Low Sex Drive in Women

Low sex drive or poor sexual libido is a bar on relationships and can significantly alter the quality of sexual and reproductive life of affected couples. According to latest estimates, the prevalence of hypoactive sexual disorder in females is fairly high. For example, according to a study reported in Jama Internal Medicine (1), about 26.7% premenopausal females report some degree of sexual dysfunction in United States. The prevalence is almost twice as much in post-menopausal women i.e. 52.4%.

Several pathophysiological factors may influence the libido or sex drive in females. In fact healthcare professionals believe that low libido in females is mostly multifactorial i.e. more than one factor is responsible. Most notable ones are; emotional and physical health, intimacy, relationship experiences, lifestyle and culture/ beliefs.

Physical Causes

Low sex can be due to medications, physical changes or illness. Most frequently reported causes include:

• Painful Sex: Sexual drive is seriously affected in females who report significant pain or discomfort during orgasm or sex. Some causes include, active infection, lump/ swelling, ulceration of female genital tract, vaginismus etc.
• Disease: Some non-sexual diseases can also affect the sexual desires in women; such as arthritis of pelvic joints, diabetes, cancer etc.
• Medication: Medications like anti-depressants and anti-seizure are known killers of libido in females.
• Lifestyle: A healthy sex life is very much dependent on the daily habits. For example, it is believed that moderate alcohol consumption takes the edge off and boost sexual desires; while excessive alcohol consumption can ruin it. The same is true for street drugs and excessive smoking. Likewise, occupational responsibilities, aggressive workout regimens, sleep deprivation or severe fatigue can also interferes with sexual libido.
• Surgery: Surgeries, particularly of genital organs or breasts can directly affect the image of self and lower sexual desire and functioning.

Hormonal Changes

Sex desires are also affected as a result of biochemical changes in the body; some scenarios are:

• Menopause: During menopause, the estrogen levels decline significantly that directly translates into decreasing interest in engaging sex. Low estrogen levels can also lead to vaginal dryness and thinning out of genital tissues, which also means that sexual intercourse become less pleasurable with advancing age.
• Pregnancy/Breast feeding: Sexual desire can drastically decrease after having a baby due to hormone changes during breast feeding and pregnancy. Intimacy isn't only due to the hormonal transition, but also due to fatigue, pregnancy pressure, baby-care problems and other related factors.

Psychological Changes and Low Sex Drive

Emotional or psychological changes can also affect sexual desires in females such as:

• Mental health issues such as depression and anxiety.
• Bad image of body/ self
• Stress
• Poor self-esteem
• History of sexual or psychological abuse in the past
• Bad sexual experiences in the past

Relationship Issues

Emotional closeness is perhaps the most important element in the sexual intimacy. Females with troubled relationships also experiences issues in the sex life. Some important factors are:

• Lack of emotional attachment between partners.
• Fights and conflicts
• Lack of trust
• Poor communication to express sexual preferences and needs.

Symptoms of Low Sex Drive/ Poor libido in Females

If both partners are not interested in engaging in sexual intercourse, no conflict is generally reported. It has been generally observed that most cases of female hypoactive desire syndrome go unnoticed for a long time. However, if male partner is more interested in sexual activity, the desire discrepancy often leads to a distress in the relationship.

There is no classic definition or measurement criteria to gauge sexual interest in women. Generally the diagnosis is clinical; depending upon the symptomatology and history of the individual.

Women with low sex drive usually presents with:

• Lack of interest in sexual activity and low rate of self-inspiration.
• No sexual thoughts and fantasies/ arousal.
• Women often feel worried/ nervous about the low sexual interest but can’t do anything to resolve the hypo-desire disorder. Such women also repeatedly ignore the sexual advances of the partner.

You can consult a doctor to address the cause of low sex drive. Sometimes, the solution can be as simple as switching the type of medications you are consuming for your medical condition.

Treatments of Low Sex Drive

The approach to treatment depends on the cause of primary problem. Some recommended modalities include; counseling, education about sex and medication.

• Counseling: Talk to a therapist or counselor to address your sexual problems and low sex desire. The therapies recommend sex education and exercises to improve the general understanding of sex.
• Medication: Some women need evaluation of existing medical and pharmacological regimen to make sure if the symptoms are due to drugs. For example, changing the type of antidepressants can improve the sex life in some women.
• Hormone Therapy: The sexual desire responds very well to small doses of estrogen (that may be administered via topical estrogen cream or Hormone Replacement Therapy; especially in menopausal or estrogen-deficient women. Estrogen increases the blood flow to the vagina; thereby minimizing the risk of vaginal dryness or thinning of vaginal lining. Sometimes, women are recommended with estrogen and progesterone replacement both. A woman’s sexual desires also responds to male hormones like testosterone patch (3).
• Flibanserin (Addyi): The renowned anti-depressant is now believed to improve libido and low sexual desire in women (especially in the menopausal age group. Daily dose of Addyi boosts sexual desire and activity in affected females, as suggested by the results of a latest clinical trial (4). Some side effects of Addyi include low BP, fainting and dizziness episodes and other mild adverse effects (especially when consumed with alcohol).

Speak to your healthcare professional to learn about other therapeutic options.

References

1. West, S. L., D’Aloisio, A. A., Agans, R. P., Kalsbeek, W. D., Borisov, N. N., & Thorp, J. M. (2008). Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Archives of Internal Medicine, 168(13), 1441-1449.

2. Kingsberg, S. A., & Rezaee, R. L. (2013). Hypoactive sexual desire in women. Menopause, 20(12), 1284-1300.

3. Simon, J., Braunstein, G., Nachtigall, L., Utian, W., Katz, M., Miller, S., ... & Davis, S. (2005). Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder. The Journal of Clinical Endocrinology & Metabolism, 90(9), 5226-5233.

4. Puppo, G., & Puppo, V. (2015). US Food and Drug Administration Approval of Addyi (Flibanserin) for Treatment of Hypoactive Sexual Desire Disorder. European urology.