Low sex drive is the most common sexual complaint among women. Anywhere from 6 to 21 percent of women experience it at some time in their lives, according to a report in American Family Physician (AFP). When a woman’s sexual desire is low, it can negatively impact her life, causing problems with relationships, self-esteem, and overall life satisfaction.
What is female sexual interest/arousal disorder?
The official name, female sexual interest/arousal disorder, came about in 2013 when the Diagnostic and Statistical Manual, Fifth Edition (DSM-V); was released. Prior to this update, two disorders were recognized – hypoactive sexual desire disorder and female sexual arousal disorder. To distinguish between male and female sexual disorder, the name was changed. Hypoactive sexual desire disorder now applies mainly to men, and the female disorder includes problems with both desire and arousal.
According to the DSM-V, there are six symptoms of female sexual interest/arousal disorder:
- Absent/reduced interest in sexual activity
- Absent/reduced sexual/erotic thoughts or fantasies
- No/reduced initiation of sexual activity, and typically unreceptive to partner’s attempts to initiate
- Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all sexual encounters
- Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
- Absent/reduced genital or non-genital sensations during sexual activity in almost all or all sexual encounters
For a diagnosis to be made, a woman must have experienced at least three of these symptoms in the past six months and must experience significant distress because of those symptoms. Diagnosis is usually based on a physical examination and a discussion of sexual history and satisfaction.
Many people see low sexual desire as a result of growing older. It is true that women who have gone through menopause often have less sexual desire than before because of a decrease in estrogen. But there are other causes as well, according to the same report in AFP:
- Chronic illnesses such as diabetes, neurological diseases, and vascular disease can interfere with sexual function.
- Hormonal problems, although most often associated with menopause, can also occur in younger women.
- Psychological and emotional distress are often associated with sexual dysfunction. Low self-esteem, a negative body image, past sexual abuse, or emotional neglect can all impact a woman’s ability to have a satisfying sex life.
- Psychological illness can play a part. The most common disorders that are associated with low sexual desire are depression and anxiety.
- Psychological medications, particularly SSRIs, can lower sexual desire. The AFP report indicates that 30-70 percent of people taking these medications for depression or anxiety report some degree of decreased sexual drive.
- Relationship issues can also lead to low sexual desire. Women unsatisfied with their relationship may find they do not want to engage in sex, which tends to make matters worse.
- Life stressors can also interfere with sexual desire. The hectic pace of life, financial worries, problems with children, or life-stage stressors, such as children moving away or retirement, can reduce your desire.
- Cultural and religious messages could result in the belief that women should not enjoy or initiate sex. For years, sexual desires may have been repressed because of the belief that they reflected low moral character.
Treatment often targets the causes rather than the symptoms. If there is an underlying medical condition, treatment should prioritize treating that condition, which can help to restore sexual desire. If the decrease in sexual desire is a side effect of medication, it is important to talk to your doctor, who can work with you to adjust your dosage or try a different type of medication. For those dealing with stress or trauma, counseling can help provide ways to better cope with difficult situations. Couples counseling may help if a lack of sexual desire is the result of relationship issues.
A few symptomatic treatments are also available. Some women see improvement when given small doses of estrogen in a vaginal cream or vaginal suppository designed to increase blood flow to the vagina.
In 2015, flibanserin (Addyi) became the first medication approved by the FDA for treating low sexual desire in premenopausal women. There is some concern about this medication. Side effects include low blood pressure, nausea, drowsiness, dizziness, and liver problems. It also comes with a warning to avoid drinking alcohol or taking certain medications, including some over-the-counter drugs or herbal supplements, while on flibanserin. This can be difficult because it takes weeks or even months to see any benefit. A 2016 study published in JAMA Internal Medicine found only modest improvements in sexual desire. After reviewing eight studies, the researchers found that the drug led to “one-half of an additional sexually satisfying encounter per month.”
If you are concerned about your level of sexual desire, bring up the topic with your doctor. It may feel uncomfortable, but there are likely things you can do to help.
Updated on: August 22, 2017