Low Libido: Common Problem Among WomenJun 2009
Women should not hesitate to consult their physician
For many men with low libido, a prescription for Viagra or Cialis is a quick solution. But for women who lose interest in sex, the challenge is figuring out why and what mix of therapies—from lifestyle changes, to counseling, to over-the-counter or prescription medications— might help.
“It can be very difficult because so many factors can be involved,” says Dr. Jeffrey Morrison, an OB/GYN with Tidewater Physicians Multi-specialty Group in Newport News. “Maybe it is hormonal, or it’s about relationship issues or medications they’re on, or sleep habits, stress levels, past sexual experiences, body image. There are some tests you can do, but it’s also an area where there aren’t a lot of good studies on what to do. When we do have success, though, it’s very rewarding.”
A drop in sexual desire can occur at any age, although doctors say the most common window for women is between the ages of 35 and 65. Changing hormone levels before, during and after menopause can cause physical changes such as decreased blood flow to the vagina and less sensation and elasticity. Common hormonal factors are falling levels of estrogen, thyroid disorders and low levels of testosterone, a hormone produced by the ovaries that plays a key role in sex drive.
Other health issues can also reduce a woman’s interest in sex. Chronic conditions such as heart disease and arthritis can cause fatigue and pain, while certain medications—particularly high blood pressure and birth control pills—can lower libido as a side effect.
And while antidepressants can also reduce libido, depression and anxiety themselves—as well as unmanaged stress—can lower libido, too. Pre-menopausal women taking care of children are one at-risk group. “If they’re doing things for everybody else but not themselves, sex can become a very low priority,” notes Beth Scharlop, an OB/GYN with Womancare of Williamsburg.
In some cases, women can solve the problem with lifestyle changes: stress management, healthy eating, regular exercise, sleeping well, quitting smoking, going to couples’ therapy and focusing more on their own sexuality. “There are many steps that can be very effective before we even start turning to medications,” says Scharlop.
If low libido is a side effect of medication, doctors may be able to try a different drug or dosage, or they may add another prescription or herbal supplement to counter the effects (although herbals are not federally regulated and tend to have limited success data). For example, according to Morrison, some patients on antidepressants have reported success with ginkgo biloba supplements. In some cases, though, women may have to accept a lowered sex drive in exchange for controlling serious medical problems such as depression or high blood pressure.
When doctors are able to pinpoint the cause of low libido, there are some over-the-counter treatments that can help. For example, women with vaginal dryness can choose from a variety of lubricants such as Replens or Astroglide, which carry longer-lasting formulas that may work for two to three days.
On the prescription front, for women whose main sexual complaints are dryness and pain during intercourse, doctors can try vaginal estrogen in the form of creams, tablets or inserted rings. In women who still have a uterus, the trick is to keep the dose of estrogen low enough to guard against an increased risk of uterine cancer; otherwise, vaginal estrogen can be used indefinitely.
Women with a wider range of symptoms linked to menopause, such as hot flashes and sleep disturbances, may decide to take oral estrogen with or without progesterone, known as hormone replacement therapy. Generally, though, doctors aim to use the lowest possible dose over the shortest possible time because studies suggest an increased risk of breast cancer and heart disease.
Women also can try prescription testosterone injections given every other week, Morrison says. Some of his patients have done well with an off-label prescription of Viagra or Cialis as well, although studies on the medications’ effectiveness in women have been inconclusive.
There are some new treatments on the horizon that show potential. Doctors in Europe and Australia are using a synthetic steroid called Tibolone—not yet approved in the United States—which seems to improve libido. Closer to home, doctors in South Hampton Roads are testing LibiGel, a testosterone gel that women apply daily to skin on the upper arm. The manufacturer is now seeking women who have had their ovaries removed for enrollment in a clinical trial to test LibiGel’s effectiveness.
“There is a real unmet need here,” says Dr. Frank Morgan, an OB/GYN with Tidewater Physicians for Women, a practice with offices in Norfolk and Virginia Beach, which is involved in the trial. “There is no one simple answer for women, but the hope is that [LibiGel] will be a safe treatment that can help a certain number of them.”
What women definitely shouldn’t do is assume the problem is unfixable—or an inevitable part of aging.
Says Scharlop: “In general, women won’t bring it up, but they shouldn’t ever be embarrassed. They’re not alone, and in many cases assistance can be offered that can really improve their situation.”