At some point or another in life you may feel that your sex life is pretty non-existent. Perhaps you feel as though your level of desire (the feeling of “wanting” sex) isn’t as high as it used to be, maybe it’s completely gone. You might wonder whether there is something going on with you specifically and whether this feeling, or lack-thereof, is “normal”. As much as we may value other aspects of ourselves and our partner(s), sex is an important part of most romantic relationships and the truth is, most people don’t know how to talk about sexual concerns with their partners, with friends, and especially with their family doctor. To make matters more difficult for those seeking help, general practitioners often lack the knowledge, tools, and time to properly assess sexual difficulties in their patients.
What is low sexual desire?
A common belief is that everyone wants sex and everyone has sex ALL the time. You’d be surprised to learn that low sexual desire is the most common complaint in women across the life cycle and that clinical conditions go mostly undiagnosed (1)(2). A diagnosis of low sexual desire disorder (sexual arousal/interest disorder or SAID) requires at least three of the following criteria, lasting for a period of at least 6 months (3):
- a reduction or lack of wanting sex,
- a reduction or lack of sexual thoughts/fantasies,
- a reduction or lack of initiating and responding to sexual activity or sexual advances from a partner,
- a reduction or lack of feeling sexual pleasure,
- reduced desire in response to sexul stimuli (pornography, erotica, etc), and/or
- a reduction or lack of genital or nongenital sensations
An important part of assessing the condition lies in whether a woman feels significant distress about her symptoms and how it affects her and her relationship. Consider this, a woman who is not in a sexual relationship or whose sexual desire level matches that of her partner may not find these symptoms distressing and wouldn’t think twice about whether or not she has a problem. When it comes to sexual desire, everything is relative.
What causes low sexual desire in women?
Levels of sexual desire in women vary significantly and for many women, wanting sex doesn’t happen spontaneously, but rather, in response to feeling close to their partner (reactive sexual desire). Desire naturally changes across the lifespan and can be affected by several factors including relationship stress, grief, illness, medication or substances, and mental disorders. Despite all of the research, at this point, there is no established cause(s) that explains low sexual desire disorder. Several links have been made with the levels of different hormones, suggesting that estrogen and testosterone influence sexual desire in women however other studies showed that these links don’t always hold true (4,5). Hormones, therefore, are known to influence sexual desire in women however their exact role in the development of low sexual desire is still not clear.
Some studies have found differences in the structure of the brain and how it functions between women with and without low sexual desire. The findings suggested that the brain may either have a tendency or predisposition to function in a way that results in low sexual desire (6), or that the differences could be adaptations to sexual experiences and behaviors (7).
Regardless of the specific cause(s), women diagnosed with a sexual desire disorder tend to report lower quality-of-life, dissatisfaction with sex life, partner, or marriage, negative emotional states like frustration, hopelessness, anger, poor self-esteem, and loss of femininity compared to women with no sexual problems (8).
You do not have to meet all of the medical conditions mentioned above to seek help. If the symptoms feel familiar to you and you are significantly bothered by them, you may want to explore potential causes or try different techniques to help put you in the mood again. A sex therapist, couples therapist, or clinical psychologist with training in sexual difficulties can help.
What does sex therapy involve?
Sex therapy for female sexual dysfunction is no, “one-trick pony”. Women’s sexual experiences are highly complex and levels of desire vary a lot. Desire is not just about physiological factors. It is also about a number of social and relationship factors like intimacy, communication about sexual wants and likes, how satisfying sexual experiences are, and people’s level of knowledge and expectations about sex and sexual function that play an important role in how often you are in “the mood”.
A common type of therapy for sexual desire disorders is cognitive behavioural therapy (CBT). It is widely used for women with low sexual desire and can have even better outcomes when it involves the sexual partner (10). This form of therapy is useful for addressing the distracting or negative thoughts that some women experience during sexual activity. These thoughts can interfere with taking notice of the changing sexual sensations in the body during sexual activity and the increase in sexual desire that often happens in response to being intimate with your partner (1). Therapy can include training to improve communication skills in the individual or in the couple, improve sexual skills, and reduce anxiety about sex to improve overall satisfaction.
