What’s Behind My Low Sex Drive? Female Sexual Dysfunction (Decreased libido)

Our interest in sex and the ability to become aroused can rise and fall throughout our lifetime. In fact, sexual desire and arousal disorders are the most common of all of the sexual disorders. And this sexual desire and arousal are referred to as libido. However, some of the causes for a drop in libido include:

6 Reasons For Your Decreased Libido 

1. Emotional Issues. For example, relationship problems, a history of sexual abuse, weight changes, stress, and negative views toward sex all affect your libido.
2. Psychological Issues. Usually, these include anxiety, depression, or poor body image.
3. Illness. For instance, diabetes, high blood pressure, neurologic disease, and premature ovarian failure lower your libido.
4. Biological Factors. In some cases, people who experience fatigue, lack of sleep, pregnancy, breastfeeding, or menopause feel a drop in their libido.
5. Medications. That is to say, drugs for depression, hormones, asthma, lung disease, high blood pressure, and insomnia can lower your libido.
6. Substance Abuse. In most cases, alcohol and drugs can have a negative impact on your libido.

Criteria for medical diagnosis of female sexual interest/arousal disorder:

1. At least three of the symptoms of decreased libido.
2. Symptoms last for at least six months.
3. Emotional distress caused by symptoms.

Symptoms of Decreased Libido:

Absence or decrease in:

•  Interest in sexual activity.
•  Sexual thoughts or fantasies.
•  Initiation of sexual activity or responsiveness to a partner’s initiation.
•  Excitement or pleasure during all or almost all sexual activity.
•  Interest or arousal in response to sexual cues.
•  Genital or non-genital sensations during sexual activity in almost all or all sexual encounters.

Having a lowered libido does not mean you no longer think about sex. You very well may. However, it is more in a way to avoid it rather than engage. Or the plan may be to get through it so that your partner may be satisfied.

So, to find the cause of your lowered sexual interest, your doctor may give you a full evaluation using The Brief Index of Sexual Functioning for Women (BISF-W). This survey is a 22-item survey that asks you to report on seven dimensions of sexuality. This helps to figure out your current level of sexual function and satisfaction.

The Seven Dimensions of Sexual Functioning

• Thoughts and desires.
• Arousal.
• Frequency of sexual activity.
• Receptivity/initiation.
• Pleasure/orgasm.
• Relationship satisfaction.
• Problems affecting sexual function.

After completing the survey, your doctor will give you a full history and physical examination. Their goal is to see if you have any physical or medical issues that may be causing sexual dysfunction.

For example, a full sexual history includes questions about:

• Sexual and Gender Identity.
• Onset, Nature, and Duration of Symptoms.
• Personal Feelings About the Symptoms.
• Medications (prescription, and over the counter).
• Alcohol and Drug Use.
• Partner’s Health and Sexual Function.
• Relationship Quality and Communication.
• Past or Present Physical/Sexual Abuse.
• Physical Activity.
• Injuries.
• Sleep Quality.
• Body Image Concerns.

In short, the physical and gynecologic exam will focus on finding changes or abnormalities that may cause sexual dysfunction. Usually, blood-work is not needed at this time. Unless, there is a specific concern. Once your exams are done, there are many treatment options depending on your initial diagnosis.

Treatment Options for Decreased Libido

1. Outpatient Psychological Counseling or Therapy: 

For instance, this may include:

• Sex-therapy.
• Sexual skills training.
• Couples-therapy.
• Marriage counseling.
• Mindful-based therapy sessions with a psychologist or psychiatrist that focus on lowering stress.

Mindful therapy brings the focus on the present. In fact, it teaches us to live in the moment instead of worrying about the past or the future.

2. Hormones: Estrogen and Testosterone

A decrease in estrogen production by the ovaries creates many changes in a woman’s genitalia. For example, a common difference is the thinning of the vaginal lining. This reduces vaginal lubrication. And it makes it harder for the vagina to deal with the friction of vaginal intercourse. As a result, sex becomes uncomfortable or even painful. So, those with a lowered libido tend to avoid it.

However, there are many ways to treat it. For one thing, there is a hormonal treatment called low-dose vaginal estrogen therapy. In fact, this is the preferred hormonal treatment for female sexual dysfunction due to these menopausal changes in the genital area. Further, there are estrogen-containing vaginal tablets, gels, creams, and rings. In most cases, they appear to be equally effective. But, you and your doctor will decide if this is a good option for you. If so, you have many choices based on what you prefer.

When you use a vaginal estrogen, your body absorbs the least amount of estrogen to resolve your sexual dysfunction. And most of its effect is local in the vagina. So, as the vaginal tissues become thicker, healthier, and more lubricated, sex becomes more enjoyable.

Did you realize that a woman’s body also produces testosterone, something we think of as a “male” hormone? Among other things, testosterone helps with our libido. As testosterone levels decline with age, it can affect our interest in sex. For example, postmenopausal women show an increase in sexual desire and arousal when using testosterone for six months or less. Still, experts do not recommend it for postmenopausal women due to lack of evidence showing the benefits and risks. Finally, pregnant women should not take medication during treatment.

