Help for Women Dealing With Low Libido

Low sex drive in women has many potential causes, including underlying medical issues, emotional or psychological problems, or work- and family-related stress. The good news is that identifying the root cause of low libido can lead to effective treatment options.

It is not unusual for couples to have a disparity in their sex drives. More often than not, in a heterosexual relationship, it's the woman who has the lower libido, according to research published by the Journal of the American Medical Association (JAMA). This can be distressing for both partners and even put the relationship at risk if it can't be resolved.

The medical term for low libido and lack of interest in sex is hypoactive sexual desire disorder (HSDD), though there is some debate as to whether or not a woman's lack of sex drive should be viewed as a disorder. Research has found that the female libido differs from that of men and that women naturally have a lower libido and think about sex less often than men.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by mental health professionals, the lack of desire would have to rise to the level where it causes the woman significant distress, where it affects her relationships or self-esteem, for six months or more. Some of the symptoms of HSDD include:

• Lack of interest in sexual activity 
• Non-existent sexual thoughts or fantasies
• Disinterest in initiating sex 
• Difficulty obtaining pleasure from sex or genital stimulation

It is important to note that some fluctuations in sexual desire are natural and healthy. There are many other factors that can reduce sexual desire, for which they wouldn't qualify as HSDD per se.

To rule out HSDD, work with your doctor to identify any potential causes, as well as treatment options. Since there are no specific medical tests that can diagnose HSDD, your doctor will want to know about your symptoms to understand more about how your low sex drive is impacting your relationships and life.

In some cases, an underlying medical condition may be behind a low libido. The following conditions and medications can potentially lower sex drive:

• Injury to blood vessels or nerves after a hysterectomy or other surgery involving the reproductive organs
• Chronic health conditions such as diabetes, hypothyroidism, arthritis, anemia, cardiovascular disease, or endocrine or neurological disorders
• Chronic or physical pain, which may be associated with a medical condition
• Depression and anxiety disorders
• Antidepressants
• Blood pressure medications
• Incontinence
• Being overweight or obese
• Hormone deficiency, hormonal fluctuations, or low levels of testosterone
• Diminished blood flow to the vagina and uterus
• Conditions, such as vulvodynia, that make sex painful
• Menopause, pregnancy, or breastfeeding

In cases where medications, such as antidepressants, cause a lowered sex drive, your doctor may suggest a prescription with fewer side effects. Do not stop taking your medications without your doctor’s approval.

Daily life stresses can have an impact on your libido. Many women, for example, have a lower desire for sex after they have children due to being extra-busy and fatigued, or because they become focused more on their children than the marriage. If your body has changed over time or after giving birth, that can also take a toll.

Work stress can negatively affect your libido as well, especially when having to care for a family. By the end of the day, sleep becomes the priority, not sex. And if you are dealing with your stress by smoking and drinking more alcohol than usual or using other substances—prescription or otherwise—your libido will likely suffer as a result.

One of the strongest factors impacting a woman's drive is the quality of her relationship and emotional connection to her sexual partner. Problems that may interfere with your sex life include:

• Long-standing unresolved relationship issues and resentment
• A desire to punish or control your husband by withholding sex
• Infidelity
• Power imbalances in the relationship

Once you have identified the issues that are contributing to your low libido, you can begin treatment. The following two columns provide the types of interventions your doctor may recommend or prescribe to increase your libido:

If the problems are identified to be stress- or relationship-based, there are several approaches that may help.

Your doctor may suggest counseling to devise a plan (ideally with your partner involved in the process) to overcome any issues that may be affecting your relationship. This is where it's vital that you and your partner work as a team with a therapist to resolve any potential issues. A therapist can help teach you how to better communicate with your partner and suggest sexual techniques right for your relationship to create a more pleasurable experience.

Lifestyle changes such as exercising regularly, using mindfulness-based interventions, avoiding tobacco and alcohol, and setting aside time for intimacy or sexual experimentation (using sex toys, new positions or role-playing) can all help alleviate stress and improve libido.

A low sex drive can also be treated with medications, though, unfortunately, medical interventions for women have not been as successful as they have been for men.

Due to a reduction of blood flow to the vagina, many premenopausal and postmenopausal women undergo changes in estrogen levels. If low estrogen levels are the cause of your HSDD symptoms, then your doctor may recommend estrogen therapy using a cream, suppository, or ring that releases estrogen in the vagina without the unwanted side effects that come with estrogen pills.

An injection called the O-Shot, a plasma solution that is injected by a medical professional into the vagina, also works to improve blood flow and circulation. The procedure is still new and has not been approved by the Food and Drug Administration (FDA).

The Eros clitoral therapy device, or Eros-CTD, is a small, hand-held device fitted with a removable, replaceable small plastic cup used to improve blood flow to the clitoris and genitalia using a vacuum system. Eros Therapy was cleared by the FDA in April 2000 to treat sexual arousal and orgasmic disorders. The device comes with a cost of about $400 and a prescription is required in the United States.

Another treatment option is a pill called Addyi (flibanserin), which is an oral prescription drug that works on brain chemicals to increase desire. However, the drug does come with some potential side effects, including low blood pressure, fainting, and dizziness.