Help! My Low Libido Is Ruining My Relationship

Look, it's not unusual for couples to hit a plateau in their sex lives. More often than not, women deal with a lower libido, or sex drive, than men. A low libido can present as a lack of interest in sex, difficulty in finding pleasure from sex, and an absence of sexual thoughts or fantasies. We get how distressing this can be for both partners' sexual well-being and could even put the relationship at risk if it can't be resolved.

The good news is that identifying what's causing your low libido can lead to effective treatment options.

Read on to learn more about understanding the causes of your low sex drive, symptoms, and options you can try to boost your libido.

Signs & Symptoms of a Low Libido in Women

The medical term for low sex drive and lack of interest in sex is hypoactive sexual desire disorder (HSDD), though there is some debate as to whether or not a woman's lack of sex drive should be viewed as a disorder.

Some of the symptoms of HSDD include:

• Difficulty obtaining pleasure from sex or genital stimulation
• Disinterest in initiating sex 
• Lack of interest in sexual activity 
• Non-existent sexual thoughts or fantasies

Diagnosing a Low Sex Libido in Women

Research has found that the female sex drive differs from that of men and that women naturally have lower libidos and think about sex less often than men.

Diagnosing Hypoactive Sexual Desire Disorder (HSDD)

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), to be diagnosed with HSDD, the lack of desire must cause someone significant distress and negatively affect their relationships or self-esteem, for six months or more.

It is important to note that some fluctuations in sexual desire are natural and healthy. Many other factors can reduce sexual desire that wouldn't qualify as HSDD.

To rule out HSDD, work with your doctor to identify any potential causes and treatment options. Since there are no specific medical tests that can diagnose HSDD, your doctor will want to know about your symptoms to understand more about how your low sex drive is impacting your relationships and life.

What Causes Women to Have a Low Libido?

Low sex drive in women has many potential causes, including:

• Perimenopause/menopause
• Aging
• Underlying medical issues (e.g., cancer, bladder/bowel issues)
• Emotional or psychological challenges
• Stress
• Anxiety
• Certain medications
• Relationship issues (i.e. lack of emotional connection or satisfaction)
• Sexual trauma
• Previous negative sexual experiences

Medical Factors

Sometimes, an underlying medical condition may be behind low sex drive. The following conditions and medications can potentially lower sex drive:

• Antidepressants
• Being overweight or obese
• Blood pressure medications
• Chronic health conditions such as diabetes, hypothyroidism, arthritis, anemia, cardiovascular disease, or endocrine or neurological disorders
• Chronic or physical pain, which may be associated with a medical condition
• Conditions, such as vulvodynia, that make sex painful
• Depression and anxiety disorders
• Diminished blood flow to the vagina and uterus
• Hormone deficiency, hormonal fluctuations, or low levels of testosterone
• Incontinence
• Injury to blood vessels or nerves after a hysterectomy or other surgery involving the reproductive organs
• Menopause, pregnancy, or breastfeeding

In cases where medications, such as antidepressants, cause a lowered sex drive, your doctor may suggest a prescription with fewer side effects. Do not stop taking your medications without your doctor’s approval.

Personal Factors

Daily life stressors can also have an impact on your sex drive.

Pregnancy

Many women, for example, have a lower desire for sex during and after pregnancy due to being extremely busy and fatigued or focusing more on their children than sexual intimacy.

If your body has changed over time or after giving birth, this can also impact feelings of sexual desire and desirability.

Stress

Work stress can negatively affect your sex drive as well, especially when having to care for a family. By the end of the day, sleep becomes the priority, not sex.

And if you are dealing with your stress by smoking and drinking more alcohol than usual or using other substances—prescription or otherwise—your sex drive will likely suffer as a result.

Relationship-Based Factors

One of the strongest factors impacting a woman's drive is the quality of her relationship and emotional connection to her sexual partner.

Problems that may interfere with your sex life include:

• Desire to punish or control your partner by withholding sex
• Infidelity
• Long-standing unresolved relationship issues and resentment
• Power imbalances in the relationship

Treatment of Low Libido in Women

Once you have identified the issues contributing to your low sex drive, you can begin treatment. The following two columns provide the types of interventions your doctor may recommend or prescribe to increase your sex drive.

Therapy and Lifestyle Changes

If the problems are identified to be stress- or relationship-based, there are several approaches that may help. Your doctor may suggest individual and/or couples counseling to devise a plan (ideally with your partner involved in the process) to address and tend to any issues that may be affecting your relationship.

This is where it's vital that you and your partner work as a team with a therapist to resolve any potential issues. A therapist can help teach you how to better communicate with your partner and suggest sexual techniques right for your relationship to create a more pleasurable experience.

Lifestyle changes you can make include:

• Exercising regularly
• Using mindfulness-based interventions
• Avoiding tobacco and alcohol
• Setting aside time for intimacy (communication, non-sexual touch like a back rub or massage) or sexual experimentation (using sex toys, sharing fantasies, or role-playing)

Medical Interventions

A low sex drive can also be treated with medications; unfortunately, medical interventions for women have not been as successful as those for men.

Estrogen Therapy

Due to reduced blood flow to the vagina, many premenopausal and postmenopausal women experience changes in estrogen levels. If low estrogen levels are the cause of your HSDD symptoms, then your doctor may recommend estrogen therapy using a cream, suppository, or ring that releases estrogen in the vagina without the unwanted side effects that come with estrogen pills.

The O-Shot

An injection called the O-Shot, a plasma solution that a medical professional injects into the vagina, also improves blood flow and circulation. The procedure is still new and has not been approved by the Food and Drug Administration (FDA).

Clitoral Therapy

The Eros clitoral therapy device, or Eros-CTD, is a small, hand-held device fitted with a removable, replaceable small plastic cup used to improve blood flow to the clitoris and genitalia using a vacuum system.

The FDA cleared Eros Therapy in April 2000 to treat sexual arousal and orgasmic disorders. The device costs about $400; a prescription is required in the United States.

Addyi

Another treatment option is a pill called Addyi (flibanserin), which is an oral prescription drug that works on brain chemicals to increase desire. However, the drug has potential side effects, including low blood pressure, fainting, and dizziness.

Vyleesi

One of the most recent entries in the treatment arena is Vyleesi (bremelanotide), which the FDA approved for use in premenopausal women in 2019. It's an at-home, self-administered injection used before sexual activity. Vyleesi activates receptors in the brain, but researchers don't know exactly why it works to increase sexual desire.

Keep in Mind

If the root cause is psychological and not medical, low sex drive in women can be used as a starting point to explore what is off, missing, or desired that may be lacking.

This can be a sensitive and vulnerable topic for all parties involved so proceed with gentleness, compassion, curiosity, and care for yourself and each other.