Understanding and Managing Low Libido in Women

Libido is one of those words. Simple to explain on paper. Complicated to explore off the page.

The ‘what’ is easy.

Libido is the medical term used to describe a person’s sex drive or desire for sex, including penetrative and non-penetrative partnered-sex and masturbation.

Low libido is a low sex drive or decrease in the frequency or intensity of sexual desire.

It’s having fewer sexual thoughts or fantasies. It’s not wanting to make the first move or not feeling excited by sexual cues from your partner. It’s finding less pleasure and feeling fewer sensations during sex.

The ‘why’ is harder.

That’s because libido is influenced by a mind-numbing number of biological, psychological, and social (bio-psycho-social) factors.

The biological factors include hormones, like estrogen and testosterone. The psychological factors include mental health concerns, like anxiety, depression, and stress. The social factors include lifestyle factors, like sleep quality, exercise, alcohol use, and belief systems.

The ‘genes’ you were born with can impact libido. The ‘jeans’ you bought to wear on date night can influence libido too.

Like I said, it gets complicated quickly.

And then there’s this. And that.

• Libido is a subjective term. There’s no such thing as ‘normal’ when it comes to desire for sex. What feels ‘healthy’ and ‘normal’ to one person may feel ‘unhealthy’ and ‘off’ to someone else.
• Libido varies from person to person; and from time to time. Libido waxes and wanes. Desire comes and goes. And this IS ‘normal’.
• Low libido is only an issue if you experience the condition AND it causes you distress, frustration, or worry. If you’re happy and satisfied with your sex life, keep doing what you’re doing.

The medical community craves certainty, but sex is surrounded by uncertainty. What’s good. What’s bad. What’s enough. What’s too much. What’s right. What’s wrong.

Some people can talk about sex for days while others (including some healthcare providers) have trouble even saying the word s…e…x. I mean, even Instagram has a hard time handling the topic of ‘seggs’.

But we don’t.

Sex, intimacy, and desire are important topics. And, at Tia, we love talking about these things. We love taking on the hard stuff and finding a way to help.

Low libido is a big topic that’s impossible to fully explain and explore in one sitting, but hopefully this little article will make a difference in the way you think about desire and the way you understand the options out there for managing low libido and improving your sexual health and wellbeing once and for all.

Common Causes of Low Libido in Women

Low libido is a multifactorial medical condition - usually there are many reasons why someone may experience it. The list is long and not completely inclusive, but here are some of the most common causes of low libido in women:

Hormone Changes

• Perimenopause and Menopause
  During perimenopause (the time period leading up to menopause) and menopause, the ovaries gradually decrease their production of estrogen, an important reproductive hormone that plays a major role in sexual desire. Lower estrogen can also contribute to vaginal and vulvar dryness and thinning, which can make sex uncomfortable or painful.

Pregnancy, Childbirth, and Breastfeeding

• Hormone changes during pregnancy, after having a baby, and during breastfeeding can put a damper on sex drive. Additionally, these events can cause stress, fatigue, body image, and uncomfortable physical symptoms, which all lower libido.

Mental Health Issues

• Anxiety, depression, and stress weigh on the mind and can weigh down sexual desire too. It’s hard to get psyched up for sex when dealing with low self-esteem, hopeless feelings, and physical fatigue. Some mental health problems (like anxiety) can also increase cortisol levels, a stress hormone that suppresses sex drive.

Physical Health Problems

• Medical Conditions
  Certain chronic diseases, like diabetes, thyroid problems (especially hypothyroidism), cancer, headaches, high blood pressure, and heart disease can impact energy levels, reduce blood flow, and cause other uncomfortable symptoms that can lower libido. Reproductive health issues – endometriosis, PCOS, and fibroids – can also have a negative impact on a person’s sex drive.
• Infections
  Yeast infections, STIs, and UTIs can make sex painful or uncomfortable and lower desire for sex.
• Surgery
  Surgeries related to the breasts or genitourinary system can affect body image and sexual function as well.

Relationships Issues

• Communication Issues
  Unresolved conflict and an inability to talk openly and honestly about sexual needs are two big reasons people feel like sex isn’t fun anymore.
• Lack of Trust and Connection
  Trust and connection are critical components of a healthy relationship. Same goes for a healthy sex life too.
• Performance Concerns
  Worries about your or your partner’s ability to have sex can reduce the desire for sexual activity. This can happen for many reasons, including erectile dysfunction (ED) or anorgasmia (inability to achieve orgasm).

Medications

• Addyi, a 5-HT1A receptor agonist, is the first and only FDA-approved drug for low libido or Hypoactive Sexual Desire Disorder HSDD) in premenopausal women. So, yes, there’s a pill (you take it daily) that can potentially provide more desire for sex, more satisfying sexual events, and less stress related to low libido.
• Some medications have the potential to lower sex drive. A class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are well-known to cause lower libido. Certain blood pressure drugs (like beta blockers) can have a similar effect. Birth control (pills, patch, implant, etc.) can also affect sexual desire.

Lifestyle Habits

• Stress
  Work stress. Financial stress. Family stress. Stress is a normal part of life (and has its benefits), but too much stress can, well, can really stress a person’s interest in sex. Chronic stress can also cause hormone fluctuations that can have an impact on libido as well.
• Sleep quality
  The math is pretty simple here. Better sleep = better sex.
• Physical activity
  Exercise is awesome for your health (and sexual health). But too much or too little physical activity can actually lower libido.
• Alcohol, smoking, and drug use
  A glass of wine may seem like a good idea in the moment, but alcohol (and many street drugs) can suppress sexual desire. Smoking can alter important sex hormones, like testosterone. It can reduce blood flow too, and good blood flow is good for sex.

