Hypoactive Sexual Desire Disorder or Low Libido

June 3, 2019

Ashley Fuller, MD, Swedish Gynecology

Many women can suffer from low sexual desire, low libido, or what we call Hypoactive Sexual Desire Disorder (HSDD). What does this mean? Well, by definition it means that for the past 6 months a woman has had less than normal desire for sexual activity with a lack of sexual thoughts and this lack of desire is distressing to her. The second part of this is important because sometimes I have patients that tell me they have little interest in sex and are happy that way. This is not HSDD as this is not distressing to the patient. Many women are very distressed when they feel low desire. In fact, many women are very embarrassed about this and feel like they are broken or not doing something right. It might be hard to talk about or bring up but you are not alone! It is estimated that 1 in 10 women will suffer from this. It is often during transitions in our life like after having a baby or transitioning through menopause, but not always. Getting to the root of the problem can be hard, but there are some great options for treatment out there!

Women’s sex drive is complicated, much more complicated than men’s sex drive. We have different motivations for sex. Sometimes women desire sex to feel close or intimate with their partner. Sometimes women desire sex for eroticism and climax. And sometimes women desire sex for other reasons, to feel better about themselves, to please their partners, or even to relieve stress. Whatever the motivation, all of these create desire and they are all okay. We might have a rough week and come home and just want to be close and intimate with our partners to rekindle that feeling of love. And sometimes we might actually feel horny and excited for pleasure. These are all normal motivators for sex.

Another thing that is different about women’s sex drive is that we don’t always have a spontaneous desire for sex. Most women don’t sit at work and have out of the blue desire to go home and have sex with their partners! Some women probably do, and that’s fabulous, but I would bet that most women, especially women in long term relationships don’t, and that’s okay too. We often have responsive desire. This is the idea that in the right situation if your partner rubs your arm a certain way, or gives you a look, or kisses you in a certain way, you could become aroused and THEN have desire to engage in sexual activity. This is still desire. It might not look like what you thought it would look like, but this is still normal desire.

As we go through life, our brain interprets everything we see, hear, smell, touch and there is a sexual center in the brain that decides if this is something that should get us excited or something that should inhibit our sexual excitement. Some people call this the accelerator and the brake or our “yes’s and no’s.” As the sexual center of our brain scans our environment it is constantly deciding whether to use the accelerator or the brake. The brake is responsible for keeping us from getting sexually excited while having dinner with our in-laws. Our accelerator is what gives us the go for sexual excitement. All of us have different levels of these. In general men have a more sensitive accelerator, and in general women have a more sensitive brake. A sensitive brake can definitely be part of having low desire. Things that can contribute to the brake are small children at home, stress, relationship issues, and exhaustion. Sometimes it can be helpful to think of all the things in your relationship that hit the accelerator. Maybe it’s a certain song, a favorite restaurant and quiet dinner, or even the smell of your partner when they get out of the shower. The basic idea is that we want to eliminate the things that cause you to hit the brakes and optimize the things that make you hit the accelerator.

When women come to see me with low desire, the reason for her low desire can be complex and hard to pinpoint. I usually ask a lot of questions trying to get at possible things that can be contributing to the problem. The answers to these questions often help me formulate the right treatment for her. Sometimes a woman is taking medications like antidepressants that can contribute to low sex drive. Sometimes women can be in an abusive or rocky relationship making desire difficult. I’ve had patients that have recently been given a new medical diagnosis of a chronic disease or cancer. Sometimes their partners have gotten the diagnosis and are going through sexual problems. Either way, these things can be very detrimental to sex drive. Commonly when women are going through hormonal transitions like menopause or recent childbirth, they can be having pain with sex, which obviously decreases desire. This is something that would have to be alleviated before I would expect the woman to want to have sex. We generally don’t want to do things that are going to be painful to us! We have to fix the pain before desire will be present. Luckily, there are a lot of good options to help women with sexual pain.

The good news is that there are definitely ways to help women increase their desire. The right treatment plan for the patient is very individualized and takes some time to determine. Some couples will greatly benefit from sex therapy. Being able to talk through things that led to low desire and making a plan to reconnect the couple can be very helpful and I’ve seen patients really succeed through this route. Sometimes the right answer is a medication. It’s exciting that there is now an FDA approved medication for the treatment of HSDD in premenopausal women. Sometimes hormonal treatment is the best option for the patient through either hormone replacement therapy or testosterone. There are more drugs in the pipeline so I’m very hopeful there will soon be a bigger arsenal of medications to help women solve this problem. The best option is specific to the patient and her specific needs and goals.

Although formal treatment options due exist, here are some things you can try at home to increase your sex drive:

Exercise. Getting into a good exercise regimen can boost your mood and your body image, while decreasing stress and anxiety. All of these can also increase your desire.
Communication. Work on good communication with your partner because open and honest communication can lead to a stronger emotional connection and better sex.
Stress less. Work on ways to decrease your stress level through exercise, mediation, massage and hopefully increase your sex drive.
Schedule it. It might not sound fun to have to schedule sex, but we schedule everything else in life right? Put it on your calendar. You don’t have to put pressure on yourself to have sex, but instead schedule time for intimacy, and see what happens…
Kick the habit. Alcohol, drugs, and smoking can have a negative impact on your sex life. Ditching the bad habits can improve your health and increase your sex drive
Spice it up. Try something new or somewhere new. Try a new position. Spice it up with sex toys or fantasy if you and your partner are open to it.

If you feel you are suffering from low sex drive or HSDD, please call and make an appointment to talk to your provider. There are options out there for treatment! Low desire can put a lot of pressure and negative feelings into a relationship. So if you are feeling this way, please talk to your provider.

Ashley Fuller, MD, is a Swedish gynecologist. Dr. Fuller has a special interest in women’s sexual health, and her goal as a physician is to partner with women to help them decide on a course of action that will help them achieve their health and wellness goals.