A woman's sexual desires naturally fluctuate over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some antidepressants and anti-seizure medications also can cause low sex drive in women.
If you have a persistent or recurrent lack of interest in sex that causes you personal distress, you may have hypoactive sexual desire disorder.
But you don't have to meet this medical definition to seek help. If you are bothered by a low sex drive or decreased sex drive, there are lifestyle changes and sex techniques that may put you in the mood more often. Some medications may offer promise as well.
If you want to have sex less often than your partner does, neither one of you is necessarily outside the norm for people at your stage in life — although your differences may cause distress. Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line: There is no magic number to define low sex drive. It varies from woman to woman.
When to see a doctor
If you're bothered by your low desire for sex, talk to your doctor. The solution could be as simple as changing the type of antidepressant you take.
A woman's desire for sex is based on a complex interaction of many components affecting intimacy, including physical well-being, emotional well-being, experiences, beliefs, lifestyle and current relationship. If you're experiencing a problem in any of these areas, it can affect your sexual desire.
A wide range of illnesses, physical changes and medications can cause a low sex drive, including:
- Sexual problems. If you experience pain during sex or an inability to orgasm, it can hamper your desire for sex.
- Medical diseases. Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.
- Medications. Many prescription medications — including some antidepressants and anti-seizure medications — are notorious libido killers.
- Alcohol and drugs. A glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive; the same is true of street drugs.
- Surgery. Any surgery related to your breasts or your genital tract can affect your body image, sexual function and desire for sex.
- Fatigue. The exhaustion of caring for aging parents or young children can contribute to low sex drive.
Changes in your hormone levels may alter your desire for sex. This can occur during:
- Menopause. Estrogen levels drop during the transition to menopause. This can cause decreased interest in sex and dryer vaginal tissues, resulting in painful or uncomfortable sex. At the same time, women may also experience a decrease in the hormone testosterone, which boosts sex drive in men and women alike. Although many women continue to have satisfying sex during menopause and beyond, some women experience a lagging libido during this hormonal change.
- Pregnancy and breast-feeding. Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sex drive. Of course, hormones aren't the only factor affecting intimacy during these times. Fatigue, changes in body image and the pressures of carrying — or caring for — a new baby can all contribute to changes in your sexual desire.
Your problems don't have to be physical or biological to be real. There are many psychological causes of low sex drive, including:
- Mental health problems, such as anxiety or depression
- Stress, such as financial stress or work stress
- Poor body image
- Low self-esteem
- History of physical or sexual abuse
For many women, emotional closeness is an essential prelude to sexual intimacy. So problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of ongoing issues, such as:
- Lack of connection with your partner
- Unresolved conflicts or fights
- Poor communication of sexual needs and preferences
- Infidelity or breach of trust
Primary care doctors and gynecologists often ask about sex and intimacy as part of a routine medical visit. Take this opportunity to be candid about your sexual concerns. If your doctor doesn't broach the subject, bring it up. You may feel embarrassed to talk about sex with your doctor, but this topic is perfectly appropriate. In fact, your sexual satisfaction is a vital part of your overall health and well-being.
What you can do
To prepare for this discussion with your doctor:
- Take note of any sexual problems you're experiencing, including when and how often you usually experience them.
- Make a list of your key medical information, including any conditions for which you're being treated, and the names of all medications, vitamins or supplements you're taking.
- Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.
Some basic questions to ask your doctor include:
- What could be causing my problem?
- Will my level of desire ever get back to what it once was?
- What lifestyle changes can I make to improve my situation?
- What treatments are available?
- What books or other reading materials can you recommend?
Questions your doctor may ask
Your doctor will ask questions about the symptoms you're experiencing and assess your hormonal status. Questions your doctor may ask include:
- Do you have any sexual concerns?
- Has your interest in sex changed?
- Do you have trouble becoming aroused?
- Do you experience vaginal dryness?
- Are you able to have an orgasm?
- Do you have any pain or discomfort during sex?
- How much distress do you feel about your sexual concerns?
- How long have you experienced this problem?