Past Sexual Experiences

• Past negative sexual experiences (pain, body shaming) and a history of emotional, physical, or sexual abuse can lower libido and make sex a proposition that triggers thoughts and feelings that provide pain instead of pleasure.

How Doctors Diagnose Low Libido in Women

Health care providers have a plethora of options when it comes to diagnosing low libido, but it all starts with taking a good physical health history, mental health history, sexual health history, relationship history, and medication history. Oftentimes, providers can make a clinical diagnosis of low libido without a lot more. But they will usually conduct a physical exam (including a pelvic exam) and may order blood tests (to check hormone levels) and/or imaging tests if the cause of low libido isn’t jumping off the page.

Treating and Managing Low Libido in Women

Treatment and management of low libido often flows from what a provider finds after doing an exam and identifying the most likely cause(s) at play. Since low libido often stems from various factors, its treatment may require a healthy dose of patience and trial and error before landing on the best approach.

Here are some of the treatment and management options available:

Hormone Replacement Therapy (HRT)

• Estrogen levels start declining during middle age and keep going until menopause. This decrease in estrogen is one of the main causes of vaginal/vulvar dryness and thinning of vaginal and vulvar tissues can lead to pain with sex and other uncomfortable symptoms that reduce libido. Even though many people associate testosterone with men, this hormone plays a key role in female sexual desire too. In the United States, testosterone isn't approved by the FDA to treat sexual conditions in women, but it’s commonly prescribed ‘off label’ to help women experiencing low libido.

Medication

• Addyi, a 5-HT1A receptor agonist, is the first and only FDA-approved drug for low libido or Hypoactive Sexual Desire Disorder HSDD) in premenopausal women. So, yes, there’s a pill (you take it daily) that can potentially provide more desire for sex, more satisfying sexual events, and less stress related to low libido.
• Vyleesi, a melanocortin receptor agonist, is the first and only as-needed treatment for premenopausal women with HSDD. This drug works by balancing excitatory signals (dopamine, melanocortin) and inhibitory signals (serotonin) in the brain that impact sexual desire.
• Osphena is a selective estrogen receptor modulator that acts like estrogen and can improve vaginal tissue and restore vaginal pH. This may help alleviate pain from sex.
• Intrarossa is a non-estrogen vaginal insert approved for moderate to severe painful sex due to menopause. It’s comprised of naturally-occurring DHEA, which the body converts into androgens (sex hormones) and estrogens. It may help ease painful sex caused by vaginal dryness, thinning, and inflammation.

Medication Change

• Your provider should review all current medications to see if any of them could be causing sexual issues as a side effect. If so, she can consider a lower dose or an alternative prescription with fewer risk factors.

Treating Underlying Conditions

• If low libido is related to a pre-existing medical condition, like diabetes, hypertension, or high cholesterol, treatment usually starts with addressing this underlying issue first.

Relationship and Sex Therapy

• Relationship and sex therapists are trained to help people identify problems related to relationships, intimacy, and sex. This kind of talk therapy can address emotional barriers, conflict resolution techniques, relationship dynamics, communication skills, and past traumas that may be affecting libido. Talking openly about feelings, concerns, and needs can alleviate relationship problems, and working together through issues can boost emotional connection and confidence, which are closely linked to sexual interest in women.

Lifestyle Modifications

• Since lifestyle choices almost always plays a part in libido, making lifestyle changes (drinking less alcohol, getting more exercise, improving sleep quality) can sometimes improve sexual problems without other interventions.

Mixing Things Up

• Making time for sex and trying something new (with consent) – using a new sex location, position, or toy; sharing fantasies or porn – can make a difference for some couples and help re-build excitement around the experience of sex.

Conclusion

Managing low libido is often about understanding the whole picture; about addressing physical, mental, sexual, and relationship health but also paying attention to lifestyle choices and having self-awareness when it comes to communication. During the journey to explore causes and treatments for low libido, it’s important to practice self-care and patience.

There’s another important topic worth mentioning too: Sometimes low libido is more about differences in desire than low desire. Mismatched desire is a buzzword that’s having a moment, and it’s one of the leading reasons couples find themselves on a couch talking to a therapist about their sex and relationship struggles.

It turns out, there are two types of sexual desire – spontaneous desire and responsive desire. Spontaneous desire is the sudden ‘spark’ or anticipation of sexual pleasure that arrives seemingly out of nowhere. Responsive desire is more passive and involves being open to exploring sexual pleasure.

Men tend to experience and express spontaneous desire more often while women usually experience responsive desire more often.

Many professional sex experts are speaking out about mismatched levels of sexual desire and their findings that responsive desire seems to be associated with better sex and sexual satisfaction in the long run.

Most sex therapists focus more on pleasure and less on the path taken to get there. It turns out, finding passion doesn’t matter as much as you might think when it comes to finding a fix for lack of sexual desire.

It’s not really about keeping the spark alive. It’s more about stoking the campfire and the slow-burning emotional embers that can spark to life with a little love, attention, awareness, practice, and patience.