~ July, 2021 ~ It is estimated that nearly 1 in 3 women between 18 and 59 years of age complain of lack of sexual desire. Typically, women will find themselves more interested in sex at some times than others, but many women are unsure about how much sexual desire is considered normal.
Women may be disappointed that they are missing out on sexual pleasure. Relationship conflicts may result if a woman’s partner desires more intimacy than she does. In some cases, women are not particularly bothered by their lack of desire, in which case it is not considered a problem.
How to know if low sexual desire is a problem
In some cases, the lack of sexual thoughts, fantasies, and arousal can be very upsetting. These women may qualify as having Hypoactive Sexual Desire Disorder or HSDD. In order to meet the criteria for this condition, the low level of desire and arousal must result in significant distress. It is estimated that 1 in 10 women has HSDD.
The Decreased Sexual Desire Screener is a validated questionnaire that may identify whether a woman’s low sexual desire is a problem:
- In the past, was your level of sexual desire/interest good and satisfying to you?
- Has there been a decrease in your level of sexual desire/interest?
- Are you bothered by your decreased level of sexual desire/interest?
- Would you like your level of sexual desire/interest to increase?
If a woman answers yes to these four questions, and there is no medical factor to cause the sexual problems, then she may be diagnosed with hypoactive sexual desire disorder.
What causes low sexual desire in women?
Here are some common causes of low sexual desire in women:
Stress triggers the release of cortisol (the main stress hormone). In the short term, cortisol helps us cope with stress, which is a good thing. When stress becomes day in and day out, cortisol can become chronically elevated, and this is where the problems typically start. Cortisol is part of our sympathetic “fight-or-flight” system. Sexual arousal requires the calming of the sympathetic system and activation of the opposing “relaxing” parasympathetic nervous system.
Deep breathing exercises, meditation, and going for a walk are all activities that can help reduce stress and activate the parasympathetic system, increasing the chances of “being in the mood.” At the very least, understanding how stress affects one’s sex drive may allow women to give themselves some grace when they are feeling stressed and just not interested in intimacy.
It can be hard to look forward to intimacy when it’s a struggle to muster up enough energy just to make it through the day. In this case, sleep may be much more appealing! Strategies for getting enough sleep include going to bed a little earlier, cutting back on caffeine, and sleeping in when possible. Making plans for intimacy in the morning, when energy levels may be better, could help.
Some prescription medicines can reduce sexual desire. The most common ones include birth control pills, certain anti-depressants, and blood pressure medications. Even anti-histamines taken for allergy symptoms can contribute to vaginal dryness. Reviewing medications (including over-the-counter ones) with a doctor is important to see if adjusting the dose or changing drugs may help.
Depression is a real downer for sex drive (and some anti-depressants make the problem even worse). Depression is typically associated with other symptoms, including fatigue, feelings of sadness or hopelessness, changes in sleeping patterns, or a change in appetite. If a women suspects she may be depressed, seeking help from a doctor or mental health practitioner is important.
5. Hormonal problems
Hormone issues are common in women at any age, and there are several different hormone issues that can result in a loss of sexual desire.
While testosterone is typically considered the male hormone, it is very important for women as well. It stimulates sexual thoughts and fantasies and readies the body for sex by allowing increased blood flow to the genital area for arousal and vaginal lubrication. Low levels of testosterone are common in women on birth control pills and in women over 40 and result in vaginal dryness, loss of interest in sex, and lack of arousal.
Low estrogen from menopause frequently results in physical changes like vaginal dryness and even painful sex due to the thinning of the vaginal tissues. No one is likely to be interested in intimacy if it hurts!
Hypothyroidism may cause fatigue and depressed mood, as well as reduced arousal and desire. Many doctors are not aware of the important link between thyroid health and sexual health.
What can be done to help women improve desire?
In order to help, the underlying problem(s) must be identified. Improving sleep and reducing stress are great places to start. A medical evaluation is a good next step to review prescription medications and address any hormonal issues that may be present.
If no treatable cause is found, there are now two different prescription medications available to treat hypoactive sexual desire disorder in premenopausal women. Addyi (flibanserin) is a pill, and Vyleesi (bremelanotide) is an injection. They both work by affecting brain chemicals responsible for desire. They can’t be taken with alcohol, and they have side effects, including fainting, dizziness, headaches, and high blood pressure.
Hormone replacement therapy (HRT) is an option for some women. For women who don’t wish to be on HRT or who aren’t candidates for HRT because of a history of breast cancer, very low doses of hormones can be used vaginally to treat vaginal dryness and painful sex.
There are also non-hormonal therapies that can be effective. Laser treatments for vaginal rejuvenation help improve vaginal health and increase lubrication. The O-Shot injection increases blood flow to the clitoris and vagina using growth factors from a woman’s own plasma. This treatment is done by a medical professional and has not been approved by the FDA. Restoring vaginal health may not fully restore sexual desire but can be an important step.
The bottom line…
Sexual function in women is complicated, and there can be many other factors involved. Relationship problems, a history of sexual abuse or rape, and underlying medical conditions, such as cancer or diabetes, can also interfere with sexual desire.
Women often don’t speak up or seek help for this problem due to embarrassment, shame, or feeling insecure about what “normal” sexual feelings should look like. Many women are not even aware that solutions are available. Opening the conversation about sexual desire and learning about possible treatment options may help more women find the answers they need.