The incidence of women's experiences of lack of sexual arousal increases in the years around the natural menopause transition. This raises the questions to what extent are sexual complaints in postmenopausal women related to hormonal changes, and what is the contribution of psychologic and contextual factors to sexual function in this transitional phase of life. This article reviews all published evidence regarding (1) the relation between menopausal status and sexual arousal symptoms, (2) the extent to which these sexual symptoms relate to measured genital vascular responses to sexual stimuli, and (3) the correlation between women's genital vascular response and their experience of subjective sexual arousal. Psychophysiologic and preliminary functional magnetic resonance imaging (MRI) studies of increases in genital congestion in response to erotic stimulation fail to identify differences between premenopausal and postmenopausal women. This suggests that although urogenital aging results in changes in anatomy and physiology of the genitals, postmenopausal women preserve their genital responsivity when sufficiently sexually stimulated. The vaginal dryness and dyspareunia experienced by some postmenopausal women may result from longstanding lack of sexual arousal and protection from pain previously afforded by estrogen-related relatively high blood flow in the unaroused state. Psychophysiologic studies confirm similar increases in genital vasocongestion from erotic stimuli in women with and without chronically low sexual arousal, even in those women focusing specifically on their perceived lack of genital response. Moreover, studies repeatedly confirm highly variable correlations between subjective sexual arousal and measured increases in genital congestion.