What Causes Low Sex Drive?

A low sex drive can stem from physical conditions or psychological problems. In order to find an effective solution, it's important to identify what has triggered it. Causes can include:

• Menopause
• Pregnancy
• Pain during intercourse
• Illness
• Obesity or anorexia
• Drugs and alcohol
• Psychological factors
• Relationship issues
• Sexual abuse

Menopause

Menopause (the time in a woman's life when she no longer has menstrual periods) can have an effect on sexual desire in several ways:

• As a woman ages, it may take longer for her to become sexually aroused, and that arousal may be less intense than it was in her earlier years.
• During menopause, a woman's ovaries stop producing the hormone estrogen. This can lead to vaginal dryness, which can make intercourse uncomfortable.
• Lack of estrogen also can thin the walls of the vagina, leading to soreness during and after intercourse.

Dryness or discomfort can be relieved with hormone replacement therapy, which replaces the estrogen her body no longer is producing, or with the use of a vaginal lubricant, which is available over-the-counter at pharmacies and grocery stores.

For more information about hormone replacement therapy, go to Hormone Replacement Therapy.

Nice To Know:

Men also may experience decreased sex drive later in life. They may have difficulty achieving or maintaining an erection even if the desire is present. Couples need to be aware of each other's changing sexual needs, and should consider different approaches to sexual relations that may not necessarily include intercourse.

It's important to remember that sexuality need not end because of increasing age. For many couples, with a bit of adjustment, a normal healthy sex life can continue as they age.

Nice To Know:

Researchers who conducted a survey in1999 for the AARP, an organization of older adults, found that among women ages 45-74, about 60% said they had sexual relations once a week or more frequently.

The study also showed that health problems played a role when sexual activity declined. About one-third of the women said that if they or their partners were healthier, they would also be more sexually active.

Pregnancy

When a woman is pregnant, her entire body is affected. Changes in hormone levels can affect her physically and emotionally. As a result, her desire for sex may temporarily change.

Nice To Know:

During pregnancy, some women will experience a stronger sex drive. This may be because of the effects of hormones and because an increased blood flow to the vagina makes intercourse more pleasurable. Others find they have no desire for intercourse, either because it is uncomfortable or because they are worried about their unborn baby.

Sexual interest may vary throughout the stages of pregnancy.

• Some women report lowered desire during the first three months, when morning sickness can be unpleasant and even debilitating.
• Many say their desire increased in the second three months (second trimester), as morning sickness diminished.
• Some say their desire decreased again the final trimester, when the abdomen's new bulk made sex awkward or uncomfortable.

How-To Information:

Many women are afraid to have intercourse during pregnancy because they think it will harm the baby. But in most healthy pregnancies, there is no reason to avoid sex. Couples may need to experiment with different positions and techniques for maximum comfort. In rare cases, if there is an increased risk of miscarriage, a woman's doctor may recommend stopping or limiting intercourse until delivery of the baby.

Within weeks after the child is born, most doctors agree that a woman can return to a normal sex life if she feels comfortable. As her body returns to its pre-pregnancy shape, sexual feelings should return as well.

Nice To Know:

Tubal ligation (a sterilization procedure in which a woman's fallopian tubes are closed off so that eggs cannot pass through) or other sterilization procedures should not interfere with sex drive unless the woman or her partner was opposed to the procedure. In fact, many couples report an increase in desire once the worry over using birth control is removed.

Pain During Intercourse

If intercourse is uncomfortable or painful, a woman may tense up in anticipation of pain from sex, or she may avoid sex altogether. Painful intercourse may result from the following:

• Dyspareunia, which is abnormal pain that a woman experiences when her partner's penis enters her vagina. It may result from:
• A lack of estrogen, which is needed for vaginal lubrication
• Pelvic infection
• A tumor or cyst
• Endometriosis, a condition in which tissue from the uterus adheres to other areas throughout a woman's internal pelvic region, causing pain and other symptoms

For further information about endometriosis, go to Endometriosis.

• Vaginismus, which is a spasm of the muscles of the lower vagina and results in painful or even impossible penetration. It can be a psychologically driven condition, related to an extremely distressing past experience such as a rape or sexual abuse.

Vaginismus may also stem from a medical problem, such as an infection or vaginal irritation. If the vaginismus is not caused by an identifiable medical problem, treatment usually involves seeing a psychologist or psychiatrist.

