Low sex drive in women

Diagnosis

If low sex desire concerns you, talk with your gynecologist or another member of your healthcare team. For some women, low sex drive is part of an ongoing condition called sexual interest-arousal disorder. It involves having at least three of the following symptoms, which cause sadness or anxiety:

• No desire to have any type of sexual activity or to masturbate.
• Few or no sexual thoughts or fantasies.
• Not wanting to make the first move in a sexual encounter with a partner.
• Less or no pleasure during sexual activity.
• Less or no interest in any sexual or erotic cues from a partner.
• Few or no physical sensations during sexual activity in most sexual encounters.

You don't have to fit this definition to reach out for help. Your healthcare professional can look for reasons that your sex drive isn't as high as you'd like.

During your appointment, your healthcare professional asks you questions about your medical and sexual history. Your health professional also might:

• Do a pelvic exam. This checks for signs of physical changes that sometimes play a role in low sexual desire. These changes can include certain skin diseases of the vulva, thinning of the vaginal tissues, vaginal dryness or pain-triggering spots.
• Recommend testing. Blood tests can check hormone levels. They also can look for thyroid problems, diabetes, high cholesterol and liver disorders.
• Refer you to a specialist. A counselor or sex therapist can help check for emotional and relationship factors that can cause low sex drive.

Treatment

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling, and sometimes medicine and hormone therapy.

Sex education and counseling

Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sex drive. Therapy often includes education about sexual response and techniques. Your therapist or counselor likely will offer recommendations for reading material or couples' exercises. Couples counseling that addresses relationship issues also may help boost feelings of intimacy and desire.

Medications

Your healthcare professional reviews any medicines you take. The review is done to see if any of the medicines tend to cause sexual side effects. For example, SSRI antidepressants such as paroxetine (Paxil) and fluoxetine (Prozac) may lower sex drive.

If your antidepressant might be the cause of your low sex drive, your healthcare professional may recommend that you:

• Wait to see if your sex drive improves.
• Lower the amount of medicine you take, called the dose.
• Take a break from use of the antidepressant.
• Change your depression treatment.

Switching to a different type of antidepressant may lead to fewer sexual side effects. Your healthcare professional may recommend medicines such as:

• Mirtazapin (Remeron).
• Vilazodone (Viibryd).
• Bupropion (Forfivo XL, Wellbutrin XL, others).
• Vortioxetine (Trintellix).

If you take an SSRI, your healthcare professional might add bupropion to your treatment.

Along with recommending counseling, your healthcare professional may prescribe a medicine to boost your libido. Options for women who have not yet reached menopause include:

• Flibanserin (Addyi). This is a pill that you take once a day at bedtime. Side effects include low blood pressure, drowsiness, dizziness, upset stomach and fatigue. Drinking alcohol can make these side effects worse. So can taking a common medicine to treat vaginal yeast infections, called fluconazole (Diflucan).
• Bremelanotide (Vyleesi). You give yourself this shot just under the skin in the belly or thigh before sexual activity. Some women get an upset stomach after taking the medicine. This is more common after the first shot. This side effect tends to get better with the second shot. Other side effects include vomiting, flushing, headache and a skin reaction at the site of the injection.

In the United States, these medicines aren't approved for use after menopause.

Hormone therapy

Dryness or shrinking of the vagina is one of the hallmark symptoms of genitourinary syndrome of menopause (GSM). This condition might make sex not comfortable and, in turn, reduce your desire. Some hormone medicines that aim to relieve GSM symptoms could help make sex more comfortable. And being more comfortable during sex may boost your desire.

Hormone medicines include:

• Estrogen. Estrogen comes in many forms. These include pills, patches, sprays and gels. Smaller amounts of estrogen are found in vaginal creams and a slow-releasing suppository or ring. Your healthcare professional can help you understand the risks and benefits of each form. Vaginal estrogen used in small doses is unlikely to raise the risk of breast cancer. But estrogen won't improve sexual functioning related to sexual interest-arousal disorder.
• Testosterone. This hormone plays a key role in female sexual function, even though testosterone level is much lower in women than in men. In the United States, testosterone isn't approved by the FDA to treat sexual conditions in women. Still, sometimes it's prescribed to help lift a lagging libido. Testosterone that is delivered to the blood through the skin may be helpful in women after menopause. At first, this treatment can be tried for up to six months. If it helps, it can be continued with close monitoring by a healthcare professional. The use of testosterone in women can cause acne, extra body hair, and mood or personality changes.
• Prasterone (Intrarosa). This vaginal insert delivers the hormone dehydroepiandrosterone directly to the vagina to help ease painful sex. You use this medicine nightly to ease the symptoms of moderate to serious vaginal dryness linked with GSM.
• Ospemifene (Osphena). Taken daily, this pill can help ease painful sex symptoms in women with moderate to serious GSM. This medicine isn't approved for women who've had breast cancer or who have a high risk of breast cancer.

