The importance of female sexual fulfillment is increasingly recognized in today's society. Women's sexual lives continue well into the menopausal years and beyond; however, the impact of menopause on the quality of that sexual life has not been comprehensively studied in the medical literature. This review attempts to clarify the impact of the physiological, psychological and psychosocial changes occurring at midlife that may affect women's quality of sexual life. Pharmaceutical and psychological interventions that may assist in improving the quality of sexual life of menopausal women are discussed. Female sexuality is complex and not fully understood and, consequently, controversy frequently arises in the discussion of female sexual problems and their treatment. This article highlights some of these controversies and provides a future perspective on how the impact of menopause on the quality of sexual life may be more cohesively investigated.