Where Did That Sex Drive Go? A Guide to Low Libido in Women

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Your libido - also known as your "sex drive" - is your overall interest in sex. It varies from person to person and throughout life. It includes your desire to have sex, your sexual thoughts and fantasies, and what sex means to you personally.

It's normal for libido to change over time. After all, sex drive is affected by many different things - like life events, hormones, your mental and physical health, and the medications you take. And it's no secret that relationships and past experiences play a role, too.

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What does it mean to have a low libido?

A low libido means that you're less interested in sex - or maybe not interested at all.

Here are some things you might notice if your sex drive is low:

• You have little to no interest in any type of sexual activity, including masturbation.

• You don't have very many sexual thoughts or erotic fantasies.

• You have difficulty initiating sex.

• You don't get a lot of pleasure out of having sex.

Not being interested in sex (asexual) can be totally normal. But, for many people, sexual intimacy is an enjoyable part of life - and it can be startling and upsetting to have your sex drive dip or completely disappear.

Is libido the same as sexual arousal?

No. Libido and sexual arousal are connected, but they're different:

• Sexual arousal is what happens physically to your body when it is stimulated sexually. It's what people call "feeling turned on." During sexual arousal, physical changes take place in your body. Your genitals start to swell, get lubricated, and become more sensitive to touch and stimulation. Sometimes this can lead to orgasm.

• Libido is your desire to have sex, either with yourself or a partner. Libido also includes your thoughts and fantasies about sex.

When you're interested in sex (libido), and able to also get physically turned on (arousal), that's often a good recipe for pleasurable sex. But it's possible to feel sexually aroused and not desire sex. Likewise, you can want sex but not be able to become physically aroused.

How common is low libido in women?

Low libido in women is very common. Studies have shown that about 1 in 3 women in the U.S. experience a low sex drive at some point in their lives.

Low libido is especially common during perimenopause and menopause. But hormonal changes at other times of life can also cause a low sex drive, as can medications, relationship conflicts, work-related stress, and more.

Let's take a closer look at some of the causes of low libido in women.

Common causes of low libido in women

There are many possible causes of low libido in women, including:

• Medications

• Birth control

• Changes in hormones that happen after pregnancy and in menopause

• Pain with intercourse and/or having a pelvic floor dysfunction

• Psychological and mental health issues

• Work or personal stress

• Relationship issues

Antidepressant medications

When it comes to low sex drive - and other sexual side effects - antidepressants are an especially common culprit. This includes different types of antidepressants, such as:

• Selective serotonin reuptake inhibitors (SSRIs)

• Serotonin and noradrenaline reuptake inhibitors (SNRIs)

• Tricyclic antidepressants (TCAs)

• Monoamine oxidase inhibitors (MAOIs)

Sexual side effects are the least common with bupropion (Wellbutrin). In fact, this antidepressant is sometimes added to other antidepressant medications to help with sexual side effects. Bupropion can also be used on its own to treat low libido (more on this below).

Hormonal birth control

It's not totally clear whether birth control affects your libido. There's some evidence that hormonal birth control - like pills, rings, or patches - seems to lower the amount of sex hormones circulating in the body, such as estrogen, progesterone, and testosterone. It's possible that this could lead to low libido.

But birth control pills don't really seem to affect a woman's sex drive, according to other studies. This may be especially true for:

• Natazia (estradiol valerate / dienogest)

• Vienva (ethinyl estradiol / levonorgestrel)

The truth is, experts just don't know for sure. More research is needed to better understand whether birth control pills can cause low libido.

Other medications that cause low libido

There are many other medications that can lower libido. These include:

• Heart failure medications: Examples include digoxin (Lanoxin), spironolactone (Aldactone), and thiazide diuretics like chlorthalidone (Diuril) and hydrochlorothiazide (Microzide).

• Blood pressure medications: These include clonidine (Catapres), beta blockers, ACE inhibitors, and alpha blockers.

• Antiseizure medications: Examples include phenytoin (Dilantin, Phenytek), and phenobarbital (Luminal).

