“I feel very little interest in sex, and my partner has more desire than I have for sex. Why is this happening to me and is it normal?”

A woman’s desire for sex, or “libido” is multifactorial and complex, and can vary across the life cycle. The issue of low libido is a common and often disturbing concern, and is the most frequent sexual complaint in women (differentiated from, but not to exclude, problems in sexual arousal or orgasm). While there is no such thing as a “normal” libido, if you feel that your desire for sex is less than you would like it to be, or if your intimate relationship is strained by this issue, you are not alone. Most women experience diminished desire for sex at some point in her life. However, you may consider exploring the issue further. Very frequently, an underlying cause or causes may be identified, and then addressed to positively change a person’s sexual desire and satisfaction.

Basically, the cycle of sexual response includes desire, arousal, and orgasm. Many different factors can impact any of these areas of sexual response. Possible red flags may include the following: an underlying medical condition (such as hypertension, heart disease, diabetes, or thyroid disorder), side effects of medication (for instance, SSRIs which include Prozac, Zoloft, and Paxil), stress, relationship/intimacy struggles, a history of sexual abuse or trauma, painful or unpleasurable intercourse, poor body image or identity issues, dietary habits, smoking, alcohol use, caffeine use, hormonal fluctuations (such as occurring with PMS, pregnancy, postpartum, lactation, perimenopause, menopause, or hysterectomy) – just to name a few! What woman has not experienced at least a few of these factors at some point in her life?

Unfortunately, there is no simple or perfect solution to treat low sexual desire. The strategies to improve libido will reflect the underlying factors identified. In order to best understand what may be contributing to your concerns about libido, your health care provider will want to carefully review your overall health and sexual history. It may be recommended that you have a full physical to rule out any possible underlying medical conditions. If you take any medications, it is also important to review any potential sexual side effects related to their use. Your health care provider may also want to obtain bloodwork – again, to evaluate for particular medical conditions, and possibly to observe for any hormonal variations from normal.

Working toward increasing sexual desire (and/or arousal and orgasm) will usually involve a multi-faceted approach. For some women, identifying an underlying strain in a relationship can lead to an opportunity for changes and growth in the relationship, and a subsequent increase in sexual desire and pleasure. Other women find that simple (but sometimes difficult!) lifestyle changes will positively affect libido – more sleep and exercise, better nutritious intake, less alcohol or caffeine intake, smoking cessation, and improvements in stress management are all associated with increased libido. Women who have experienced sexual trauma or abuse will often do best in a safe, therapeutic environment in which they can begin to work through the complicated and negative associations with sex and work toward healthier, more pleasurable sexual experiences. Women experiencing depression or anxiety may also consider beginning to address their concerns with a therapist and with or without the use of medication, in order to lead a healthier life both overall and with regard to sexuality. As mentioned previously, any woman taking medication may be experiencing side effects which affect libido. Often, a change in dose or medication can help to reverse the sexual side effects. Not to be overlooked, hormonally based libido changes (whether related to menopause, pregnancy, post-partum, lactation, or even the use of oral contraceptives) can be addressed with your health care provider. Though the use of hormones is not always appropriate, supplemental hormonal therapy, or a change in a hormone regimen can, in some cases, positively affect libido. For women experiencing pain, discomfort, or a lack of physical pleasure with sex, it is important to be evaluated by your provider in order to discover the source of displeasure and thereby seek to improve sexual enjoyment and interest. Still for others, simply reserving more space in one’s life for intimacy will lead to more enjoyment and desire for sex.

Medications may be used to correct an underlying medical or emotional cause for low sexual desire – for instance, treating depression, diabetes, or hypothyroidism. However, the FDA has not as of yet approved the use of any medication for the specific treatment of low libido. Research trials are currently underway examining several possibilities for the future. A medication currently used to treat depression called buproprion hydrochloride SR may show promise in improving satisfaction with sexual desire, arousal, and orgasm. The use of androgens (i.e., testosterone) is presently being studied with particular regard to improving libido. There are also studies examining in women the use of medications which enhance blood flow to the genitals (i.e., Viagra, which is currently FDA approved for use in men with erectile dysfunction). However, medications that increase blood flow to the genitals will only address issues of arousal or orgasm, as opposed to actual desire for sex. Any of the above mentioned medications carry with them the potential for side effects, and should be discussed carefully with your health care provider. Additionally, there are many herbal remedies which have shown promising results in improving sexual desire and satisfaction. Seek more information from your health care provider or any clinician trained in the use of herbal medicines.

For further reading or information:

For Each Other: Sharing Sexual Intimacy by Lonnie Barbach
For Yourself: The Fulfillment of Female Sexuality by Lonnie Barbach
The Busy Couple’s Guide to Great Sex by Rallie McAllister, MD
www.AASECT – the American Association of Sex Educators, Counselors & Therapists

Trish Maginn Yauch MSN, ARNP
Harbour Women’s Health