Loss of libido is an important quality-of-life issue that affects many women.

Introduction

Female lack of libido is a common and challenging problem in clinical practice. According to the PRESIDE study, 38.7% of women reported they never or rarely feel desire to engage in sexual activity.¹  Low libido may be temporary or persistent depending on the cause. When it persists, management is based on determining which factors are inhibiting desire then eliminating or reducing these factors as much as possible. This may involve education and reassurance, management  of medical issues, as well as sexual, relationship and general lifestyle counselling.  

Primary or secondary?

The first challenge is to establish  whether the low desire is primary (lifelong) where the woman cannot recall ever experiencing much interest in sex or secondary (acquired) where the woman reports being interested in sex in the past but not at present which is far commoner.

Women with primary low libido fall into two groups:  those where interest in sex is innately low and has always been so since puberty. Typically, desire in these women cannot be increased and they should be reassured, educated about the wide range of normal desire in the female population and given advice about how to manage the desire discrepancy that is the usual reason for them to seek help.

The remainder are those whose sexual development has been negatively affected by factors such as a sexually repressive upbringing, family of origin issues or childhood sexual abuse. This group may benefit from psychotherapy to resolve their sexual issues.

Situational loss of desire

A key fact to establish when a woman has secondary loss of libido is whether the problem is total (global) or situational. If the problem is situational the woman will report that, while she has no desire for sex with her partner, she still feels attracted to other men, has erotic thoughts and may desire to masturbate. A woman in this situation does not have a desire problem. Instead she may have a problem with her relationship, with her partner or with their sexual interaction.  Relationship issues include ongoing conflict and unresolved hurts, loss of loving feelings between partners, problems with commitment and fidelity, domestic violence, poor communication or lack of intimacy. She may no longer be attracted to her partner due to his lack of personal hygiene or poor grooming, weight gain or poor sexual technique. He may have a sexual dysfunction such as premature or delayed ejaculation or erectile dysfunction or he may be sexually demanding and insist on sexual activities that the woman does not enjoy. These relationship, partner and sexual issues must be addressed for the woman to re-experience desire for her partner. Intensive sexual and relationship counselling may be necessary.

Total loss of desire

If the problem is total –the woman does not want sex with her partner or others nor does she desire masturbation – a thorough history must be taken to elicit physical, emotional, sexual and lifestyle desire-diminishing factors. These may include:

• depression, stress, grief or dissatisfaction with body image
• fatigue or chronic pain
• health problems (exclude hyper- or hypothyroidism and hyperprolactinaemia)
• desire-diminishing medications (such as SSRI anti-depressants and anti-psychotics),
• co-morbid sexual concerns such as dyspareunia, anorgasmia or dissatisfying sex,
• drug and alcohol abuse.²

There are no approved pharmacological therapies for the treatment of low desire in women. Testosterone therapy in women remains controversial and additional studies are needed before long term use can be recommended.³

Persistent desire discrepancy

Despite efforts to address desire inhibitors, female libido often remains low. In this situation, as long as the relationship is happy and the sexual activity is enjoyable, the couple may need to plan for sex. Many people are resistant to this idea believing that sex should always be spontaneous. Yet without planning and negotiation, for many couples with differing sexual appetites, regular sex may fail to occur. Due to time pressures GPs may not have the resources to work with couples to find a sexual compromise that satisfies both partners.  Advice on suitable books and referral for sexual and relationship counselling may be of benefit to couples with ongoing differences in desire.

The Jean Hailes Foundation for Women’s Health is offering GPs a FREE women’s health DVD for your waiting room Women’s Health experts discuss ‘40s health issues’ including: libido, preventative health measures, hormonal changes & contraception

To view and/or order a copy go to www.jeanhailes.org.au/webcast  or phone 1800 151 441

 The problem of low libido  130.89 Kb

References

1 Schifren J, Monz B, Russo P et al. Sexual problems and distress in United States women: prevalence and correlates. Obstetrics and Gynecology; Volume 112, No. 5, Nov 2008:970-978

2 King R. Where did my libido go? Random House 2010

3 Basson R, Wierman M, Brotto L. Summary of recommendations on Sexual Dysfunctions in Women. Journal of Sexual Medicine.  Jan 2010; Volume 7. Issue 1 pt2: 314-326

Content updated 25 February 2011