• Cancer treatments: Low libido is common in women treated with chemotherapy and radiation therapy.

• Opioid pain medications: Oxycontin (Oxycodone) is one example.

• Heartburn medications: Cimetidine (Tagamet) is one example.

Pregnancy and childbirth

It's normal for your hormones to change throughout life. And sometimes hormonal changes can lead to a low libido. One especially common time this happens is after childbirth. The other is during perimenopause and menopause (more on that below).

During and after pregnancy, your hormones go through big shifts. Many people notice that their sex drive is lower during pregnancy or the first couple months after a child is born. This may be due in part to the physical and hormonal changes in your body during these times.

Plus, taking care of a new baby can take a toll physically and emotionally. Being sexually intimate with yourself or your partner might not be a top priority. The good news is that after recovering from pregnancy and delivery, many people find that their sex drive comes back to baseline.

Perimenopause and menopause

During perimenopause and menopause, your body starts making smaller amounts of two sex hormones: estrogen and progesterone. This is linked to many different symptoms, like hot flashes, night sweats, mood changes, vaginal dryness, and - you guessed it - low libido. Changes in your sex drive are also due, in part, to slowly decreasing testosterone levels.

All of these can combine to make you feel less interested in sex. Physical changes in your body can also make sex less pleasurable, or even painful, which can have a major effect on your thoughts and feelings about sex.

Psychological or emotional factors

Your emotional and mental health can affect your sex drive, too. In particular, depression and anxiety are both linked to problems with sexual arousal and desire.

Anxiety and sexual pain can also go hand in hand, and this can make you less interested in having sex. For example, sexual pain is 10 times more common in women who have been diagnosed with an anxiety disorder. Part of this is due to tightening of the pelvic floor muscles. Pain with sex can make you less interested in having sex. It can also be hard on your self-image, sexual self-confidence, and relationships - all of which can influence your sex drive even more.

Stress

Everyday stress can affect your libido, whether it is work, personal, or financial stress. This is especially true if you have ongoing (chronic) stress in your life.

When you're stressed, your body switches over into "fight-or-flight" mode. This means that you make more stress hormones, like epinephrine and cortisol, which may be linked to a lower libido. Chronic stress can also take a mental toll - and leave you feeling even less interested in sex.

When to talk to your healthcare provider about low libido

If you're troubled by your low libido, talking to a healthcare provider can be a great next step. This could be your general practitioner, your gynecologist, or another provider you feel comfortable with. They may be able to help figure out what's causing your lowered sex drive and suggest potential treatments.

In addition to talking to you about your symptoms and your medical history, your provider might recommend other tests or exams that can help guide treatment. These include:

• A full physical exam

• A pelvic exam

• Blood tests

Some healthcare providers use a questionnaire called the Decreased Sexual Desire Screener (DSDS) to better understand your symptoms. The DSDS is a simple test that includes questions such as:

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

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

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

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

This test can help you and your provider figure out whether low libido is a problem for you. It can also help you track changes over time to see if your libido is increasing or decreasing.

And remember: Though many people feel shy or embarrassed to talk about sex with their healthcare provider, it's an important part of your overall health. Sexual issues are very common, and it's likely that your provider has dealt with your particular symptoms or situation before. Despite that, most providers will not ask you about sexual issues as part of your general exam. So it may be up to you to start the conversation.

What is female sexual interest/arousal disorder (FSIAD)?

Most people use the term "low libido" to talk about low sex drive. And, as we mentioned above, having a low libido isn't always a problem.

But, if your low libido has lasted for more than 6 months and it's making you feel down or distressed, it's possible that you could have a sexual health condition called female sexual interest/arousal disorder (FSIAD).

People with FSIAD have a low sex drive and trouble getting physically aroused. To be diagnosed with FSIAD, at least three of the following must apply to you:

• You have little to no interest in sexual activity.

• You have very few - or no - sexual thoughts or fantasies.

• You're not interested in initiating sex, or you're not very responsive when your partner attempts to initiate sex.

• Sex isn't very exciting or pleasurable for you at least 3 out of 4 times.

