Low sex drive in women

Women's levels of sexual desire change over the years. It's common for highs and lows to happen along with the start or end of a relationship. Or they can happen with major life changes such as pregnancy, menopause or illness. Some medicines used for conditions that affect mood also can cause low sex drive in women.

If your lack of interest in sex continues or returns and causes personal distress, talk with your healthcare professional. You may have a treatable condition called sexual interest-arousal disorder.

But you don't have to meet this medical definition to seek help. If you're bothered by a low or reduced sex drive, you can take steps to boost your libido. Lifestyle changes and sexual techniques may put you in the mood more often. Some medicines may offer promise as well.

neither of you may have a sex drive that's outside what's typical for people at your stage in life.

And even if your sex drive is lower than it once was, your relationship may be strong. Bottom line: There is no magic number to define low sex drive. It varies.

Symptoms of low sex drive in women include:

• Having less or no interest in any type of sexual activity, including masturbation.
• Never or only seldom having sexual fantasies or thoughts.
• Being sad or concerned about your lack of sexual activity or fantasies.

When to see a doctor

If you're concerned about your low desire for sex, talk to your gynecologist or other healthcare professional. The answer might be as simple as changing a medicine that you take. Or you may need to get a condition such as high blood pressure or diabetes under tighter control.

Desire for sex is based on a complex mix of many things that affect intimacy. These factors include:

• Physical and emotional well-being.
• Experiences.
• Beliefs.
• Lifestyle.
• Your current relationship.

If you have challenges in any of these areas, it can affect your desire for sex.

Physical causes

A variety of illnesses, physical changes and medicines can cause low sex drive, including:

• Sexual conditions. If you have pain during sex or can't orgasm, it can lower your desire for sex.
• Diseases. Many nonsexual diseases can affect sex drive. These include cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.
• Medicines. Some prescription medicines lower sex drive — especially depression medicines called selective serotonin reuptake inhibitors (SSRIs).
• Lifestyle habits. A glass of wine may put you in the mood, but too much alcohol can affect your sex drive. The same is true of street drugs. Also, smoking decreases blood flow, which may dull arousal.
• Surgery. Any surgery related to your breasts or 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.

Hormone changes

Changes in your hormone levels may alter your desire for sex. This can occur during:

• Menopause. Estrogen levels drop during menopause. This can make you less interested in sex and cause vaginal dryness, leading to painful or uncomfortable sex. Many women still have satisfying sex during menopause and beyond. But some have a lagging libido during this hormone change.
• Pregnancy and breastfeeding. Hormone changes during pregnancy, just after having a baby and during breastfeeding can put a damper on sex drive. Fatigue and changes in body image can affect your sexual desire. So can the pressures of pregnancy or caring for a new baby.

Psychological causes

Your state of mind can affect your sexual desire. Psychological causes of low sex drive include:

• Mental health conditions such as anxiety or depression.
• Stress tied to things such as finances, relationships or work.
• Poor body image.
• Low self-esteem.
• History of physical, emotional or sexual abuse.
• Past negative sexual experiences.

Relationship issues

For many people, emotional closeness is a key to sexual intimacy. So problems in your relationship can be a major factor in low sex drive. Often, less interest in sex is a result of ongoing issues such as:

• Lack of connection with your partner.
• Unresolved conflicts or fights.
• Poor communication of sexual needs and desires.
• Trust issues.
• Concern over your partner's ability to have sex.
• Not enough privacy.

Factors that can raise the risk of low sex drive include:

• Conditions such as diabetes, high blood pressure and coronary artery disease.
• Pain during sex or not being able orgasm.
• Mental health conditions and life circumstances that affect your state of mind.
• Various prescription medicines, including depression medicines called selective serotonin reuptake inhibitors.
• Surgeries related to the breasts or genital tract.
• Changes in hormone levels during menopause, pregnancy or breastfeeding.
• Relationship issues that lessen emotional closeness with your partner.

