Why is sexual pleasure still seen as a luxury in medicine? For decades, discussions about sexual health have focused on avoiding harm rather than embracing joy, leaving an important aspect of well-being overlooked. Intimacy and sexual pleasure are integral to women’s health and wellness, yet our culture and medical system have long treated these topics as taboo or, worse, as afterthoughts. Conversations about sexually transmitted infections (STIs) and contraception dominate the field, and while those discussions are essential, they often imply that the scope of sexual health care ends there. The implicit message is clear: avoiding harm is enough. But is it?
At this year’s International Society for the Study of Women’s Sexual Health (ISSWSH) Annual Meeting, I saw the beginnings of a shift in perspective. Researchers and clinicians across disciplines were not only asking how to treat pain and dysfunction, but also how to create pleasure. That distinction is more important than it seems.
As a medical trainee, I have been taught to recognize dysfunction: find what is broken, diagnose it, and fix it. This framework serves a vital purpose, but when it comes to women and nonbinary individuals’ sexual health, the system often stops at alleviating pain, as though the absence of discomfort is the highest possible outcome. People deserve more than just surviving their bodies. They deserve to feel good in them.
This shift in focus became clear during some of the most compelling research presentations at ISSWSH. One study examined sexual function and orgasm after gender-affirming hysterectomy in transgender and gender-diverse individuals, a population historically excluded from sexual health research. The findings stood out not because something went wrong, but because things went right. Orgasm frequency remained high, and overall sexual functioning improved over time. Another study on sexual satisfaction after gender-affirming vaginoplasty revealed that nearly half of participants were consistently able to reach orgasm, and two-thirds were satisfied with their orgasm quality. Many reported pleasurable genital sensation within months of surgery.
What stood out to me was not just the results, but the fact that pleasure was being measured at all. For so long, medicine has treated pleasure as an illegitimate clinical outcome, particularly for women and nonbinary people. As Dewitte and Borg’s recent review in Nature Reviews Urology explains, this neglect is deeply rooted in historical, societal, and gender biases. Sexual medicine has focused on dysfunction and reproduction, often sidelining pleasure as a secondary concern or dismissing it as too subjective to measure. Yet pleasure is a fundamental driver of human sexuality and closely tied to mental health, relationship satisfaction, and overall well-being.
In my own research on menopause-related content on TikTok, I saw how this gap plays out in everyday conversations. Across more than 800 videos, influencers frequently discussed mood changes, fatigue, and hot flashes, but direct sexual concerns like low libido, vaginal dryness, and arousal difficulty were rarely mentioned, and orgasmic challenges were discussed in just 0.12%. Even in spaces where people are trying to be open, sexual health is something we talk around rather than address directly.
Part of this silence is rooted in stigma, but part of it is the failure of medicine to give people the language or permission to talk about pleasure as something they deserve. For too long, the narrative has been that women and nonbinary people should tolerate discomfort, endure pain, and accept bodily changes as inevitable, even when those changes profoundly affect intimacy, identity, and quality of life.
Sexual pleasure is not frivolous. It is not a bonus or an indulgence. It is fundamentally about quality of life. Dewitte and Borg argue for a biopsychosocial view of sexual pleasure that recognizes the interplay between biological, psychological, and social factors in shaping sexual experiences. Addressing sexual symptoms, whether through hormonal therapy, pelvic floor physical therapy, counseling, or interventions like sexual aids, is not just about reducing discomfort. It is about restoring connection, agency, and a sense of presence in one’s own body.
That is what felt different about ISSWSH this year. The conversations were not just about alleviating pain, but about what comes after pain is addressed. They pushed us to think about what patients actually want their lives to look like, and what it means to redefine the goals of care beyond simply treating dysfunction.
As a future physician, this is the kind of medicine I want to practice. Not one that stops at survival, but one that recognizes that people deserve more from their bodies and their lives. Sexual health should not be defined solely by the absence of dysfunction. It should also include the presence of pleasure, because that is what makes a life feel full.
Pleasure is not a luxury. It is a fundamental part of health and wellness, and it is time we treated it that way.
Leona Hariharan is a first-year medical student at UCSF interested in sexual medicine and women’s midlife health. She can be found on Instagram at @leona.hari.
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