• Vaginal infections, such as a yeast or bacterial infection within the vagina that can irritate its sensitive tissues. Vaginal infections can be easily treated with oral medication or creams that are inserted inside the vagina.

Illness

Sickness frequently decreases desire, whether it's a mild illness such as a head cold or a more chronic or serious illness. When you don't feel well physically, it's often difficult to even think about having intercourse.

Several diseases have been found to directly reduce sex drive:

• Addison's disease, in which the adrenal glands (glands located above the kidneys that produce many of the body's hormones) fail
• Cushing's syndrome, a condition caused by high levels of a hormone called cortisol in the body over a long period of time
• Diseases of the pituitary gland, a gland located near the brain that produces many important hormones

In many cases, it is not the disease itself, but rather the medications used to treat the disease, that reduces a woman's sex drive. This is particularly true of high blood pressure medications and some diuretics.

It's important to report any illness-related changes in sex drive to a physician or therapist.

Other conditions that may affect sexual function include:

• Cancer. Living with cancer can be psychologically and physically distressing. Chemotherapy medication may leave a woman feeling ill and tired, eradicating any sexual appetite. Cancer also may affect a woman's self-esteem and her overall feeling of femininity, especially if she has lost her hair from chemotherapy, her ovaries through a hysterectomy, or her breast through a mastectomy.

Counseling may be an effective way of helping a woman cope with the side effects of her illness. Often group therapy or support groups will provide a woman with reassurance as she meets others who had gone through this painful process and survived.

• Arthritis. Arthritis causes pain and swelling in the joints, which can hamper mobility and make sex a physically painful experience. Some types of arthritis may dry out membranes responsible for vaginal lubrication. If you suffer from arthritis, you may be able to enhance your comfort during sex with these suggestions:
• Try sexual positions that don't put pressure on painful joints
• Use vaginal lubricants to ease dryness
• Apply heat before sex to loosen joints

For more information about arthritis, go to Osteoarthritis.

• Diabetes. Nerve damage associated with diabetes may lead to decreased vaginal lubrication and difficulty in achieving orgasm. Vaginal lubricants may be effective in treating dryness.

For more information about diabetes, go to Diabetes In Adults.

• Kidney Disease. Kidney disease may cause hormonal imbalances and nerve damage, which in turn may affect sex drive. Women with kidney disease also should watch for vaginal infections, which may cause extreme discomfort during sex.
• Spinal Cord Injury. When the spinal cord is injured, there is almost always some loss of sensation to the body, but this doesn't necessarily mean the end of a healthy sex life. A specialist can provide you with instructions on how to use special methods and devices to enable you to continue to enjoy sex even after a spinal cord injury.
• Epilepsy. Epilepsy causes a "short circuit" in the messages sent throughout the brain, and this may include those sent from the nerves that control sexual arousal. Individuals with epilepsy may experience a loss of sex drive and lack of responsiveness. Medication can be very effective in controlling epilepsy.

For more information about epilepsy, go to Epilepsy.

• Thyroid Disorders. Thyroid disorders such as an underactive thyroid gland (hypothyroidism) or an overactive thyroid gland (hyperthyroidism) are marked by changed levels of thyroid hormone in the body. These changes, particularly an abnormally low thyroid level, may decrease sex drive. However, once the condition has been effectively treated, sexual problems usually go away.

For more information about hypothyroidism, go to Hypothyroidism.

For more information about hyperthyroidism, go to Hyperthyroidism.

Obesity Or Anorexia

Women come in all shapes and sizes, and in most cases, weight is irrelevant to sex drive. However, those who are medically obese may:

• Be physically unfit and lethargic, which could result in a lack of physical activity and possibly a lack of sexual interest as well
• Be deficient in certain sex hormones that can influence desire
• Feel less sexually attractive and may therefore avoid intimate contact

On the opposite end of the weight scale, women who suffer from anorexia nervosa or who are severely underweight may also experience a lack of sexual interest, in addition to other serious health problems. An overly thin woman may feel sexually undesirable, and this can affect her sex drive.

For more information about anorexia, go to Anorexia.

Drugs And Alcohol

Many prescription medications may interfere with arousal and the ability to achieve orgasm. These include:

• Antidepressants to treat anxiety or depression
• Antipsychotic drugs to treat severe mental disorders
• Antihypertensive agents to treat high blood pressure

Many people think that alcohol reduces inhibition and therefore is an effective treatment for low sex drive. This is not true. A small amount of alcohol may lower sexual inhibitions when anxiety or tension is the primary cause for low sex drive, but research has proven that alcohol consumption does not improve either sex drive or performance.