• It's hard for you to get interested in or aroused by sexual or erotic cues.

• You don't have a lot of "feel-good" sensations in your genitals or other parts of your body at least 3 out of 4 times when you have sex.

To be diagnosed with FSIAD, your symptoms also can't be caused by:

• Another mental health condition

• Severe relationship distress, such as intimate partner violence or other major stressors

• Substance use or medication

• A medical condition

What is hypoactive sexual desire disorder?

Hypoactive sexual desire disorder (HSDD) is an outdated term for FSAID. It's an older diagnosis from the DSM-4 - a clinical guidebook - that was combined with female sexual arousal disorder (FSAD) to become FSAID when the newer DSM-5 came out in 2013.

Treating low libido in women

Sex drive is complex. There's no single treatment that fits everyone. Nor does everyone with a low libido need or want treatment. Remember that low libido is only a problem if it's causing you distress.

That said, there are many things that can help with low libido. Let's look at some options.

Identifying an underlying cause

A lot of times, the best treatment for low libido starts with finding the underlying cause - and making changes if you can. For example, this could mean:

• Stopping a prescription medication that's causing low libido

• Treating a mental health problem that's affecting libido, such as depression or anxiety

• Addressing ongoing stress at work, home, or in your relationships

Therapy

Therapy can also help with low libido, both on your own or with a partner. And many types of therapy can also help with mental health problems that can affect your sex life too, like depression and anxiety.

Options for treating low libido include:

• Individual psychotherapy

• Couples therapy

• Sex therapy

Lifestyle changes

Lifestyle changes can also go a long way toward helping to increase your libido - especially changes that help you to feel more rested, less stressed, and more focused on your sexuality.

Here are some evidence-based ideas to consider:

• Eat nutritious foods, like those featured in the Mediterranean diet.

• Try to reduce stress by exercising or practicing mindfulness or yoga.

• Set aside time for intimacy with your partner. You may even think of creative ways to add variety to your relationship, such as planning a date night, taking a trip together, or exploring a new hobby together.

• Read books about sex, either for educational reasons or for erotic enjoyment.

• Visit a "sex store" that sells items designed to increase interest in sex.

• Create a space in your home that feels safe and private, where you can engage in sexual activities.

Medications

When it comes to treatment options, some women also benefit from prescription medications. In general they're only used if low libido is still a problem after trying the other approaches listed above.

Medication options for low libido include:

• Hormone therapy: This might include testosterone, estrogen, and/or progesterone. Though these treatments are not FDA approved for low libido in women, they can be helpful in some cases.

• Flibanserin (Addyi): Addyi is a new FDA-approved medication for low libido during premenopause. It's a nonhormonal treatment that affects serotonin, dopamine, and norepinephrine in your brain. But there's not a lot of evidence that Addyi really helps much with libido. And many people have major side effects with this medication - like low blood pressure, dizziness, and fainting.

• Bupropion (Wellbutrin): Bupropion is a good first-choice medication for treating low libido - even though it's an off-label use. Just like Addyi, bupropion affects serotonin, dopamine, and norepinephrine. But bupropion has been around a lot longer (1985), which means researchers know much more about its side effects and long-term safety.

• Bremelanotide (Vyleesi): Vyleesi is another new FDA-approved medication for low libido during premenopause. It works on melanocortin receptors in your brain, though experts don't know exactly how this is connected to sex drive. The two key differences are that Vylessi is an injection, and you only take it as needed before having sex. There hasn't been as much research done on Vylessi compared with older medications like testosterone and bupropion, but it did work better than placebo in clinical trials.

Treating pain during sex

Experiencing pain during sex can have a major effect on your libido. It's a common condition, too, affecting as many as 1 in 5 women in the U.S.

There are many additional treatments that can help with sexual pain - and in turn, help with your libido.

Depending on what's causing pain during sex, treatment options may include:

• Pelvic floor physical therapy

• Vaginal estrogen

• Oral medication, like ospemifene

• A topical numbing medication

• Cognitive behavioral therapy (CBT)

• Sex therapy

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