A recent survey of American women (ages 18-59) found that the most common sexual problem in women is hypoactive sexual desire disorder (HSDD), more commonly referred to as low sex drive or libido (33.4%), followed by difficulty with orgasm (24.1%). Pain during intercourse–which occurs in 14.4% of women–was the only condition to show a relationship to age — it decreases as women get older. HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity, as defined by the American Psychiatric Association (APA). The definition is vague because the APA acknowledges that there can be significant differences in sexual interest levels among women. According to the survey mentioned above, 37% of women think about sex a few times a month and only 33% think about sex 2-3 times a week or more. Happier women seem to think about sex more often than unhappy women. The Difficulty with orgasm, or female orgasmic disorder, is a persistent delay or absence of orgasm. This definition is also from the APA and it again attempts to allow for individual variation by not giving a specific number or percentage to define a “normal” amount of orgasms. The survey states that 29% of women say they always have orgasms during sex and 40% say they are physically satisfied with their partners. There are wide variations in sexual functioning, and there is no gold-standard that women should feel they must meet for their sexual functioning to be considered ‘normal.’ If a woman experiences a sexual problem that troubles her, then it is a problem that needs to be addressed and she should be encouraged to talk to her doctor about it to see how it can be improved.
Low sex drive can be caused by a range of factors, which vary from one individual to the next. Fatigue, the daily responsibilities and multiple roles women often assume, and many possible psychological causes can impact a woman’s sexual appetite. It is also known that certain health conditions and medications can affect a woman’s sexual desire. Depression and anxiety disorders can interfere with sexual desire, but so can some of the drugs used to treat these conditions. Many antidepressants, in particular, Selective Serotonin Reuptake Inhibitors, also called SSRIs (e.g., Prozac, Paxil, Zoloft), have side effects that have a negative impact on women’s libidos. Wellbutrin SR is a possible alternative, as it does not seem to cause sexual problems. Serzone, Remeron and, Luvox may not cause problems with sexual desire either. In addition, birth control pills, mood stabilizers, tranquilizers, and other medications have been shown to decrease libido. If you notice a drop in your sexual desire around the time you start a new medication, talk to your doctor to see if there is a connection. Do not stop taking any medication without talking to your doctor first.
In most women who are not experiencing sexual problems, libido and arousal are closely related and difficult to separate. Libido refers to a baseline interest in sex and might be redefined as sexual appetite. Arousal refers to the physiological response to sexual stimuli. Women with higher libidos generally have a greater response to sexual stimuli, or greater arousal. Physical manifestations of sexual arousal include vaginal lubrication and increased blood flow to the labia, clitoris and vagina.
There is great variability in testosterone levels among healthy men so not all will experience the same changes. It is estimated that 30% of men in their 50s will have testosterone levels low enough to be causing symptoms. These symptoms can impact their quality of life and may expose them to other, longer-term risks of low testosterone, like effect on bone, sexual drive and heart.
One of the symptoms of decreased sexual arousal in women is a reduced amount of vaginal lubrication. Over-the-counter vaginal lubricants can augment lubrication. If a decrease in vaginal lubrication has been caused by menopause, hormone replacement therapy can help. This is the only approved drug therapy for this disorder. Viagra (sildenafil) and a class of medications called alpha-adrenergic blockers, such as Regitine (phentolamine), can also increase the vaginal lubrication response to sexual stimulation. However, it should be mentioned that study after study of Viagra for various female sexual problems have not shown an increase in sexual pleasure in women. Aside from pharmacologic solutions, women can also choose behavioral therapy to help increase sexual arousal. Such therapy is aimed at enhancing sexual fantasies and focusing one’s attention on sexual stimuli. For women in on-going relationships, the therapist would also look into the possibility of communication problems in the relationship, or lack of sexual stimulation by the woman’s partner.
At this time, there are no approved drug treatments for low sexual desire. However, a recent study of 66 women, ages 23 to 65, with HSDD for an average of six years, found that Wellbutrin SR may be an effective treatment. Approximately one third of women experienced doubled interest in sexual activity, sexual arousal and sexual fantasies. Although Wellbutrin SR is an antidepressant, the women in this study did not suffer from depression and they did not have relationship difficulties. More studies are needed to support this preliminary data. There have also been studies that indicate that testosterone can increase sexual desire in women who’s low sex drive is a result of the surgical removal of their ovaries. Continual treatment with testosterone does have side effects and may lead to “masculine” side effects in some women (i.e., lower voice, hair loss, enlarged clitoris). Another factor to consider is that for some women, feelings of guilt and shame learned in early childhood may interfere with adult sexual function and may affect one or more phases of the sexual response cycle. In these instances, as well as in cases of sexual abuse, psychotherapy may be beneficial. Marriage counseling or couples therapy can also be of value.