Low sex drive in women

If you feel bothered or distressed due to a lack of sexual thoughts or interest, you may be having hypoactive sexual desire. Hypoactive sexual desire disorder (HSDD), also known as sexual interest/ arousal disorder is a one of the most prevalent female sexual dysfunction that reduces women’s sex drive, causing personal distress or difficulties in a relationship. Many women may dismiss the signs of HSDD as the natural results of aging or physical changes.  

How do I know if I have HSDD? 

While it’s normal and healthy for women to have fluctuating sexual dysfunction, a women with HSDD typically lacks sexual desire for 6 months or longer. HSDD causes an extreme change in sexual desire that affects your relationship or self-esteem. 

Symptoms of HSDD include: 

• Little to no interest in sexual activity 

• Never or seldom having sexual fantasies or thoughts 

• Lack of interest in initiating sex 

• Difficulties enjoying sex 

• Lack of pleasure when the genitals are stimulated 

Factors causing HSDD

There is no specific test to diagnose HSDD. To find out whether you fit the diagnosis, your doctor may ask you whether your low sex drive is affecting your overall health. The first 4 questions of the Decreased Sexual Desire Screener (DSDS) to diagnose HSDD are: 

1. In the past, was your level of sexual desire/interest good and satisfying to you?

2. Has there been a decrease in your level of sexual desire/interest?

3. Are you bothered by your decreased level of sexual desire/interest?

4. Would you like your level of sexual desire/interest to increase?

The doctor will also try to determine the underlying cause of the condition. Causes of HSDD may be psychological, physical or both.

Physical causes associated with HSDD are: 

1. Medical conditions: breast cancer, diabetes, thyroid problems, hormonal changes during or after pregnancy, arthritis, coronary artery disease

2. Hormonal changes: decreased estrogen or testosterone levels

3. Lifestyle causes: fatigue or exhaustion after work, too little sleep, drinking too much alcohol or smoking, eating unhealthy diet 

4. Taking certain medications that affect sex drive (i.e. benzodiazepines, anticonvulsant medications, antidepressants, benign prostatic hyperplasia treatments, hormonal contraceptive, opioid pain relievers, steroid medications, cancer treatments etc) 

Psychological causes of HSDD may include: 

1. Depression, anxiety, low self-esteem, poor body image, history of sexual abuse, 

2. Relationship issues: trust issues with a sexual partner 

Furthermore, your doctor may conduct a pelvic exam to check for any signs of physical changes that might have affected your low sexual desires. A blood test to check your hormone levels and medical conditions including thyroid problems, diabetes, high cholesterol and liver disorders might also be performed. 

Sometimes, there may not be a specific reason for HSDD. But this does not mean that HSDD cannot be treated.

Are there treatments available for HSDD? 

Treatment of HSDD is based on the underlying cause of your symptoms. Your doctors may recommend to either: 

1. Change your medications: Your doctor may either change the dosage of the causative medications or change it to an equivalent or alternative treatment that may not have sexual side effects. For instance, a few antidepressants such as mirtazapine and bupropion do not affect libido very much but can improve it. Remember not to stop taking your medications without consulting your doctor to prevent any uncontrolled medical conditions or side effects. 

2. Change your lifestyle: exercise regularly, set aside time for intimacy, reduce alcohol intake, quit smoking, eating a healthy diet, practice stress relieving techniques (i.e. mindfulness based interventions). 

3. Take supplements: Many herbal aphrodisiacs contain natural ingredients that help with sexual drive, libido and erectile dysfunction when used at the right dose. Examples of herbal products include fenugreek, Tribulus, Eurycoma longifolia (Long Jack), and Panax Ginseng etc. Do discuss with your pharmacists or doctor for further information about the herbal products. 

4. Seek for counseling: Your doctor will suggest counselling or sex therapy to address any mental health or relationship issues.

5. Treating the underlying cause: Estrogen therapy in the form of cream, suppository or ring may be suggested by your doctor if your low estrogen levels are the root cause of HSDD. The FDA- approved drug bremelanotide or Vyleesi may be recommended by the doctor to treat low sex drive in premenopausal women. But not everyone should use the medication as it can cause side effects such as hypotension (low blood pressure), fainting and dizziness. Another treatment option is the pill flibanserin (Addyi) which has been found to increase sex drive in premenopausal women. 

Written by Rosamund, Bpharm(Hons)
Reviewed by Dr. Nur Ariffin, MB BCh BAO

Reference: 

1. Mayo Clinic. Low Sex Drive in Women. Accessed on 13 July 2022. https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/symptoms-causes/syc-20374554 

2. Healthline. Low Sex Drive in Women: Symptoms, Diagnosis, and Treatment. Accessed on 13 July 2022. https://www.healthline.com/health/treating-hsdd/symptoms-diagnosis-treatment#How-do-doctors-diagnose-HSDD?- 

3. American Sexual Health Association. Hypoactive Sexual Desire Disorder. (HSDD). Accessed on 13 July 2022. https://www.ashasexualhealth.org/hypoactive-sexual-desire-disorder/ 

4. Single Care. These medications cause low libido. Accessed on 13 July 2022. https://www.singlecare.com/blog/low-libido-caused-by-medication/

Written by

Rosamund, Bpharm(Hons)