Women and low libido: Is it stress or hormones? How do you get your sex drive back?
There is “very strong evidence” for increasing sexual desire through cognitive behavioural therapy and mindfulness meditation.
Are there any proven treatments for low libido in women? “Proven” is a strong word – and one that makes scientists squeamish. But it is safe to say that there is “very strong evidence” for increasing sexual desire through certain types of psychological interventions like cognitive behavioural therapy and mindfulness meditation, said Lori Brotto, a psychologist and professor at the University of British Columbia in Vancouver and a renowned expert in women’s sexual health.
When it comes to medications, however, it’s a different story.
In recent years, two new medications for women with low libido have been approved by the US Food and Drug Administration, “though their efficacy is marginally better than a placebo”, said Dr Stacy Tessler Lindau, a gynaecologist at the University of Chicago Medicine and the creator of WomanLab, a website about sexual health.
These drugs, flibanserin (a pill) and bremelanotide (an injection that is self-administered about 40 minutes before sexual activity), were approved for the “very small subset of women” who are premenopausal, have low libidos and do not have any identifiable physical, mental or relationship problems, Dr Lindau said.
“They may have modest benefit, but they also come with side effects and cost,” she added. “So far, insurance coverage has been limited.”
In the end, the most beneficial solution will depend on the reason you are experiencing low libido and why you consider your libido to be a problem.
For older women, loss of oestrogen during menopause is commonly associated with a change in libido because it can cause vaginal dryness and tightness that can make intercourse painful.
Some women also find it more difficult to get aroused. And when menopause is accompanied by hot flashes and night sweats, that can make sex seem less appealing, too.
Untreated conditions like depression and anxiety can also be problematic for libido. However, some medications, including certain antidepressants, have been shown to negatively affect sexual desire, arousal and orgasm. So it’s best to speak to your doctor about all of the available options.
Certain medical procedures may also lower libido, for example, if a woman had her ovaries removed or her oestrogen blocked to treat cancer.
“When possible, replacing oestrogen can be a helpful adjunct to addressing low libido in some women,” Dr Lindau said, as can lubricants, exercise and speaking with a therapist.
The hormone testosterone may also improve sexual function in postmenopausal women, who are distressed by a chronic loss of interest in sex, but there is limited data on its safety and effectiveness.
Oftentimes, problems with libido are not purely physical. Stress is one of the most common reasons a woman’s sex drive plummets, the experts said.
Low libido also can stem from energy and sleep issues, body image, relationship quality, gender inequities and other concerns.
“I would encourage people complaining of low desire and those who hear the complaints to think about all the influences that exist on desire, including and beyond inside bodies,” said Sari van Anders, a professor who studies sexuality and testosterone at Queen’s University in Ontario.
“Desire does not just come from a drive within our bodies; it reflects and responds to all sorts of life and societal situations.”
An journal article written last year by Dr van Anders, Dr Brotto and others suggested that four factors, each influenced by societal expectations of women, contribute to the low sexual desire experienced by women in heterosexual relationships.
They are inequitable divisions of household labour, the tendency for women to take on a caregiver-mother role with their male partners, an emphasis on a woman’s appearance over her own sexual pleasure – which can make her own feelings of desire contingent upon her perceived desirability – and gender norms that influence which partner initiates sex.
For example, women are not typically socialised to initiate sex or prioritise their own pleasure, and they may feel uncomfortable experiencing or initiating pleasure unrelated to penetrative intercourse.
The paper also noted that “low desire” might mean different things to different people. Some people want sex more than others, and it is normal for sexual desire to fluctuate over the years.
The experts suggest asking yourself: Are you dissatisfied with the amount of sex that you crave? If so, why?
“Low erotic desire is not a problem in and of itself unless and until partners, health professionals, media and/or culture make it into one,” Dr van Anders said.
“A promising way forward is to consider that low desire itself may reflect a problem, for those who aren’t asexual, rather than be a problem in and of itself.”
For example, some women may be concerned not about their own lack of desire but about a mismatch between their libido and a partner’s higher libido.
“If their discrepant desire is creating a problem for the relationship, then a couples sex therapy approach is warranted,” Dr Brotto said.
If therapy is not possible – perhaps you cannot find a therapist with openings or one who is affordable – Dr Brotto suggested having a conversation with your partner.
Discuss planning sex during times when the person with lower desire feels most ready to do so, and increasing the amount of sexual activities that do not involve penetration. These activities may be more likely to provide pleasure to the person who has less desire.
And here’s another thing to keep in mind: Feeling like you’re not in the mood doesn’t necessarily mean that you have less desire or that your level of desire is somehow insufficient. Not everyone experiences desire, then arousal. Some people need to be aroused first to experience desire.
“Libido has historically been equated with spontaneous sexual desire – that feeling of wanting sex that happens out of the blue,” Dr Brotto said.
“It is far less common than responsive desire – the kind of desire that is present after a sexual encounter begins.”
If you tend to feel physical arousal first and mental desire second, don’t just wait for the sudden urge to have sex.
Instead, set aside time to be intimate and prepare to put yourself in the right mind-set to connect physically with your partner.
This might involve taking time out of your day to think about sex, masturbating, listening to a musical playlist that makes you feel sexual or watching a movie that arouses you.
Talk with your partner about the different types of desire (spontaneous versus responsive) and the specific things that help you get in the mood.
That way, your partner will also be thinking about how to help you build feelings of desire rather than just jumping right into it. The more you understand and respond to each other’s needs, the better your sex life will become.
Finally, being mindful – a practice that helps you remember to return to the present when you become distracted – can be especially helpful when you are thinking about sex or engaging in sexual activity.
“Cultivating attention to the present moment is really important for the brain-body connection that gives way to sexual response,” Dr Brotto said.
By Christina Caron © 2022 The New York Times
This article originally appeared in The New York Times.