By Mayo Clinic Staff
A woman's sexual desire naturally fluctuates 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 — also referred to as female sexual interest/arousal 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 sexual desire, 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, also known as desire discrepancy, 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.
Some signs and symptoms that may indicate a low sex drive include a woman who:
- Has no interest in any type of sexual activity, including self-stimulation
- Doesn't have sexual fantasies or thoughts, or only seldom has them
- Is bothered by her lack of sexual activity or fantasies
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.
- Lifestyle habits. 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. And smoking decreases blood flow, which may dampen arousal.
- Surgery. Any surgery, especially one related to your breasts or your genital tract, can affect your body image, sexual function and desire for sex.
- Fatigue. Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a 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. 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 sexual desire. Of course, hormones aren't the only factor affecting intimacy during these times. Fatigue, changes in body image, and the pressures of pregnancy 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
- Previous negative sexual experiences
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 gynecological surgeries?
By definition, you may be diagnosed with hypoactive sexual desire disorder — also called female sexual interest/arousal 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 sexual desire 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. Your doctor may order blood tests to check hormone levels and look 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 sexual desire.
Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling and sometimes medication.
Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sexual desire. Therapy often includes education about sexual response and techniques and recommendations for reading materials or couples' exercises. Couples counseling that addresses relationship issues may also help increase feelings of intimacy and desire.
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) may lower sex drive. Adding or switching to bupropion (Aplenzin, Wellbutrin) — a different type of antidepressant — usually improves sex drive.
Estrogen delivered throughout your whole body (systemic) by pill, patch, spray or gel can have a positive effect on brain function and mood factors that affect sexual response. But systemic estrogen therapy may have risks for certain women.
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.
Originally developed as an antidepressant, Flibanserin (Addyi) is a prescription medication approved by the Food and Drug Administration as a treatment for low sexual desire in premenopausal women.
A daily pill, Addyi may boost sex drive in women who experience low sexual desire and who find the experience distressing. Potentially serious side effects include low blood pressure, dizziness and fainting, particularly if the drug is mixed with alcohol. Experts recommend that you stop taking the drug if you don't notice an improvement in your sex drive after eight weeks.
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. Ask your partner to spend more time on foreplay. If you and your partner are open to experimentation, sex toys and fantasy can help rekindle your sexual sizzle.
- Ditch bad habits. Smoking, illegal drugs and excess alcohol can all dampen sexual desire. Ditching these bad habits may help rev up your sexual desire as well as improve your overall health.
Disclosing low sexual desire to your doctor may be difficult for some women, and some people may turn to over-the-counter herbal supplements instead. But, herbal supplements aren't regulated by the Food and Drug Administration, and in many cases, haven't been well-studied. Because these products can have side effects or interact with other medications you may be taking, it's important to talk with your doctor before using these products.
One product that's a blend of herbal supplements is called Avlimil. This product has estrogen-like effects on the body. And while those effects may help with some sexual difficulties, those same effects may also promote the growth of certain types of breast cancer.
Another product — a botanical massage oil called Zestra — is applied to the clitoris, labia and vagina. One small study found that Zestra increased arousal and pleasure when compared with a placebo oil. The only side effect was mild burning in the genital region. Zestra is not a good option for women with vaginal dryness or sensitive vaginal tissues.
Low sexual desire 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 sexual desire 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 sexual desire 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.
Aug. 28, 2015
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