On October 4, 2026, Vijesti published a report by CIN-CG on women’s sexual dysfunction in Montenegro, combining an anonymous online questionnaire with clinicians’ accounts of difficulties getting help.
Beyond resignation
The report did not announce a new treatment guideline or overturn a formal medical consensus. It challenged a quieter assumption: that sexual pain is something women should tolerate after childbirth or during menopause and ageing.
Gynecologist Aleksandra Vuksanović Božarić told CIN-CG that pain should not be treated as an unavoidable part of those experiences. Her position was that causes vary and care should respond to the individual, with other specialties involved when needed.
For midlife women, that is a meaningful distinction. Recognising menopause as part of a woman’s health history is different from using it to close the conversation about discomfort. The report’s central challenge is to resignation, not to the idea that hormonal change can matter.
What the report shows
CIN-CG’s anonymous online questionnaire was answered by 90 women in Montenegro who reported experiencing some form of sexual dysfunction. Balkan Insight’s separate coverage of the same questionnaire described both the concerns women reported and their experiences of seeking help.
- The concerns were varied. Among respondents, 51 reported reduced sexual desire and 32 reported pain during intercourse. Vaginal dryness was reported by 24 women. Almost as many as reported pain said they had difficulty reaching orgasm. These findings support a useful distinction: wanting sex, feeling comfortable during it and reaching orgasm are different concerns rather than interchangeable descriptions of one problem.
- Seeking help did not always mean feeling the problem was resolved. Balkan Insight reported that around 50 respondents had sought medical help, while 10 said their problem was fully resolved. This places two questions beside each other: whether women can reach care and whether they feel that care has addressed their concern. Both belong in a discussion about sexual healthcare.
- Confidence in the system was another issue. Almost half of the questionnaire respondents said they did not believe Montenegro’s healthcare system offered help for sexual dysfunction. The finding brings attention to the visibility of care, not just its availability. A service that women do not know about or do not believe can help remains distant from their experience of needing support.
- The barriers extended beyond symptoms. The reporting described embarrassment and financial concerns alongside uncertainty about where to seek help. Some respondents doubted that the healthcare system could assist them. Psychotherapist Adriana Pejaković also discussed taboo, shame and a lack of coordinated care as obstacles. Her observations place the difficulty of asking for help within the wider care problem rather than treating silence as a personal failing.
- Specialist access was part of the reported gap. The report said experts saw too few healthcare professionals in Montenegro with relevant expertise. It also described treatments available in some European Union countries as still largely unavailable there. These accounts raise a service-level question: how can women move from naming an intimate concern to finding someone equipped to assess it?
More than menopause
The clinicians interviewed by CIN-CG did not offer one explanation for all the questionnaire responses. Their shared emphasis was on looking at the particular concern and its possible contributors rather than assuming that every midlife sexual change has the same origin.
- Hormonal change was one possible context. Gynecologist and endocrinologist Marija Đurović discussed menopause-related estrogen deficiency in relation to vaginal dryness and painful intercourse. She also noted that these symptoms can occur outside menopause. Her explanation leaves room for hormones without making age or menopausal status a complete answer to a woman’s discomfort.
- Pelvic-floor concerns were not reduced to hormones. Pelvic-floor physiotherapist Nevena Miletić Đurić pointed to changes involving tissues and muscles alongside the nervous system and pelvic-floor function. This was her explanation of possible contributors, not an assessment of individual questionnaire respondents. It gives context to the pelvic floor’s place in sexual wellbeing without implying that every painful experience starts there.
- The range of possible causes was broad. Vuksanović Božarić identified gynecological and hormonal contributors alongside infectious or urological concerns. Musculoskeletal, neurological and psychological factors were also part of her account. The practical point is not that every woman needs investigation in every area. It is that the label sexual dysfunction does not identify the cause by itself.
- Care could involve several professions. Vuksanović Božarić recommended individualized assessment with collaboration when appropriate. Her proposed model included gynecologists and pelvic-floor physiotherapists. Psychologists or psychotherapists, urologists and other specialists could also contribute according to the concern. This frames referral as a response to clinical need rather than an assumption that one profession should address every aspect of sexual wellbeing.
- Earlier attention was part of her clinical argument. Vuksanović Božarić said sexual health should be addressed before a problem becomes chronic. She argued that timely diagnosis and appropriate therapy can improve quality of life, relationships and emotional wellbeing. The value she described was broader than a change in symptoms: it included how a woman experiences her life and her relationships.
For readers sorting through overlapping changes, separating desire from dryness and pain offers a useful editorial starting point. Different concerns deserve to be named clearly before they are gathered under one broad label.
Reading the evidence
This was a self-selected group of women already reporting sexual dysfunction, not a national prevalence survey. The reporting does not provide recruitment details or a response rate, and the symptom categories may overlap. No exact count is given for orgasm difficulty. The figures should therefore remain descriptions of these respondents rather than estimates for all women in Montenegro.
The account also does not specify what care respondents received or how long treatment lasted. It does not define what each woman meant by fully resolved. The help-seeking figures cannot establish the effectiveness of a particular treatment.
The descriptions of shortages and treatment availability are reported assessments, not a complete inventory of Montenegrin services. The multidisciplinary model is a clinician’s recommendation rather than a documented national care pathway. The communication suggestions below are editorial implications of the reporting, not a tested protocol.
A clearer conversation
For a woman navigating midlife, the report’s most useful implication is not a particular treatment choice. It is the legitimacy of bringing a sexual concern into a healthcare conversation. Vuksanović Božarić’s position supports discussing pain or a change affecting wellbeing rather than accepting it solely because of age or menopause.
A more specific description can give that conversation a clearer focus:
- The concern itself. Pain during intercourse, vaginal dryness, reduced desire and difficulty reaching orgasm are distinct descriptions. Where several are present, naming each keeps the conversation from collapsing into a vague statement that sex has changed. It also leaves the cause open for assessment rather than attaching a hormonal explanation before the concern has been understood.
- Its place in a woman’s life. The report’s clinicians discussed quality of life, relationships and emotional wellbeing. Those are legitimate subjects alongside the physical concern. A conversation about sexual health does not have to be limited to whether intercourse is possible; it can also address comfort and the personal meaning of the change.
- The kind of assessment needed. The clinicians’ accounts support individualized evaluation and collaboration where appropriate. Decisions about investigation or treatment belong with qualified professionals who can assess the person’s circumstances. The relevant question is which expertise fits the concern, not whether every woman should follow the same route through care.
For readers uncertain about where to begin, Refemina’s guide to finding appropriate professional support provides related context. The Montenegro report makes the reason for that question clear: acknowledging a concern and knowing where it belongs in healthcare are separate parts of getting help.
The clinical direction
For clinical practice, the report’s forward-looking lesson is to replace resignation with individualized assessment and coordinated care rather than treating age or menopause as the end of the conversation.
How Refemina helps
Sexual difficulties should not turn a changing midlife body into a verdict on a woman’s identity or confidence. Refemina’s research-led coverage connects sexual wellbeing with the wider hormonal transition, helping readers understand evidence and personal change without reducing intimacy to a single explanation or turning uncertainty into symptom panic.
Explore Resources
Sources
- Cin CG pain that is heard about sexual dysfunction in women is a difficult problem to solve in Montenegro
- Montenegrin Women Suffer Sexual Dysfunction in Silence, Often Untreated
