSO |
MBSR program: The program lasted for 8 weeks and consisted of weekly sessions lasting 2.5 hours, a 4-hour silent retreat evening, and home mindfulness exercises for participants to practice 6 days a week for 30–45 minutes per day. The home exercises were guided via MP3 player instructions. Mode of delivery: face-to-face, group-based MBSR Setting: clinical environment Duration: 8 weeks, including:
Frequency: twice a week Protocol type: standard MBSR protocol |
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A significant improvement was observed in the FSFI scores in the MBSR group (p < 0.05). Additionally, a significant decrease was noted in the FSDS scores (p < 0.05). No significant changes were found in either of the two scales in the control group. |
9.5/13 |
| Wong et al. 2018 | Hong Kong | Sample size: In total, 197 perimenopausal and postmenopausal women participated in the study. Intervention group: received mindfulness-based stress reduction (MBSR) training. Control group: received education on health issues related to menopause transition, along with exercises and group discussions. Age range: 40–60 years. Menopausal status: All participants were in the perimenopausal or postmenopausal stages. Inclusion criteria:
|
The MBSR program was conducted over 8 weeks with weekly 2.5-hour sessions. Intervention type: in-person group-based MBSR Location: clinical setting Duration: The program consisted of 8 weeks, with two 2.5-hour sessions per week, totaling 20 hours. Frequency: twice a week. Protocol type: standard MBSR protocol |
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The results for the sexual subscale of the Greene Climacteric Scale are as follows: Baseline: MBSR group: 1.47 (0.94) Control group: 1.32 (0.79) 8 Months later: MBSR group: 1.26 Control group: 1.26 Statistical difference: No significant difference (p = 0.248). Although there was a time effect, no significant changes were observed in sexual function within either group. There was no meaningful improvement in sexual aspects. |
11.5/13 |
2.4. Quality assessment
Two independent researchers assessed the methodological quality of the included studies using the Joanna Briggs Institute Critical Appraisal Checklists for RCTs (Barker et al., 2023). Initially, methodological quality assessments were independently conducted by both researchers and subsequently compared in a joint review. Discrepancies were discussed until a consensus was reached. The methodological quality scores for RCTs ranged between 9.5 and 13, depending on the study type. The revised JBI critical appraisal tool for RCTs, as described by Barker et al. (2023), comprises 13 checklist items evaluating domains such as randomization, allocation concealment, blinding, baseline similarity, outcome measurement, and statistical analysis. Each item is scored as yes, no, or unclear/not applicable, with higher total scores indicating better methodological rigor and a lower risk of bias. For example, a score of 9.5 suggests that most quality criteria were fulfilled (moderate to high quality), while a score closer to 13 corresponds to very low risk of bias and stronger internal validity. This granular scoring approach enhances transparency and aids in interpreting how methodological quality may influence the outcomes reported.
3. Results
3.1. Search results
The extracted studies were categorized according to the PRISMA guidelines (Figure 1). The PRISMA flow diagram is a guideline developed by an international group in 1996 to assess the reporting characteristics of systematic reviews (Moher et al., 2015). The search yielded 862 studies (PubMed, 4; Web of Science, 19; Scopus, 533; and ScienceDirect, 306). Following duplicate record removal, 793 studies were evaluated. Titles and abstracts were screened to identify relevant articles, review papers, protocols, duplicates, and studies with different populations, leading to the exclusion of 780 studies that did not meet the inclusion criteria. The remaining 23 full-text articles were assessed for eligibility, and seven studies that met the criteria for RCTs were included in the final analysis (Figure 1). The references of the final seven included studies were manually reviewed; however, no additional studies meeting the inclusion criteria were identified. The study details, quality scores, and participant characteristics are presented in Table 1. Additionally, this table includes information on the methodologies, intervention models (e.g., MBSR, mindfulness combined with aromatherapy), and the specific sexual health outcomes assessed in each study.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.
3.2. Study characteristics
This systematic review included seven studies with a total of 609 menopausal women, investigating the effects of MBIs on sexuality. The data were collected from five different countries, including the United States (John et al., 2022; Thomas & Brotto, 2023), Iran (Mojtehedi et al., 2022; Yazdani et al., 2021), India (Enjezab et al., 2019), the Netherlands (van Driel et al., 2018), and Hong Kong (Wong et al., 2018). All included studies were published after 2018.
