Loss of Sexual Desire in Women

Robert W. Griffith, MD
September 3, 2004

This article is taken, with permission, from the Sexual Dysfunction Association website. The Sexual Dysfunction Association is a UK charitable organization that primarily aims to help sufferers of impotence (erectile dysfunction), and their partners, and to raise awareness of the condition among both the public and health professionals. Robert Griffith, Editor

Causes of reduced sexual desire in women

Disorders of sexual drive and desire are the most common sexual problem, possibly affecting up to 35% of women. Often there may be more than one sexual dysfunction present. Many women with this condition can respond to their partner's sexual approaches and may become sexually aroused and experience orgasm. An absence of desire for sex does not mean that intimacy is unwanted, and not dealing with this problem can cause conflict within the relationship.

Inhibited Desire Disorder is defined as the persistent or recurrent deficiency or absence of sexual fantasies, thoughts and/or desire, or receptivity to sexual activity, which causes personal distress. An attempt to distinguish it from sexual drive disorder is often necessary. Often situations where energy levels are low can affect sexual desire. This is commonly seen as a consequence of a busy job, childcare, depression, stresses in life, and difficulties within the relationship, low thyroid levels, and drug or alcohol misuse.

Sex is safe during pregnancy and intercourse does not harm the fetus, but there may be reduced sexual activity. Once the baby is born there will be a marked change in hormone levels, a time of poor sleep and increased demands from the mother and perhaps also a healing episiotomy scar, all of which affect sexual desire.

Androgen deficiency in women can bring about a global loss of sexual drive and desire, decreased sensitivity to sexual stimulation in the nipples and clitoris, decreased arousability and capacity for orgasm, loss of muscle tone, diminished vital energy, thinning and loss of pubic hair and dry skin. Differential diagnosis of major depression or marked relationship problems is necessary.

Medications such as antihypertensive agents and psychotropic medications (including most antidepressants), indomethacin, digoxin and the oral contraceptive can all affect desire.

Other chronic conditions such as diabetes, multiple sclerosis, arthritis and cardiovascular disease can affect sexual function, both directly through disease processes in the pelvis and psychologically with an effect on body self image and feelings of attractiveness to others.

Conflicts or difficulties within a relationship can often contribute or cause loss of sexual desire and these may need addressing before a couple can begin to focus on the sexual side of the relationship. Loss of sexual desire may also be secondary to another sexual problem in either partner. For example, a postmenopausal woman may experience pain during intercourse with reduced sexual pleasure and secondary reduction in sexual desire. In particular, associated psychological problems within the partner, including depression and substance misuse, can decrease intimacy.

Treatments available

A thorough assessment is necessary to establish the role played by physiological, pharmacological, psychological and relationship elements in the development and maintenance of the desire disorder.

The first part of any management plan should include sharing with the patient that this is a common condition. Education about the sexual response cycle and provision of books and leaflets can be beneficial in making an understanding of the problem possible. Likewise education about pelvic anatomy and physiology can be very helpful.

Encouragement to share the problem with their partner is promoted whenever possible. Likewise, the partner should be helped to understand more about the sexual problem. This can lessen the woman feeling under pressure and guilty, and reduce the chance of the partner feeling rejected and hurt. If there are difficulties within the relationship or there is lack of emotional intimacy, couples therapy may be helpful; it can be available through the practice counselor or specialist clinics or agencies (see links below).

Psychosexual therapists can help re-ignite affection and intimacy through techniques of touching, stroking, relaxation, self-focus work and other training exercises in the privacy of the couple's home. A focus on pleasuring for the woman, both non-sexually and then sexually, is helpful, with a stated aim of increasing sexual intimacy for both partners. Techniques, including sensate focus, can be helpful for some of this experience. Learning distraction techniques can be useful alongside specific relaxation exercises that should be practiced before any sexual activities are attempted. The use of sexual fantasies or daydreams may be helpful by increasing arousal and keeping the mind sexually focused, thus preventing negative and unhelpful thoughts. The change of 'sexual scripts' and alleviating sexual boredom through encouraging the use of erotica, vibrators and change of sexual positions can also be helpful.

Where there are problems with hormone levels or disease states, such as a thyroid disorder, specific treatments will be available from the physician. Where prescription medication is causing the problem, a change in the oral contraceptive or anti-depressant may be necessary. Adjustment of the dosage of medication may be sufficient without having to change the medication itself as long as the condition for which medication is being prescribed is not jeopardized. Estrogen replacement is helpful in some cases of desire disorder and urogenital atrophy associated with arousal disorder. Progesterone is necessary if there is an intact uterus. Tibolone¹ or testosterone therapy may be helpful in post menopause women with loss of desire. Some physicians in the USA have advocated DHEA (50mg daily by mouth) to be beneficial.

Finally, the development of several pharmacological agents may bring additional therapeutic opportunities to women with sexual disorders. Sildenafil (Viagra^®) is still under considerable investigation with conflicting reports of benefit in some women. However successful any future pharmacological agents may be, understanding and assessing the role played by the mind, body and the relationship in the development of sexual desire disorder should not be underestimated and treatment strategies must attempt to integrate these elements.

(Authors: Kevan Wylie MD, Consultant in Sexual Medicine, Sheffield UK, and Angela Gregory, Psychosexual Therapist, Nottingham, UK.)

Source

• Sexual Dysfunction Association website accessed on 07/25/04 at: http://www.impotence.org.uk/index1.htm

Footnotes
1. Tibolone is a steroid compound that combines oestrogenic, progestogenic and androgenic properties that mimic the action of the sex hormones. It is a form of hormone replacement therapy that is not available in the USA.

Related Links
AAMFT: Therapist Locator
American Association of Sex Educators, Counselors, and Therapists
Sexual Dysfunction Association (UK)
It Never Ends: Aging and Sexuality - Part I
Just How Common Are Sex Problems in Women?

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.