Nice To Know:

Many women report that drinking before sex has a "numbing" effect on them and actually results in diminished desire.

Psychological Factors

Stress, fear, and anxiety are all factors that can dampen sexual desire. The demands of juggling work, family and many other daily responsibilities can be overwhelming for many people. Bills may pile up and cause financial worries, and this distress can lead to low sex drive.

Anxiousness and fear over an ability to perform in bed or to satisfy a partner may sometimes lead to "spectatoring," in which individuals are so concerned about monitoring the experience that they are unable to enjoy it.

Emotional-medical issues, such as depression, have also been linked to dampened desire. In addition, many medications that are prescribed to combat depression or anxiety may have a negative impact on sex drive.

Relationship Issues

The quality of a relationship often strongly influences the couple's sexual satisfaction. In many cases, a lack of communication is at the heart of the problem. The problem may lie both inside and outside the bedroom. For example, the woman may feel that her partner is not responsive or listening to her concerns, likes, and dislikes in her daily life. The communication problem may transfer to the bedroom or it may start there.

Nice To Know:

Many women are too shy or embarrassed to discuss their sexual desires and needs frankly with their partner. Yet it is crucial to communicate openly. Bottling up emotions, or failing to tell your partner what pleases you, may lead to sexual frustration and unhappiness, and could even bring your sex life to a grinding halt.

Remember, few men have an innate knowledge of what pleases a woman. But in a healthy relationship, most are willing and eager to learn how to please their partners. Many men may need to be taught where to touch and how to stimulate their partner to the point of arousal.

Sexual Abuse

Sexual abuse is a deeply traumatic experience and may lead to fear and avoidance of sexual experiences later in life. Some women who have been victims of past abuse are afraid to trust a man; others respond to these negative experiences by losing sexual desire altogether. Counseling can be extremely valuable in helping women come to terms with the trauma and restore sexual desire.

What Types Of Treatments Are Available?

If you suspect that you may be suffering from low sex drive, the first step is to visit your doctor, to ensure that a medical problem is not to blame for your low sex drive.

Your doctor may identify a medical problem even if you do not realize that one exists. For example, what may seem like depression or anxiety could stem from a hormonal imbalance, vitamin deficiency, or other medical problem.

If your physician rules out a medical problem, it may be wise to seek the advice of a mental health professional.

Nice To Know:

Use this checklist to determine what factors may be linked to your low sex drive:

• Are you tired almost all of the time?
• When you think about sex, do you feel angry, anxious, or guilty?
• Have you recently (in the past year) experienced a stressful life event, such as a change of job, financial troubles, a move, a new baby, or loss of a loved one?
• Do you have a quiet, comfortable place where you can have sex undisturbed?
• Are you and your sexual partner having serious difficulty with your relationship?

If you have answered yes to one or more of these questions, these factors could be influencing your sex drive. Some issues can be resolved by talking the situation over with your partner, while others may require more specialized treatments.

Counseling

You may find that a psychologist or therapist can help you identify and examine underlying problems in your life.

To find a qualified mental health professional, look for the following educational criteria:

• Advanced degree, such as M.D. (psychiatrist) or Ph.D. (psychologist)
• M.S.W. (social worker), M.A. or M.S. (marital and family therapist or nurse), or M.F.C. (marriage and family counselor)

Check with clinics, universities, hospitals, medical schools, or social agencies, or ask for a referral from a university department of psychology.

Sex Therapy

If the medical examination reveals no problems and a psychologist or therapist finds no underlying issues that should be addressed, it may be wise to consider seeing a sex therapist. Sex therapists have special training in dealing with issues related to sexual health.

Need To Know:

Sex therapists should not be confused with sex surrogates. Unlike sex surrogates, therapists do not engage in sexual relations with their patients.

To find a sex therapist, look for experts with:

• Experience working with couples dealing with sexual problems
• Training in the treatment of sexual function

During therapy sessions, couples discuss their relationship and sexuality. Treatment involves identifying and modifying the emotions responsible for the problem, like guilt and fear, and teaching the couple better responsiveness techniques.

