Low sex drive in women

If you want to have sex less often than your partner does, neither one of you is necessarily outside the norm for people at your stage in life — although your differences may cause distress.

Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line: There is no magic number to define low sex drive. It varies among women.

Symptoms of low sex drive in women include:

• Having no interest in any type of sexual activity, including masturbation
• Never or only seldom having sexual fantasies or thoughts
• Being concerned by your lack of sexual activity or fantasies

When to see a doctor

If you're concerned by your low desire for sex, talk to your doctor. The solution could be as simple as changing a medication you are taking, and improving any chronic medical conditions such as high blood pressure or diabetes.

Desire for sex is based on a complex interaction of many things affecting intimacy, including physical and emotional well-being, experiences, beliefs, lifestyle, and your current relationship. If you're experiencing a problem in any of these areas, it can affect your desire for sex.

Physical causes

A wide range of illnesses, physical changes and medications can cause a low sex drive, including:

• Sexual problems. If you have pain during sex or can't orgasm, it can reduce your desire for sex.
• Medical diseases. Many nonsexual diseases can affect sex drive, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.
• Medications. Certain prescription drugs, especially antidepressants called selective serotonin reuptake inhibitors, are known to lower the sex drive.
• Lifestyle habits. A glass of wine may put you in the mood, but too much alcohol can affect your sex drive. The same is true of street drugs. Also, smoking decreases blood flow, which may dull arousal.
• Surgery. Any surgery related to your breasts or genital tract can affect your body image, sexual function and desire for sex.
• Fatigue. Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a low sex drive.

Hormone changes

Changes in your hormone levels may alter your desire for sex. This can occur during:

• Menopause. Estrogen levels drop during the transition to menopause. This can make you less interested in sex and cause dry vaginal tissues, resulting in painful or uncomfortable sex. Although many women still have satisfying sex during menopause and beyond, some experience a lagging libido during this hormonal change.
• Pregnancy and breast-feeding. Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sex drive. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby also can contribute to changes in your sexual desire.

Psychological causes

Your state of mind can affect your sexual desire. There are many psychological causes of low sex drive, including:

• Mental health problems, such as anxiety or depression
• Stress, such as financial stress or work stress
• Poor body image
• Low self-esteem
• History of physical or sexual abuse
• Previous negative sexual experiences

Relationship issues

For many women, emotional closeness is an essential prelude to sexual intimacy. So problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of ongoing issues, such as:

• Lack of connection with your partner
• Unresolved conflicts or fights
• Poor communication of sexual needs and preferences
• Trust issues

By definition, you may be diagnosed with hypoactive sexual desire disorder if you frequently lack sexual thoughts or desire, and the absence of these feelings causes personal distress. Whether you fit this medical diagnosis or not, your doctor can look for reasons that your sex drive isn't as high as you'd like and find ways to help.

In addition to asking you questions about your medical and sexual history, your doctor may also:

• Perform a pelvic exam. During a pelvic exam, your doctor can check for signs of physical changes contributing to low sexual desire, such as thinning of your genital tissues, vaginal dryness or pain-triggering spots.
• Recommend testing. Your doctor may order blood tests to check hormone levels and check for thyroid problems, diabetes, high cholesterol and liver disorders.
• Refer you to a specialist. A specialized counselor or sex therapist may be able to better evaluate emotional and relationship factors that can cause low sex drive.

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling, and sometimes medication 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 provide recommendations for reading materials or couples' exercises. Couples counseling that addresses relationship issues may also help increase feelings of intimacy and desire.

Medications

Your doctor will want to review the medications you're already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as paroxetine (Paxil) and fluoxetine (Prozac, Sarafem) may lower sex drive. Switching to bupropion (Wellbutrin SR, Wellbutrin XL) — a different type of antidepressant — usually improves sex drive and is sometimes prescribed for women with sexual interest/arousal disorder.

Along with counseling, your doctor may prescribe a medication to boost your libido. Food and Drug Administration (FDA)-approved options for premenopausal women include:

• Flibanserin (Addyi), a pill that you take once a day at bedtime. Side effects include low blood pressure, dizziness, nausea and fatigue. Drinking alcohol or taking fluconazole (Diflucan), a common medication to treat vaginal yeast infections, can make these side effects worse.
• Bremelanotide (Vyleesi), an injection you give yourself just under the skin in the belly or thigh before anticipated sexual activity. Some women experience nausea, which is more common after the first injection but tends to improve with the second injection. Other side effects include vomiting, flushing, headache and a skin reaction at the site of the injection.

