Diagnosis

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.

Treatment

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling and sometimes medication.

Counseling

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.

Medication review

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.

Hormone therapy

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.

Flibanserin (Addyi)

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.

Lifestyle and home remedies

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.

Alternative medicine

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.

Coping and support

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.

Preparing for your appointment

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?
Aug. 28, 2015
References
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