All studies included in this systematic review assessed sexuality in menopausal women and were RCTs. Each study examined the effects of MBIs on sexuality in menopausal women. The age range of the participants was 45–71 years. Six studies implemented an 8-week MBI for menopausal women. However, a 6-week MBI was implemented in one study (Thomas & Brotto, 2023).
In three studies, the control group did not receive any intervention, whereas in the studies conducted by Thomas et al. (2023) and John et al. (2022), the control group received health education (John et al., 2022; Thomas & Brotto, 2023). In the study by Mojtehedi et al. (2022), the control group only received placebo aromatherapy (Mojtehidi et al., 2021). In contrast, in the study by Wong et al. (2018), the control group received menopausal transition-related health information and education, as well as exercise sessions and group discussions (Wong et al., 2018). The program was conducted over 8 weeks with 2.5-h weekly sessions. Participants were taught simple stretching exercises; however, the attention and mindfulness level required for the MBIs was not provided. The study characteristics and details of the MBIs are summarized in Table 1.
3.3. Outcomes
Of the seven included RCTs, three primarily focused on sexuality as the primary outcome (Mojtehedi et al., 2022; Thomas & Brotto, 2023; van Driel et al., 2018), whereas four (Enjezab et al., 2019; John et al., 2022; Wong et al., 2018; Yazdani Aliabadi et al., 2021) evaluated sexuality as a secondary outcome in relation to other scales.
All studies focused on sexual function, with two of them also evaluating sexual distress. Two of three studies that primarily investigated MBIs on sexual function reported positive effects, noting that MBIs improved certain components of sexual function, such as arousal, desire, and satisfaction (Mojtehedi et al., 2022; van Driel et al., 2018). However, one study reported no significant effect of MBIs on sexual function (Thomas & Brotto, 2023).
Two studies that assessed sexual distress reported that MBIs reduced sexual distress levels. All three studies evaluating the sexuality subdomain of the Menopause-Specific Quality of Life (MENQOL) reported positive effects of MBIs. However, one study assessing reduced sexual desire did not observe significant results.
Among the included studies, sexual function in three studies was assessed using the Female Sexual Function Index (FSFI) (Mojtehedi et al., 2022; Thomas & Brotto, 2023; van Driel et al., 2018). However, in four studies, sexual function was measured through the subdomains of different instruments (Enjezab et al., 2019; John et al., 2022; Wong et al., 2018; Yazdani Aliabadi et al., 2021).
3.3.1. MBIs’ effects on sexual function and sexual distress
The results of studies investigating the effects of MBIs on sexual function in postmenopausal women vary depending on the intervention methods employed. The study conducted by Mojtehedi et al. (2022) evaluated the effects of MBIs combined with aromatherapy on sexual function, anxiety, and depression in postmenopausal women (Mojtehedi et al., 2022). Participants were categorized into the following four groups: MBI, aromatherapy, MBIs combined with aromatherapy, and an education group. The MBIs was applied using various techniques, including mindfulness meditation, breath awareness, and yoga, with participants attending 2-h weekly sessions. At least 30 min of each session was dedicated to mindfulness practice. In addition, participants were encouraged to practice daily mindfulness exercises at home using audio recordings. MBIs combined with aromatherapy significantly improved outcomes (95% confidence interval: 5.6–10.3, p < 0.001), with notable improvements particularly in the sexual desire and arousal subscales.
Conversely, in the study conducted by Thomas et al. (2023), an MBI was implemented as a 6-week program (Thomas & Brotto, 2023). The program comprised several techniques, including mindfulness meditation, breath awareness, body scan, mindful yoga, and loving-kindness meditation. The participants were supported with audio recordings to practice mindfulness for 60 min daily. In this study, the MBIs did not lead to a significant change in tests measuring sexual function (FSFI); however, sexual distress levels were significantly reduced (Female Sexual Distress Scale–Revised [FSDS-R]) (p = 0.021). The group that received only health education demonstrated no significant change in either FSFI or FSDS-R.
Another study by van Driel et al. (2018), conducted as part of the Psychosexual Consequences of Risk-Reducing Salpingo-Oophorectomy in BRCA1/2 Mutation Carriers (PURSUE) study, evaluated the effects of the MBSR intervention following risk-reducing salpingo-oophorectomy (van Driel et al., 2018). In this study, the MBSR intervention group exhibited a significant improvement in sexual function (FSFI) (p < 0.05) and a significant reduction in sexual distress levels (FSDS) (p < 0.05). In the control group, no significant changes were detected in either measure.
