Low Sex Drive in Women

What Causes a Low Sex Drive?

A low sex drive can be caused by many different factors.

Often it is related to simple life circumstances. Juggling a busy workload and young kids often means that sex becomes a low priority. Other common causes include being in an unhappy relationship, fatigue, low self-esteem and excessive use of alcohol.

A low libido can also be caused by many health-related conditions. Several medications (especially antidepressants) are known to lower the sex drive. Other potential culprits include pregnancy, breastfeeding, diabetes, thyroid issues, arthritis, high blood pressure, depression and anxiety.

For many women, a lower sex drive arrives hand-in-hand with aging and menopause: as hormone levels drop, so does the desire for sex. Sometimes that is due purely to hormone levels, but it’s often related to common physical changes of menopause, such as vaginal dryness, that can make sexual activity uncomfortable or painful.

The condition is surprisingly common. “About one in three women will experience a low sex drive,” Dr. Kagan says.

A critical factor in assessing your own sex drive is not “how low is low,” but whether or not your personal sex drive bothers you, Dr. Kagan says. If you have little or no desire for sex, but that is not causing you (or your relationship) any distress, there is no reason to try to change it.

Some couples have agreed that sex is not a central part of their relationship. For them, a low sex drive is not a problem. Likewise, if your relationship includes sex, but you rarely achieve orgasm and that’s OK with you, and you are satisfied with simply feeling close to your partner, then your low sex drive is not a problem. There is no reason to treat it.

If, however, your low sex drive is causing you distress, it is a problem, and you might want to seek solutions.

For many women – those who can attribute their lack of interest to life circumstances, medication or other common causes – fixing the underlying issue or introducing some new elements into their sex life will often help.

For a smaller number of women there is no easily identifiable cause. “About 1 in 10 women have a low sex drive, are distressed by it, and there are no other reasons,” Dr. Kagan says. “These women are said to have HSDD, or hypoactive sexual desire disorder.”

If you want to make changes in your own libido, there are a number of options you can explore.

Medical Approaches

A first step is a frank talk with your doctor about your low sex drive. Don’t be shy; your sex life is a vital part of your overall health, and your doctor might well have some solutions.

Your doctor may do a physical exam, review your current medications, and talk about your health history to determine if there are physical reasons for your low sex drive. He or she may also order blood tests to check hormone levels and other factors.

“Sometimes a simple change in medication, such as using a different antidepressant or birth control pill, will bring things back to where they once were,” Dr. Kagan says. “For some women, it’s as simple as switching from an oral form of hormone therapy to a transdermal (patch) form.”

“If you are in menopause, local or systemic hormone therapy might help,” she adds. Local hormone therapy, which delivers estrogen primarily to the vagina, can often help with discomfort. Systemic hormone therapy, which poses health risks to some women, might be considered after other solutions are tried (and usually only if you are also having severe symptoms of menopause).

Supplemental testosterone also helps a small number of women. Treatment usually starts with local application, using a gel or cream in the genital area. It can help with sensitivity and give a little boost of libido. For some women, it helps them to achieve orgasm or have stronger orgasms.

A new option is the prescription medication Addyi (flibanserin), which the FDA has approved for use – but only in premenopausal women who have HSDD. “This drug is not for women who have low sex desire due to common issues such as stress, kids, or the normal decrease that comes with age,” Dr. Kagan says. “To make a diagnosis of HSDD, we need to first rule out all of those other reasons for low desire.”

Addyi is not “Viagra for women.” It is not a performance enhancer. Rather, it is believed to act on brain neurotransmitters that help to regulate sexual desire. It has to be taken every day, not just when you are planning sexual activity. In clinical trials, women taking Addyi reported modest improvement in satisfying sexual events and sexual desire, and decreased distress related to sexual desire.

The drug has some significant drawbacks. It may take several weeks of treatment to see any effect, and the drug can lead to severely low blood pressure and loss of consciousness. Those effects are even more severe in women who drink alcohol, take certain medications, or have liver impairment. Addyi is therefore advised only for women who do not drink any alcohol, and prescribers are required to advise patients of those issues.

Dr. Kagan, who is certified to prescribe Addyi, says the new drug will help some women. “There is a big difference between plain old low sex desire and HSDD. There hasn’t been anything to help women with this condition until now.” Addyi was also studied in postmenopausal women, Dr. Kagan notes, and might be approved for use by them in the future.

Non-Medical Solutions

If you and your doctor don’t uncover any medical reasons for your low libido:

• Think about what you can do to spice things up. Have you and your partner fallen into a rut in the bedroom? Consider taking a weekend away from your daily responsibilities, or adding some sex toys or massage oils to your repertoire. See more ideas at Great Sex in Midlife.
• Take some time to focus on rekindling your relationship with your partner. Set aside time to do things together as a couple, as you did when you were first dating.
• Talk to a therapist. If your low desire is caused by psychological issues such as depression, poor body image, or the aftermath of sexual abuse, therapy might help. If relationship issues are the problem, talking with a counselor who specializes in couples might help.