Usually, postmenopausal women that wear a testosterone patch have a major rise in satisfying sexual episodes, activity, orgasms, and desire. Unfortunately, we don’t know enough about how safe or effective testosterone is for long-term use. In fact, most studies have not gone past six months. Plus, the FDA has not approved testosterone use for premenopausal women with interest/arousal disorder.

Potential Side Effects of Testosterone Therapy (not inclusive):

• Unwanted hair growth (facial and body).
• Acne.
• Possible voice deepening.
• Enlargement of the clitoris.

Sadly, these effects may be irreversible in some women. And, the effects of long-term testosterone use (past six months) on heart disease and breast cancer risk are unknown. But they could be harmful.

3. Medications: Addyi, Viagra, and Wellbutrin

In 2015, a non-hormonal medication called Addyi was approved to treat sexual interest/arousal disorders in premenopausal women who have no history of depression. However, Addyi’s has common side effects. For instance, they include dizziness, nausea, sleepiness, fatigue, and dramatic drops in blood pressure and fainting. And the use of alcohol makes these side effects worse. Addyi is also expensive. Sometimes, a one month supply can cost as much as $830.

But despite all these potential side effects and costs, the benefit is not that great. Studies show minimal improvement in libido. To point out, with the use of Addyi, you can expect to have an increase of less than one more satisfying sexual episode per month. Additionally, users of the drug must sign a document stating that you will not drink alcohol while taking Addyi. So, considering the very small improvement in libido, the cost, and the major side effects, Addyi is not a good solution for most women. And studies have also looked at Viagra as a treatment option for decreased libido in women. But results have been conflicting. And at this time, it is not been approved for use in women.

Finally, certain antidepressants may cause sexual interest and arousal disorder. But adding the drug Wellbutrin can help. In most cases, women treated with Wellbutrin with their antidepressant had more desire, arousal, lubrication, orgasm, and satisfaction compared to women who were only taking their antidepressant.

4. Devices: 

In 2000, the FDA approved a battery-powered clitoral suction device called the Eros Clitoral Therapy Device. This device improves arousal and orgasm by increasing blood flow to the clitoris. There have been no well-controlled studies looking at how effective this device is. Still, in 2017 a paper was published, which concluded that there were improvements in sexual function, satisfaction, sexually related distress, and genital sensation after using the device for three months.

Summary:

Healthy and satisfying sex life is an essential part of your overall well-being. Women who maintain a healthy sex-life have improved overall health.  Normal versus abnormal sexual functioning in women remains poorly understood. The concept of what constitutes normal female sexual function continues to develop.

Evolution of Knowledge of Female Sexual Disorder over Past 50 Years

• Clearer definitions of female sexual disorders.
• Models of female sexual response that reflect both the physical and emotional aspects of a women’s sexual experience.
• Emerging treatment options.

The future of Decreased Libido. We need to:

• Better understand women’s typical sexual activity and function during midlife and beyond, including how sex may or may not change with aging.
• Determine why some women become distressed by changes in sexual function while others do not
• Continue to develop safe and effective treatments for female sexual dysfunction, particularly for midlife and older women who are often excluded from many studies.
• Make behavioral therapy approaches more widely available as they have shown promise in the treatment of several types of female sexual dysfunction.

Using a biopsychosocial approach, which addresses the biology, psychology, cultural and interpersonal aspects of sexual health, will allow researchers and healthcare providers to better understand and improve this key component of a woman’s well-being.

Helpful Facts About Decreased Libido

• Female sexual complaints are common, occurring in approximately 40 percent of women
• Decreased desire is the most common sexual complaint.
• Sexual dysfunction peaks at midlife, with 14% of women aged 45-64 reporting at least one sexual problem causing them significant distress.
• Only 21% of women with persistent sexual problems discuss it with their healthcare provider
• Less than 50% of healthcare providers are aware of their patients’ sexual concerns.

Written by:  Lisa Shephard, MD Feb 23, 2020 | Editor: Dayna Smith MD | Last Reviewed Sep 08, 2020. Copyright myObMD Media, 2020

Glossary:

1. Sexual Dysfunction: Sexual dysfunction occurs when you have a problem that prevents you from wanting or enjoying sexual activity.
2. Libido: A person’s overall sexual drive or desire for sexual activity.
3. Gender Identity: A person’s sense of feeling female, male, or somewhere in-between. It may not go along with the sex they were assigned at birth.
4. Premature Ovarian Failure: Occurs when a woman’s ovaries stop producing hormones before they are supposed to.
5. Menopause: The time when a woman’s menstrual periods stops occurring for over one year and will not resume again.
6. Postmenopausal: The time in a woman’s life when she has gone through menopause and no longer menstruates.
7. Premenopausal: The time in a woman’s life before menopause occurs, when she is still having menstrual periods.
8. Labia: The fleshy folds that surround the opening of the vagina (the larger outer labia majora and smaller inner labia minora).
9. Clitoris: Corresponding to the penis in a male, the clitoris is highly sensitive when stimulated during sexual activity.
10. Urethra: The tube that leads from the bladder and transports urine outside the body. In females, the urethra is shorter than in the male, and it emerges above the vaginal opening.