These findings suggest that MBIs can be effective in reducing sexual distress but do not significantly improve sexual function. Additionally, aromatherapy combined with MBIs likely fosters significant improvements in sexual function.
3.3.2. MBIs’ effect on sexual aspects as a subdomain of quality of life
The studies included in this systematic review investigated whether MBIs are effective on sexual aspects in postmenopausal and perimenopausal women. In these studies, the MENQOL scale was used for assessing the sexual subdomain of quality of life. It is important to clarify that the sexual domain of MENQOL evaluates three specific aspects: sexual desire, vaginal dryness, and avoidance of intimacy, each measured through separate items. Meanwhile, the Greene Climacteric Scale was employed for evaluating decreased sexual desire using a single-item measure.
In the study conducted by John et al. (2022), the sexual score in the mindfulness group significantly decreased to 0.9 ± 0.21 following the intervention (John et al., 2022). However, the control group exhibited no significant change (p < 0.001). Additionally, the effect of the mindfulness intervention persisted for 10 weeks, and the improvement in sexual function remained significant (p < 0.001). These findings suggest that MBIs can positively affect sexual health in menopausal women.
Another study conducted by Yazdani Aliabadi et al. (2021) investigated the effects of MBSR on the sexual quality of life in postmenopausal women (Yazdani et al., 2021). In this study, the sexuality subdomain demonstrated a significant improvement, as evaluated using the MENQOL scale, following the MBI (Yazdani et al., 2021). This improvement was notably different from the worsening observed in the control group (p < 0.001). These findings suggest that MBIs can positively influence the sexual quality of life in postmenopausal women.
The study by Enjezab et al. (2019) examined the effects of MBIs on sexual function in perimenopausal women (Enjezab et al., 2019). The intervention group demonstrated significant within-group improvements (p < 0.001) following the intervention. However, no statistically significant difference was observed between the intervention and control groups following the intervention or during follow-up. These findings suggest that MBIs can provide individual-level improvements in sexual function; however, the effect may not be significantly different compared with that of the control group.
Wong et al. (2018) conducted a randomized controlled clinical trial comparing mindfulness-based stress reduction (MBSR) and psychoeducation interventions for alleviating menopausal symptoms. The study found that while both interventions improved overall menopausal symptoms, neither produced a significant effect on decreased sexual desire, as measured by the Greene Climacteric Scale. These findings suggest that MBSR interventions improve menopausal symptoms but do not significantly impact decreased sexual desire.
All studies that assessed the sexual subdomain of quality of life using the MENQOL scale reported significant improvements following MBIs. However, the one study that evaluated decreased sexual desire using a single-item measure from the Greene Climacteric Scale found no significant effect.
4. Discussion
Menopause-related hormonal changes, including estrogen deficiency, may lead to vulvovaginal atrophy, reduced lubrication, and genitourinary symptoms—factors that increase the risk of sexual dysfunction (Chen et al., 2021). This systematic review synthesized seven RCTs to evaluate the impact of MBIs on sexual health during menopause. The findings suggest that while MBIs may offer some benefit—particularly for sexual desire, arousal, and distress—results vary across studies, and the overall effect on total sexual function scores remains inconsistent.
4.1. MBIs and sexual function
Among the three studies that assessed sexual function as a primary outcome, two reported significant improvements in subdomains such as desire and arousal (Mojtehedi et al., 2022; van Driel et al., 2018), while one study found no effect on total FSFI scores (Thomas & Brotto, 2023). The effectiveness of MBIs in these cases may be shaped by differences in intervention delivery. For instance, studies that combined mindfulness with additional techniques such as aromatherapy or in-person structured sessions demonstrated more promising outcomes (Mojtehedi et al., 2022). In contrast, shorter or less comprehensive programs showed limited effects (Thomas & Brotto, 2023).
These results align with the findings of Jaderek and Lew-Starowicz (2019), who reported that MBIs improved desire, arousal, and satisfaction while also enhancing sexual self-efficacy. Nevertheless, the variation in results may be influenced by differences in delivery format (e.g., group vs. self-guided), session frequency, or cultural context.
