Higher BMI Linked to Poorer Sexual Function in Postmenopausal Women, but Pooled Evidence Remains Weak

Higher body mass index is frequently associated with reduced sexual function in postmenopausal women, but the pooled statistical evidence does not yet support a firm conclusion, according to a systematic review and meta-analysis published in the European Journal of Medical Research. The review found that most of the included studies reported a statistically significant inverse association between BMI and sexual function, yet a meta-analysis of a small subset of studies showed no significant pooled effect.

The research team, led by Soheila Nazarpour with colleagues Masoumeh Simbar, Zahra Kiani and Reza Taherian, set out to clarify a question of growing public health relevance. Female sexual dysfunction is described in the paper as a common and multifactorial problem in postmenopausal women that affects quality of life. With obesity rates rising worldwide, the authors considered body mass index a potential contributing factor worth examining systematically.

The review followed PRISMA guidelines. The researchers searched international databases including PubMed, Scopus, Web of Science, ScienceDirect, Embase and the Cochrane Library, along with Iranian databases such as IranMedex, Magiran, IranDoc and SID, with the search covering literature up to August 2026. They included observational studies of cross-sectional, cohort and case-control design that examined the association between BMI and sexual function in postmenopausal women, applying no restrictions on language or publication date.

Study quality was assessed with the Joanna Briggs Institute checklists. For the quantitative synthesis, the team used a random-effects model with restricted maximum likelihood estimation. Between-study heterogeneity was evaluated with Cochran’s Q test and the I2 statistic, and publication bias was assessed using Egger’s regression test.

After an updated search, 25 studies met the eligibility criteria and entered the qualitative synthesis. Thirteen of these studies, or 52 percent, enrolled exclusively postmenopausal women, while the remainder included mixed menopausal populations. The studies were conducted across 14 different countries between 1996 and 2026, spanning three decades of research on the topic.

The main instrument for assessing sexual function was the Female Sexual Function Index, used in ten of the studies. The remaining studies relied on other measures, including the Cervantes scale, the MHR-QOL, the McCoy scale, the CSFQ-14, the Sexual Activity Questionnaire, the Modified Kupperman Menopausal Index, or questionnaires designed by the researchers themselves.

The systematic review of the 25 studies showed mixed findings across the included studies, with most reporting an inverse association between BMI and sexual function. Nineteen studies, or 76 percent, reported a statistically significant inverse association between BMI and sexual function, with the effect appearing particularly in the domains of satisfaction, desire and arousal. However, three studies, or 12 percent, found no significant relationship, and another three studies, also 12 percent, reported a positive relationship between BMI and sexual function, underscoring the inconsistency in the literature.

The meta-analysis told a more cautious story. Pooling four studies that allowed a quantitative estimate, the researchers found no significant association between overweight BMI and sexual dysfunction, with an odds ratio of 1.00 and a 95 percent confidence interval of 0.81 to 1.24. In other words, the pooled data could not distinguish women with overweight BMI from those with lower BMI in terms of sexual dysfunction risk.

The authors concluded that although most studies report a negative association between higher BMI and reduced sexual function in postmenopausal women, the meta-analysis, based on a limited number of eligible studies, did not show a significant pooled effect. They noted that elevated BMI is frequently correlated with poorer sexual function but that the current evidence is insufficient to support BMI as an independent causal factor, and they called for additional high-quality longitudinal studies to clarify the nature and direction of the relationship.

For clinicians and researchers, the review highlights both a signal and a gap. The authors’ note that the published version is still subject to further editorial updates, as the article was released early as a citable accepted manuscript with a permanent DOI.

Subject of Research: The relationship between body mass index and sexual function in postmenopausal women

Article Title: The relationship between sexual function and body mass index in postmenopausal women: a systematic review and meta-analysis

Article References: Nazarpour, S., Simbar, M., Kiani, Z., & Taherian, R. (2026). The relationship between sexual function and body mass index in postmenopausal women: a systematic review and meta-analysis. European Journal of Medical Research. https://doi.org/10.1186/s40001-026-05389-3

Image Credits: AI Generated

DOI: 10.1186/s40001-026-05389-3

Keywords: postmenopausal women, body mass index, sexual function, female sexual dysfunction, systematic review, meta-analysis, obesity, FSFI questionnaire, observational studies, quality of life, relationship, between