Advice for women with low sex drive

January 7, 2010 7:12:17 PM PST
Not in the mood? You're not alone. One survey reports that 43 percent of women experience some type of sexual dysfunction.

Dr. Laurie Green is an OB-GYN at the Pacific Women's OB/GYN Medical Group in San Francisco and offers these tips:

Having too little sexual desire is the most common sexual issue among women, reported by 10-51% of women surveyed. One large survey reported that 43% of women experience some type of sexual dysfunction.

Women lacking sex drive often feel isolated and embarrassed, especially in the context of constant media messaging that intense and frequent sexual desire is the norm. But data from around the world suggest otherwise. Intercourse frequency may be high among 18-29 year olds, averaging 10-12 times per month in one study, but frequency drops among coupled women to 4-7 times per month in the 40-50 year old age range, to less than twice a month in over 70 couples.

There are three distinct times during which desire is low in women: 1) after giving birth; 2) as women are caring for young children or in longer term relationships; and 3) at menopause and beyond.

Post-birth women

Women who nurse experience a significant drop in their estrogen levels, rendering the vagina dry, raw, and inelastic. This persists until 2 months after nursing ends, so longterm nursing women may have pain with intercourse for many months. Nature may have purpose in falling libido and nursing: the nursing mother is sustaining not only her own life, but that of her newborn. A pregnancy would add a third life to sustain, possibly threatening the survival of all three. As such, there is a natural drive to protect the newborn and not to add another to the brood. Additionally, women nursing full time tend not to ovulate for at least the first 4 months postpartum. Many studies demonstrate that sex drive increases around and before ovulation; nursing women who fail to ovulate lack this stimulus.

The busy mom

For women in established relationships, the desire for emotional closeness motivates more often than raw sexual desire. While the majority of women are capable of arousal, 40% of women in one large study reported little or no desire to initiate sexual activity. Factors that might blunt sex drive are physiologic and environmental. Commonly prescribed medications, such as birth control pills or anti-depressants, can lower libido, as can certain blood pressure medications and anti-seizure drugs. Illnesses such as low thyroid, diabetes, or pelvic conditions such as endometriosis can have the same effect, but so can the sheer fatigue of our busy lives as mothers and workers. And, since sex drive in women is more emotionally motivated than in men, issues of body image, relationship stress, emotional well-being, past sexual experiences, and history of abuse also color sexual responsiveness. Studies suggest that couples in long-term relationships are sexually active less often.

The menopausal women

Up to 40% of menopausal women experience dryness of the vaginal tissue enough to cause pain with intercourse and diminished libido. There is a gradual decline of testosterone production in women beginning at age 30; and, contrary to popular belief, there is no acute fall in male hormone output by women at menopause. Perhaps this is nature at work again: sex drive was probably encoded so that the species would go on, not so that life would be pleasurable! When women reach an age that sex no longer results in reproduction, there may be a natural decline in the drive that leads to offspring. How do you approach this problem, and what is and isn't true?

Your physician should not only take a medical and social history, but also review your medications and work you up for illnesses. Some women must stop their birth control pills, or change anti-depressants. Of all the anti-depressants, Wellbutrin seems to have the least negative effect on sex drive. Underactive thyroid also lowers drive. If you have a history of abuse, or are under great stress, please share this with your doctor. Therapy does help: in one landmark trial combining behavioral and sex therapy, 74% of women had improved sexual and marital satisfaction for over a year after treatments ended. Your partner should be a pivotal participant.

Pain with intercourse can be a deterrent for many women. Vaginal dryness can be cured with lubricants; or, if the estrogen level is low, with estrogen vaginal creams, rings, or tablets. Although estrogen must be used intensively for the first two weeks of therapy, maintenance requires only twice a week use. The dose is so low that there is no increased risk of breast or uterine cancer. Among lubricants, Replens and Silk-e are the best. Use them generously. Women who experience pain with deeper penetration may be suffering from endometriosis, or vaginismus, a condition of pelvic floor muscle spasm. Your doctor can work you up for both conditions. Botox has been used quite successfully for the latter condition.

Another mistaken premise is that low male hormone levels cause sex drive problems. In reality, large population studies have failed to demonstrate any correlation between male or female hormone levels and sex drive. This may relate to the insensitivity of tests to measure the levels. The only male hormone preparation for women approved by the Food and Drug Administration is called Estratest, and is a combination of estrogen and testosterone for use with hormone replacement therapy. While a testosterone patch for women was developed and presented to the FDA for approval, the patch failed to pass scrutiny. The lower dose of the patch worked no better than placebo (ie, drug-free patch); and, although the higher dose improved sexual response slightly, the results were minimal and patients developed too many male hormone side effects including acne, facial hair growth, male pattern baldness, and insulin resistance leading to diabetes. Likewise, the supplement DHEA showed minimal benefit. Formulating pharmacies are not under FDA regulation, so can concoct male hormone preparations, but the long term side effects and benefits are unknown.

There is no 'Female Viagra". Viagra itself was tried in women, but the largest study of nearly 800 women showed no effect on arousal, orgasmic potential, or desire. Some supplements are marked as being 'Female Viagra', but no solid scientific evidence has been presented to prove the claims. In contradistinction to pharmaceutical companies, supplement manufacturer may claim their products 'help' conditions without producing any proof to support their claims. Supplements that have been tried include ArginMax, which is L-Arginine, an amino acid, and the topical cream Zestra.

Finally, the Eros device is an FDA approved treatment. The battery operated handheld device is placed over the clitoris and provides adjustible vacuum suction and a low level vibratory sensation. A nonblinded study suggested it improved arousal, orgasm, and overall satisfaction in patients.

Please speak with your physician: we are here to help! And you are not alone!

About Laurie Green:
Laurie Green MD has been a practicing ob/gyn physician in the Bay Area for the past 27 years. She is a founding partner of Pacific Women's Ob/Gyn Medical Group, and past president of both the California Academy of Medicine and the San Francisco Gynecology Society. She has been a member of the board of directors of Brown and Toland Medical Group for the past decade. Between 1995 and 2002, she was a weekly guest on KTVU's "Mornings on 2" discussing medical topics, and since 1982 has appeared on a variety of local television and radio talk shows. For more information, go to www.pacwomens.com


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