4.2. MBIs and sexual distress
The two RCTs assessing sexual distress (Thomas & Brotto, 2023; van Driel et al., 2018) reported significant reductions following MBIs. This effect may be attributed to mindfulness’s potential to reduce negative self-appraisal, regulate attention, and increase body awareness. Similarly, a large cross-sectional study involving 1,718 women reported that higher mindfulness levels were significantly associated with lower sexual distress scores, reinforcing the potential role of MBIs in regulating sexuality-related cognitive and emotional processes (Sood et al., 2022).
4.3. MBIs and sexuality as a subdomain of quality of life
Four studies assessed sexual function using subscales of broader quality-of-life tools such as the MENQOL and Greene Climacteric Scale. In John et al. (2022) and Yazdani et al. (2021), significant improvements were observed in the MENQOL sexual domain post intervention, and these effects persisted during follow-up. However, Enjezab et al. (2019) observed within-group improvements that did not reach statistical significance when compared to the control group, while Wong et al. (2018) reported no change in sexual desire based on a single-item measure. Such discrepancies may be attributed to variations in the sensitivity of the assessment tools employed. The reliance on brief or unidimensional instruments may fail to capture the multifaceted effects of mindfulness-based interventions, thereby underestimating their potential impact.
4.4. Methodological considerations and future directions
Despite their RCT design, the studies reviewed here vary in protocol intensity, duration, and components. For example, some interventions included yoga and cognitive techniques (Mojtehedi et al., 2022), while others relied solely on meditation (Thomas & Brotto, 2023). Such heterogeneity limits comparability. Additionally, sample characteristics, such as baseline psychological status and sociocultural context, may influence outcomes (Enjezab et al., 2019; John et al., 2022).
The lack of long-term follow-up also remains a limitation. Future studies should incorporate postintervention tracking to examine the sustainability of effects. Moreover, reliance on single-item measures for constructs like sexual desire weakens interpretability. Use of comprehensive tools such as FSFI or validated multi-item scales should be prioritized.
4.5. Broader evidence context
Beyond menopausal populations, broader literature supports the use of MBIs in addressing sexual dysfunction. A review by Ciaurriz Larraz et al. (2024) found that MBIs benefited both women and men with various sexual difficulties. Similarly, psychological intervention studies emphasize the feasibility and efficacy of mindfulness for sexual concerns in women (Durna et al., 2020). This wider evidence base supports the continued investigation of MBIs as a complementary approach in menopausal sexual health care.
Future research should include more high-quality RCTs using comprehensive, sexuality-specific tools with detailed subscale reporting. Long-term effects, cultural differences, and qualitative insights also warrant further exploration.
4.5.1. Strengths and limitations
This review is one of the first to systematically examine the impact of MBIs on sexuality in menopause. By including RCTs and studies in both English and Turkish, it strengthens the methodological and cultural scope of the evidence.
However, the limited number of studies and variability in measures make comparison difficult. Notably, FSFI subdomains data were not consistently reported, preventing domain-specific analysis; only total scores could be considered. Additionally, some studies relied on limited items from general quality-of-life scales, which may not fully reflect the complexity of sexual function.
5. Conclusion
This systematic review provides significant findings on the effects of MBIs on sexual function and sexual distress during menopause. There is consistent evidence that MBIs reduce sexual distress levels; however, their effects on sexual function are less consistent. The findings suggest that the effects of mindfulness on sexual function depend on individual differences and methodological factors. Therefore, to better understand the impact of mindfulness on sexual health during menopause, further high-quality research is warranted. These findings may implications for informing the development of healthcare protocols, nursing education programs, and policy development focused on women’s health during menopause.
Acknowledgments
We express our gratitude to the researchers whose studies contributed to this systematic review.
Funding Statement
The author(s) reported there is no funding associated with the work featured in this article.
Author contributions
Concept/idea: E.A.; design: E.A, G.Ü.S., Ü.O.; supervision/consultancy: Ü.O.; analysis and/or interpretation: E.A., Ü.S., Ü.O.; literature review: E.A., G.Ü.S.; manuscript writing: E.A., G.Ü.S.; critical review: Ü.O.
Disclosure statement
No potential conflict of interest was reported by the authors.
Availability of data
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to restrictions (e.g., data containing information that could compromise the privacy of research participants).
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to restrictions (e.g., data containing information that could compromise the privacy of research participants).