These medications aren't FDA-approved for use in postmenopausal women.

Hormone therapy

Dryness or shrinking of the vagina, one of the hallmark signs of genitourinary syndrome of menopause (GSM), might make sex uncomfortable and, in turn, reduce your desire. Certain hormone medications that aim to relieve GSM symptoms could help make sex more comfortable. And being more comfortable during sex may improve your desire.

Possible hormone therapies include:

• Estrogen. Estrogen is available in many forms, including pills, patches, sprays and gels. Smaller doses of estrogen are found in vaginal creams and a slow-releasing suppository or ring. Your doctor can help you understand the risks and benefits of each form. But, estrogen won't improve sexual functioning related to hypoactive sexual desire disorder.
• Testosterone. The male hormone testosterone plays an important role in female sexual function, even though testosterone occurs in much lower amounts in women. Testosterone isn't approved by the FDA for sexual dysfunction in women, but sometimes it's prescribed off-label to help lift a lagging libido. The use of testosterone in women is controversial. Taking it can cause acne, excess body hair, and mood or personality changes.
• Prasterone (Intrarosa). This vaginal insert delivers the hormone dehydroepiandrosterone (DHEA) directly to the vagina to help ease painful sex. You use this medication nightly to ease the symptoms of moderate to severe vaginal dryness associated with GSM.
• Ospemifene (Osphena). Taken daily, this pill can help relieve painful sex symptoms in women with moderate to severe GSM. This medication isn't approved in women who have had breast cancer or who have a high risk of developing breast cancer.

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

• Exercise. Regular aerobic exercise and strength training can increase your stamina, improve your body image, lift your mood and boost your libido.
• Stress less. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive.
• Communicate with your partner. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex. Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy.
• Set aside time for intimacy. Scheduling sex into your calendar may seem contrived and boring. But making intimacy a priority 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 experimentation, sex toys and fantasy can help rekindle your sexual desire.
• Ditch bad habits. Smoking, illegal drugs and excess alcohol can all dampen your sex drive. Ditching these bad habits may help give your sex drive a boost and improve your overall health.

Talking about low sex drive with a doctor may be difficult for some women. So some women may turn to over-the-counter herbal supplements. However, the FDA doesn't regulate such products, and in many cases, they haven't been well-studied. Herbal supplements can have side effects or interact with other medications you may be taking. Always talk with a doctor 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 may also fuel the growth of certain breast cancers.

Another choice is a botanical massage oil called Zestra. 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. The only reported side effect was mild burning in the genital area.

Low sex drive can be very difficult 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 you used to be.

At the same time, low sex drive can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex.

It may help to remember that fluctuations in the sex drive are a normal 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 actually be the best foreplay.

Primary care doctors and gynecologists often ask about sex and intimacy as part of a routine medical visit. Take this opportunity to be candid about your sexual concerns.

If your doctor doesn't broach the subject, bring it up. You may feel embarrassed to talk about sex with your doctor, but this topic is perfectly appropriate. In fact, your sexual satisfaction is a vital part of your overall health and well-being.

What you can do

To prepare for this discussion with your doctor:

• Take note of any sexual problems you're experiencing, including when and how often you usually experience them.
• Make a list of your key medical information, including any conditions for which you're being treated, and the names of all medications, vitamins or supplements you're taking.
• Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.

Some basic questions to ask your doctor 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 materials can you recommend?

Questions your doctor may ask

Your doctor will ask questions about the symptoms you're experiencing and assess your hormonal status. Questions your doctor may ask include:

• Do you have any sexual concerns?
• Has your interest in sex changed?
• Do you have trouble becoming aroused?
• Do you experience vaginal dryness?
• Are you able to have an orgasm?
• Do you have any pain or discomfort during sex?
• How much distress do you feel about your sexual concerns?
• How long have you experienced this problem?
• Are you still having menstrual periods?
• Have you ever been treated for cancer?
• Have you had any gynecological surgeries?