Lifestyle and home remedies

Healthy lifestyle changes can make a big difference in your desire for sex:

• Exercise. Regular aerobic exercise and strength training are great for you in general. But they also can increase your stamina, improve your body image, lift your mood and boost your libido.
• Stress less. Finding ways to cope with stress tied to work, money and daily hassles can enhance your sex drive. For instance, you could try journaling or meditation.
• Talk with your partner. Couples who learn to talk in an open, honest way often keep up a stronger emotional connection. And that can lead to better sex. Talking about sex also is important. Sharing your likes and dislikes can set the stage for more intimacy.
• Set aside time for intimacy. Schedule sex into your calendar. It may seem contrived and boring. But making the extra effort to be intimate can help put your sex drive back on track.
• Add a little spice to your sex life. Try a different sexual position, a different time of day or a different location for sex. Ask your partner to spend more time on foreplay. If you and your partner are open to new ideas, sex toys and fantasy can help spark your sexual desire.
• Try vaginal lubricants and moisturizers. If you have genitourinary syndrome of menopause, these products may ease certain symptoms, such as vaginal dryness. With regular use, they might work about as well as estrogen therapy.
• Be aware of your habits. Smoking, using illegal drugs and drinking too much alcohol can dampen your sex drive. Stopping these habits may help give your sex drive a boost. It can improve your overall health too.

Alternative medicine

Talking about low sex drive with a healthcare professional can be hard for some people. So some people decide to try herbal supplements available without a prescription. But these products aren't regulated. And often, they aren't well studied. Herbal supplements can have side effects or change how other medicines work. Always talk with a healthcare professional before using them.

One herbal supplement blend is called Avlimil. This product has estrogen-like effects on the body. While estrogen may boost your sex drive, it also may fuel the growth of certain breast cancers.

Another product called Zestra is a plant-based massage oil. It's applied to the clitoris, labia and vagina. One small study found that Zestra increased arousal and pleasure when compared with a placebo oil. But some participants in the study said they had mild burning in the genital area.

Coping and support

Low sex drive can be challenging for you and your partner. It's natural to feel frustrated or sad if you aren't able to be as sexy and romantic as you want or used to be.

At the same time, low sex drive can make your partner feel rejected. That can lead to conflicts and strife. And this type of relationship stress can lessen the desire for sex even more.

It may help to remember that changes in sex drive are typical. They're part of every relationship and every stage of life. Try not to focus all of your attention on sex. Instead, spend some time nurturing yourself and your relationship.

Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favorite restaurant. Feeling good about yourself and your partner can be the best foreplay.

Preparing for your appointment

Primary healthcare professionals and gynecologists often ask about sex and intimacy as part of a routine medical visit. Take this chance to talk about your sexual concerns.

If your healthcare professional doesn't mention the subject, you can bring it up. You might feel embarrassed to talk about sex with your healthcare professional. But this topic is perfectly fine to talk about. In fact, your sexual satisfaction is a vital part of your overall health and well-being.

What you can do

To prepare for this talk with your healthcare professional:

• Take note of any sexual problems you've been having. Include when and how often you usually have these issues.
• Make a list of your key medical information. Include any conditions for which you're being treated. Also note the names of all medicines, vitamins or supplements you take.
• Think about questions to ask your healthcare professional and write them down. Bring along notepaper and a pen or a device you can type on. That way, you can jot down information as your healthcare professional answers your questions.

Some basic questions to ask your healthcare professional include:

• What could be causing my problem?
• Will my level of desire ever get back to what it once was?
• What lifestyle changes can I make to improve my situation?
• What treatments are available?
• What books or other reading material can you recommend?

Questions your doctor may ask

Your healthcare professional asks questions about your symptoms and checks your hormone levels. Questions your healthcare professional may ask include:

• Has your interest in sex changed? And do you have trouble becoming aroused?
• Do you have vaginal dryness, trouble having an orgasm or any pain during sex?
• How much distress do you feel about your sexual concerns?
• How long have you felt a lack of desire or other symptoms?
• Are you still having menstrual periods?
• Have you ever been treated for cancer?
• Have you had any surgeries of the genitals or reproductive system?