If low sex desire concerns you, talk with your gynecologist or another member of your healthcare team. For some women, low sex drive is part of an ongoing condition called sexual interest-arousal disorder. It involves having at least three of the following symptoms, which cause sadness or anxiety:

• No desire to have any type of sexual activity or to masturbate.
• Few or no sexual thoughts or fantasies.
• Not wanting to make the first move in a sexual encounter with a partner.
• Less or no pleasure during sexual activity.
• Less or no interest in any sexual or erotic cues from a partner.
• Few or no physical sensations during sexual activity in most sexual encounters.

You don't have to fit this definition to reach out for help. Your healthcare professional can look for reasons that your sex drive isn't as high as you'd like.

During your appointment, your healthcare professional asks you questions about your medical and sexual history. Your health professional also might:

• Do a pelvic exam. This checks for signs of physical changes that sometimes play a role in low sexual desire. These changes can include certain skin diseases of the vulva, thinning of the vaginal tissues, vaginal dryness or pain-triggering spots.
• Recommend testing. Blood tests can check hormone levels. They also can look for thyroid problems, diabetes, high cholesterol and liver disorders.
• Refer you to a specialist. A counselor or sex therapist can help check for 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 medicine and hormone therapy.

Sex education and counseling

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. Your therapist or counselor likely will offer recommendations for reading material or couples' exercises. Couples counseling that addresses relationship issues also may help boost feelings of intimacy and desire.

Medications

Your healthcare professional reviews any medicines you take. The review is done to see if any of the medicines tend to cause sexual side effects. For example, SSRI antidepressants such as paroxetine (Paxil) and fluoxetine (Prozac) may lower sex drive.

If your antidepressant might be the cause of your low sex drive, your healthcare professional may recommend that you:

• Wait to see if your sex drive improves.
• Lower the amount of medicine you take, called the dose.
• Take a break from use of the antidepressant.
• Change your depression treatment.

Switching to a different type of antidepressant may lead to fewer sexual side effects. Your healthcare professional may recommend medicines such as:

• Mirtazapin (Remeron).
• Vilazodone (Viibryd).
• Bupropion (Forfivo XL, Wellbutrin XL, others).
• Vortioxetine (Trintellix).

If you take an SSRI, your healthcare professional might add bupropion to your treatment.

Along with recommending counseling, your healthcare professional may prescribe a medicine to boost your libido. Options for women who have not yet reached menopause include:

• Flibanserin (Addyi). This is a pill that you take once a day at bedtime. Side effects include low blood pressure, drowsiness, dizziness, upset stomach and fatigue. Drinking alcohol can make these side effects worse. So can taking a common medicine to treat vaginal yeast infections, called fluconazole (Diflucan).
• Bremelanotide (Vyleesi). You give yourself this shot just under the skin in the belly or thigh before sexual activity. Some women get an upset stomach after taking the medicine. This is more common after the first shot. This side effect tends to get better with the second shot. Other side effects include vomiting, flushing, headache and a skin reaction at the site of the injection.

In the United States, these medicines aren't approved for use after menopause.

Hormone therapy

Dryness or shrinking of the vagina is one of the hallmark symptoms of genitourinary syndrome of menopause (GSM). This condition might make sex not comfortable and, in turn, reduce your desire. Some hormone medicines that aim to relieve GSM symptoms could help make sex more comfortable. And being more comfortable during sex may boost your desire.

Hormone medicines include:

• Estrogen. Estrogen comes in many forms. These include pills, patches, sprays and gels. Smaller amounts of estrogen are found in vaginal creams and a slow-releasing suppository or ring. Your healthcare professional can help you understand the risks and benefits of each form. Vaginal estrogen used in small doses is unlikely to raise the risk of breast cancer. But estrogen won't improve sexual functioning related to sexual interest-arousal disorder.
• Testosterone. This hormone plays a key role in female sexual function, even though testosterone level is much lower in women than in men. In the United States, testosterone isn't approved by the FDA to treat sexual conditions in women. Still, sometimes it's prescribed to help lift a lagging libido. Testosterone that is delivered to the blood through the skin may be helpful in women after menopause. At first, this treatment can be tried for up to six months. If it helps, it can be continued with close monitoring by a healthcare professional. The use of testosterone in women can cause acne, extra body hair, and mood or personality changes.
• Prasterone (Intrarosa). This vaginal insert delivers the hormone dehydroepiandrosterone directly to the vagina to help ease painful sex. You use this medicine nightly to ease the symptoms of moderate to serious vaginal dryness linked with GSM.
• Ospemifene (Osphena). Taken daily, this pill can help ease painful sex symptoms in women with moderate to serious GSM. This medicine isn't approved for women who've had breast cancer or who have a high risk of breast cancer.