Nice To Know:

A sex therapist may assign "homework" exercises geared at improving sexual communication and intimacy. These may include "sensate focus" exercises, in which couples lovingly touch each other but do not engage in sexual intercourse. They take turns caressing each other's body, teaching and learning how to give and receive pleasure. Eventually, once they feel ready, the exercise progresses to direct genital stimulation and then intercourse.

The woman may also need to take time to get to know her own body and find out what truly stimulates her. Once she understands her own body, she can better instruct her partner in what pleases her.

Medication

Many women experience lowered sex drive as a result of physical discomfort within the vagina. Often after menopause, vaginal tissue becomes more sensitive and is prone to soreness during and after intercourse. If sufficient lubrication is the problem, lubricants such as K-Y Jelly or Replens can often make sex more comfortable.

Premarin, which is prescribed by a doctor, is an estrogen cream that may help rebuild thinning vaginal walls and also improve moisture. Ogen (estrone) and Estrace (estradiol) are two other similar vaginal creams available.

Some postmenopausal women may also have low sex drive from lack of the male hormone testosterone. While it is strange to think of women lacking testosterone, women do produce this hormone, although in much smaller quantities than men. It is sometimes called androgen and is produced in the ovaries and adrenal glands.

Some doctors prescribe testosterone creams or a pill which combines testosterone and estrogen, to bring back a woman's sex drive after menopause. While testosterone treatments have been shown to be effective for many women, they have also been controversial because of several unpleasant side effects, such as:

• Acne
• Facial hair
• Deepening of the voice
• Emotional mood swings

Nice To Know:

Some women find that the ginseng herb ginseng helps improve libido. Ginseng has also been shown to be effective in reducing feelings of stress and fatigue. It is available at pharmacies and health-food stores.

Living With Low Sex Drive

You can take steps to make your sex life more enjoyable. For enhancing sexual satisfaction:

• Try Kegal exercises, which can enhance sexual gratification. These exercises strengthen the pelvic floor muscles. You do them by tightening and then relaxing the pelvic floor muscles (it's as if you are starting and stopping the flow of urine). Kegal exercises can improve sensation during sex and also can decrease urinary incontinence (many cases of incontinence are linked to weakened muscles).
• Increase the time spent on foreplay before engaging in intercourse. This will not only help you discover each other's bodies, but will allow more time for your body's natural lubrication to occur.
• Exercise regularly. Becoming physically fit will not only improve your self-esteem, but increased blood flow to the vagina can also stimulate your sex drive.

How To Information:

Here is helpful advice for women at any age:

• Learn to communicate effectively with your partner to gain the most from your shared sexual experience.
• Consider counseling to help you and your partner talk through any sexual frustrations and open up to each another.
• Realize that exploring her own body is a healthy way for a woman to learn what truly arouses her.
• If you face serious psychological issues, particularly prior sexual abuse, it is crucial to get help from a mental health professional.

Nice To Know:

Don't fall into the common trap of believing that only intercourse "counts" as sex. Touching, kissing, and holding can all be good ways of overcoming obstacles due to illness, and can add intimacy to a relationship.

Sex After Menopause

While some women experience a decrease in libido after menopause, studies have shown that many couples in their 50s and up through their 80s (or beyond!) still enjoy a healthy sex life.

How To Information:

Here are a few tips to maintaining a healthy sex drive after menopause:

• Use an estrogen cream or pill to maintain vaginal lubrication
• Have sex or try self-stimulation at least once a week to maintain lubrication
• Ask your doctor about taking testosterone in small doses, after considering possible negative side effects

Just because you're past menopause does not mean that you should live without sexual intimacy. Have sex - have great sex - but don't assume it will be just like it was when you were in your 20s. Instead, focus on sharing affection.

It's also a good idea to find alternatives to intercourse that make your sex life rich and enjoyable for both of you, such as touching, kissing, and holding.

Putting It All Together

Here is a summary of the important facts and information related to low sex drive in women:

• Many women experience a reduction in sex drive at some point in their lives.
• Low sex drive should not be confused with inability to achieve orgasm.
• Signs of low sex drive may include decreased desire, less frequent fantasies or sexual thoughts, and reluctance to initiate sex.
• Low sex drive may be triggered by many factors, including menopause, pregnancy, illness, drugs and alcohol, stress or anxiety, and relationship issues.
• A licensed counselor or sex therapist may help identify and treat sexual problems.
• Good communication with your partner usually improves not only your relationship, but also your sex life