- Are you still having menstrual periods?
- Have you ever been treated for cancer?
- Have you had any gynecologic surgeries?
- What medications or vitamin supplements do you take?
By definition, you may be diagnosed with hypoactive sexual desire disorder if you frequently lack sexual thoughts or desire, and the absence of these feelings causes you personal distress. Whether you fit this medical diagnosis or not, your doctor can look for reasons that your sex drive isn't as high as you'd like and find ways to help.
In addition to asking you questions about your medical history, your doctor may also:
- Perform a pelvic exam. During a pelvic exam, your doctor can check for signs of physical changes contributing to low sexual desire, such as thinning of your genital tissues, vaginal dryness or pain-triggering spots.
- Recommend testing. Blood tests may check for evidence of thyroid problems, diabetes, high cholesterol and liver disorders.
- Refer you to a specialist. A specialized counselor or sex therapist may be able to better evaluate emotional and relationship factors that can cause low sex drive.
Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling and sometimes medication.
Your doctor will want to evaluate the medications you're already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as paroxetine (Paxil, Pexeva) and fluoxetine (Prozac, Sarafem) often lower sex drive. Switching to bupropion (Aplenzin, Wellbutrin) — a different variety of antidepressant — usually improves sex drive.
Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sex drive. Therapy often includes education about sexual response and techniques and recommendations for reading materials or couples' exercises.
Estrogen delivered throughout your whole body — by pill, patch or gel — can have a positive effect on brain function and mood factors that affect sexual response. But this systemic estrogen therapy may increase your risk of heart disease and breast cancer.
Smaller doses of estrogen — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire without the risks associated with systemic estrogen. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in women. However, replacing testosterone in women is controversial and it's not approved by the Food and Drug Administration for sexual dysfunction in women. Plus, it can cause acne, excess body hair, and mood or personality changes.
Healthy lifestyle changes can make a big difference in your desire for sex:
- Exercise. Regular aerobic exercise and strength training can increase your stamina, improve your body image, elevate your mood and boost your libido.
- Stress less. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive.
- Communicate with your partner. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex. Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy.
- Set aside time for intimacy. Scheduling sex into your calendar may seem contrived and boring. But making intimacy a priority can help put your sex drive back on track.
- Add a little spice to your sex life. Try a different sexual position, a different time of day or a different location for sex. If you and your partner are open to experimentation, sex toys and fantasy can help rekindle your sexual sizzle.
Low sex drive can be very difficult for you and your partner. It's natural to feel frustrated or sad if you aren't able to be as sexy and romantic as you want — or you used to be. At the same time, low sex drive can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex.
It may help to remember that fluctuations in your sex drive are a normal part of every relationship and every stage of life. Try not to focus all of your attention on sex. Instead, spend some time nurturing yourself and your relationship. Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favorite restaurant. Feeling good about yourself and your partner can actually be the best foreplay.
Jan. 20, 2012
- Shifren JL. Sexual dysfunction in women: Epidemiology, risk factors, and evaluation. http://www.uptodate.com/home/index.html. Accessed Nov. 14, 2011.
- Lenz G. Emotional aspects of gynecology: Sexual function and dysfunction. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed Nov. 14, 2011.
- Giustozzi AA. Sexual dysfunction in women. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-05610-6..C2009-0-38600-6--TOP&isbn=978-0-323-05610-6&about=true&uniqId=230100505-53. Accessed Nov. 14, 2011.
- Clayton AH, et al. Female sexual dysfunction. Psychiatric Clinics of North America. 2010;33:323.
- Biggs WS. Medical human sexuality: Female sexual dysfunction. In: Rakel RE. Textbook of Family Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/191205553-4/0/1481/0.html#. Accessed Nov. 14, 2011.
- Shifren JL. Sexual dysfunction in women: Management. http://www.uptodate.com/home/index.html. Accessed Nov. 14, 2011.
- Bhasin S, et al. Management of low desire and arousal in women. In: Kronenberg HM, et al. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/191205553-3/0/1555/0.html#. Accessed Nov. 14, 2011.