For the typical woman, low libido — or a decreased interest in sex — is not a topic of everyday conversation. But maybe it should be?
For many women, consistency in the sexual desire department is, well, inconsistent,according to Stacy Tessler Lindau, MD, MA, a tenured professor of obstetrics and gynecology and medicine-geriatrics at the University of Chicago Medicine and the director and principal investigator at WomanLab, a website that “spreads truths” about female sexual function.
Libido commonly fluctuates, increasing during ovulation and, for some of us, during pregnancy, only to drop at less-fertile times of the month and then, for many, when we reach peri-menopause and beyond, says Dr. Lindau.
A WomanLab blog post about libido shares that 1 in 3 adult women reports having low libido, making it a fairly common occurrence. The post also says that if low libido does not cause you stress, it’s not a problem. “You do not have sexual dysfunction,” the post says. That’s reassuring.
“Female sexual function is a normal and important part of overall health. Women across all age groups, even women in their 80s and 90s without a partner, say that they value their sexual function and feel the topic of sex is relevant to their health,” says Dr. Lindau.
For the sake of increasing awareness and knowledge about our bodies — and the bodies of our wives, daughters and other female loved ones — here are four things to know about low libido, with wisdom from Dr. Lindau.
1. Many factors contribute to low libido
Much like the color of our eyes, our sexual appetites are highly individual. “Knowing what’s normal for you is an important barometer for your sexual function and overall health,” Dr. Lindau says, adding that when a woman feels distressed by a low, decreased or absent desire for sex, this can be detrimental to overall health and well-being — especially if it causes feelings of worry, frustration, guilt, low self-esteem or grief. “A distressing change in libido may indicate an underlying health or relationship condition and should be investigated,” she adds.
“These conditions warrant care and attention. Women and the clinicians caring for women need to take a thoughtful, holistic, caring approach and lasting solutions often take time to implement,” she says.
In addition to low libido in relation to ovulation, pregnancy or menopause, women can feel a lack of desire when stressed. “Libido is commonly decreased in times of emotional or psychological stress, physical illness and when sleep is poor,” says Dr. Lindau. Pain related to sex can also trigger the brain to want to avoid sex as a protective mechanism, she says.
2. Low libido can be complex
Referring to the brain as an important sex organ, Dr. Lindau says that it’s possible for a woman with low libido to have sexual thoughts and a cognitive desire to have sex with her partner but her body just isn’t on the same page. Or, she may have no spontaneous sexual thoughts or feelings.
“Oftentimes, women with low libido in a loving relationship say they are able to get turned on by their partner, especially if the partner has strong libido, and they are able to become aroused and experience sexual pleasure. Other times, low libido comes along with difficulty with arousal, difficulty with orgasm and even pain,” she says.
3. Tips for seeking help
If your libido isn’t where you’d like it to be, or anything about your own sexual function is causing you distress, it’s important to seek help from a physician, psychologist or other therapist. “You should expect a competent, compassionate response,” says Dr. Lindau. “There is plenty of evidence in the mainstream medical and mental health literature to guide treatment of low libido in women. While it has been sorely neglected in the past, this topic is neither fringe nor outside the pale of medical concern.”
You can raise your concerns at a routine visit and then make a specific appointment to return and more fully discuss the topic, even letting the scheduler or nurse know that sexual function is your main concern, suggests Dr. Lindau. “I would not recommend tacking on a concern about low libido to a visit for a UTI or a yeast infection, for example, and expecting a solution then and there,” she says. “Sure, bring it up, but expect that another visit will be needed for a thorough evaluation and treatment plan.
4. There are treatments
Getting to the bottom of low libido sometimes means talking about relationship strains, conflicts or communication about sexual likes and needs — and these can all be addressed with the help of a couples or sex therapist. If pain is a concern, this can be treated by your physician, too.
“Has sleep been really compromised for an extended period because you have a 2 year old and now you are nursing your newborn? Then let’s be reassured that lower libido is expected under these circumstances, optimize your sleep as best you can because it’s good for your overall mood and health, address any vaginal dryness that might come with prolonged nursing and expect libido will improve with time,” says Dr. Lindau.
5. Medications and substance use concerns
A couple of relatively new drugs that are approved by the FDA for treatment of low libido in women “have only been proven effective in pre-menopausal women and only tested in women with rare form of low libido — that is, low libido in the absence of any other condition that is known to contribute to low libido,” says Dr. Lindau, noting that she has not had any patients elect to use these drugs. “I do routinely counsel women about them and I’m a proponent for effective, safe and affordable treatments for female sexual function concerns,” she says.
“Flibanserin (marketed in the U.S. as Addyi) is a pill indicated for pre-menopausal women and it has to be taken every day. Bremelanotide (marketed in the U.S. as Vyleesi) is an injection a woman with low libido gives herself about 40 minutes before she wishes to experience libido,” she explains, adding that few, if any, insurers cover these medicines.
Absolutely worth noting is the fact that some women self-medicate in order to boost receptive feelings for sex. But this choice carries concerns, says Dr. Lindau.
“Some women use alcohol and, increasingly, cannabis-related products to promote libido or otherwise facilitate sex,” she says. “Women and their partners should be aware that any strategy that can cause intoxication diminishes a woman’s capacity for agency over her body and to consent to sex.”
You can learn more about female sexual function (including libido!) at womanlab.org.