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Low Sex Drive in Women

  • Understanding Loss of Libido and Its Causes

  • Low sex drive in women is not a black and white issue. After all, there is no objective way to measure sexual desire or pleasure, and every woman has to define for herself whether her libido is adequate for her or not.

    In polls, many women over age 40 tend to report their sex drive as being “below average.” In other words, the majority of women older than 40 believe they are in the minority (below the average) and more importantly may believe there is something wrong with them.

    Just as the factors that contribute to each woman’s sexuality are complex and unique so too are the possible causes of low sex drive. Sometimes lowered sex drive is prompted by an underlying condition, but often it’s a normal part of aging. Women nearing menopause stop ovulating. And since ovulation often prompts a surge in sexual interest, women may feel that their libido flatten out as menopause nears. Other physical changes associated with menopause like hot flashes, insomnia, and vaginal dryness can also impact a woman’s desire to have sex.

  • Drugs to Boost Low Sex Drive?

  • There are more than 1.5 million Internet websites that address “female libido,” and most of them are promoting some unproven, untested, non-FDA approved “libido-booster.” But some of these over-the-counter products are possibly unsafe and most are untested. Two medications have been studied as possible therapies for treating low libido in women, although neither has received FDA approval for use in women: Viagra® and testosterone.

    One short-term placebo-controlled study, funded by the manufacturer of Viagra® showed that the drug might be helpful in women for treating the sexual side effects of some anti-depression medications. But other studies looking at Viagra as a libido booster have had disappointing results – for both women and men.

  • Testosterone for Women?

  • The hormone testosterone, however, has received the most interest for treatment of low libido in women; although, there is no evidence that low testosterone levels in otherwise healthy women causes low libido. Women who report a low sex drive are just as likely to have normal testosterone levels as those women who report a high sex drive. In spite of this, testosterone is being promoted both in the medical and non-medical worlds as a treatment for low sex drive in women because medical research has shown that women taking very high (“super-physiologic”) doses of testosterone experience increased sexual desire. Unfortunately, these high doses of testosterone also cause elevated cholesterol levels, male-pattern hair loss, facial hair growth, deepening voice, and acne. (For more on this, see our recent Q&A about testosterone patches for women.)

    Yet when testosterone was given at lower (“normal physiologic”) doses in placebo-controlled studies, there was no improvement in libido except in those women who had had their ovaries surgically removed and were also on estrogen therapy. Then again, the enhanced libido benefit from “placebo” in these studies was almost as great as the benefit from testosterone which highlights the important contribution of psychological factors in improving libido.

    Aside from the lack of success using lower doses of testosterone and the mostly unacceptable side effects of using high doses of testosterone, the major concern with using testosterone in women is that we do not know what the long-term risks of using testosterone might be. These safety concerns are especially significant for women who have a history of breast or uterine cancer, for whom elevated levels of estrogen present genuine risks. Testosterone, after all, is naturally converted to estrogen once it is in the body. In addition, no published medical study evaluating testosterone as therapy for women went on for longer than six months. Because of the limited data to support its efficacy and the absence of data to ensure its long-term safety, the FDA has not approved testosterone products for use in women.

  • Understanding Changes in Sex Drive

  • The bottom line is that libido is influenced by a variety of factors. A woman’s sexuality and libido are not entirely determined by hormones or other physical conditions. As with men, a woman’s sexual desire and pleasure are also strongly influenced by emotional factors such as having a healthy and trusting relationship with a compatible partner.

    Ultimately, women and their doctors should avoid approaching a complaint of “low libido” simply as a medical problem in search of a medical solution. Sometimes the most important thing doctors can do for women who express concerns about low libido is to help them understand the normal and healthy changes in our aging bodies that influence how we feel about sex.

Ask our experts your sexual health question(s).