Healthy lifestyle changes can make a big difference in your desire for sex:

• Exercise. Regular aerobic exercise and strength training are great for you in general. But they also can increase your stamina, improve your body image, lift your mood and boost your libido.
• Stress less. Finding ways to cope with stress tied to work, money and daily hassles can enhance your sex drive. For instance, you could try journaling or meditation.
• Talk with your partner. Couples who learn to talk in an open, honest way often keep up a stronger emotional connection. And that can lead to better sex. Talking about sex also is important. Sharing your likes and dislikes can set the stage for more intimacy.
• Set aside time for intimacy. Schedule sex into your calendar. It may seem contrived and boring. But making the extra effort to be intimate 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 new ideas, sex toys and fantasy can help spark your sexual desire.
• Try vaginal lubricants and moisturizers. If you have genitourinary syndrome of menopause, these products may ease certain symptoms, such as vaginal dryness. With regular use, they might work about as well as estrogen therapy.
• Be aware of your habits. Smoking, using illegal drugs and drinking too much alcohol can dampen your sex drive. Stopping these habits may help give your sex drive a boost. It can improve your overall health too.

Talking about low sex drive with a healthcare professional can be hard for some people. So some people decide to try herbal supplements available without a prescription. But these products aren't regulated. And often, they aren't well studied. Herbal supplements can have side effects or change how other medicines work. Always talk with a healthcare professional before using them.

One herbal supplement blend is called Avlimil. This product has estrogen-like effects on the body. While estrogen may boost your sex drive, it also may fuel the growth of certain breast cancers.

Another product called Zestra is a plant-based massage oil. It's applied to the clitoris, labia and vagina. One small study found that Zestra increased arousal and pleasure when compared with a placebo oil. But some participants in the study said they had mild burning in the genital area.

Low sex drive can be challenging 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 used to be.

At the same time, low sex drive can make your partner feel rejected. That can lead to conflicts and strife. And this type of relationship stress can lessen the desire for sex even more.

It may help to remember that changes in sex drive are typical. They're 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 be the best foreplay.

Primary healthcare professionals and gynecologists often ask about sex and intimacy as part of a routine medical visit. Take this chance to talk about your sexual concerns.

If your healthcare professional doesn't mention the subject, you can bring it up. You might feel embarrassed to talk about sex with your healthcare professional. But this topic is perfectly fine to talk about. In fact, your sexual satisfaction is a vital part of your overall health and well-being.

What you can do

To prepare for this talk with your healthcare professional:

• Take note of any sexual problems you've been having. Include when and how often you usually have these issues.
• Make a list of your key medical information. Include any conditions for which you're being treated. Also note the names of all medicines, vitamins or supplements you take.
• Think about questions to ask your healthcare professional and write them down. Bring along notepaper and a pen or a device you can type on. That way, you can jot down information as your healthcare professional answers your questions.

Some basic questions to ask your healthcare professional 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 material can you recommend?

Questions your doctor may ask

Your healthcare professional asks questions about your symptoms and checks your hormone levels. Questions your healthcare professional may ask include:

• Has your interest in sex changed? And do you have trouble becoming aroused?
• Do you have vaginal dryness, trouble having an orgasm or any pain during sex?
• How much distress do you feel about your sexual concerns?
• How long have you felt a lack of desire or other symptoms?
• Are you still having menstrual periods?
• Have you ever been treated for cancer?
• Have you had any surgeries of the genitals or reproductive system?