Therapy can also involve mindfulness techniques. Mindfulness has become more prominent in the literature and online as an effective technique to help with a number of problems. It turns out that mindfulness, a practice much like meditation which originates from Buddhist traditions, can also be used for low sexual desire in women. Mindfulness-based therapies involve clients focusing on the present moment thoughts, emotions, and bodily sensations. This helps women become more aware of the changes that occur in the body during sexual activity or in the anticipation of sexual activity.
Like CBT, mindfulness training for low sexual desire can also focus on any learned negative thinking that may be taking place after years of negative sexual experiences. So far, mindfulness has been successfully used in populations of women surviving gynecological cancer, women with a childhood history or sexual abuse, and women with chronic genital pain, and seems to improve sexual functioning and sexual desire (1, 10, 11, 12,13). Another advantage of learning mindfulness techniques is that clients can continue using the techniques they learn in therapy at home.
Treatments for low sexual desire will tackle the sexual problem and address aspects of romantic relationships as a whole to assess overall relationship functioning and quality of life. When therapy ends, the effectiveness of the treatment should not only cover whether you are wanting and having more sex but also your expectations about desire, how satisfied you are with your sexual experiences, how you feel those experiences improve your quality of life, and your level of confidence regarding sexual activity (9).
What about medication?
At the moment, in Canada, there is no established medication for the treatment of low sexual desire in women. You may be asking, “What about the female Viagra? I’ve seen it on the news!”. The “pink pill” incorrectly labelled as the female Viagra is currently available in the United States and has yet to be approved by Health Canada. The drug, Flibanserin (Addyi) was originally developed as an antidepressant but became more known for helping to increase sexual desire in women that had lost their sex drive. Addyi does not function in the way that Viagra does for men, which targets blood flow to the genitals, and instead changes some the chemical signals in the brain that are involved in sexual desire.
A great deal of controversy has followed the development and approval of drugs to increase sexual desire in women with some clinicians expressing the opinion that female sexual desire is too complex a phenomenon to be treated with a simple pill. Others hold the opinion that this drug is just another tool that women would have the choice to use, if they feel their problem warrants it. Yet others, feel that the existence of a pill for women sends the message that having low sexual desire means there is something innately wrong instead of focusing on other relationship factors and educating men and women about the fluidity and complexity of women’s sexual desire. Whether this option will be available to Canadian women is yet to be determined, however, if available, it unlikely to be recommended as a primary treatment, instead something to complement other therapies when low sexual desire is particularly problematic and causes significant distress.
Although we need more research on different treatments for low sexual desire in women, psychological and mindfulness-based therapies do show promise and indicate that low sex drive in women can be improved when we consider sexual desire as a multifaceted phenomenon that involves not only individual factors but also relationship factors and sex education. If you are concerned with your lack of sex drive take some time to explore the characteristics within yourself and even aspects of your relationship and your environment that may contribute to it. Seek out professionals with training in couples and sex therapy. Don’t be shy, they are here to help.
Written by: Mayte Parada, PhD
- Brotto, L.A. (2017) Evidence-based treatments for low sexual desire in women. Frontiers in Neuroendocrinology, 45, pg: 11-17.
- Goldstein, I., Kim, N.N., Clayton, A.H., DeRogatis, L.R., Giraldi, A., Parish, S.J., Pfaus, J.G., Simon, J.A., Kingsberg, S.A., Meston, C., Stahl, S.M., Wallen, K. (2017). Hypoactive sexual desire disorder: International society for the study of women’s sexual health (ISSWSH) expert consensus panel review. Mayo clinic proceedings, 92, pp. 114-128.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC.
- Reed, B.B., Bou Nemer, L., Carr, B.R. 2016. Has testosterone passed the test in premenopausal women with low libido? A systematic review. International Journal of Women’s Health, 8, pp. 599-607.
- Dennerstein, L., Koochaki, P., Barton, I., Graziottin, A. (2006). Hypoactive sexual desire disorder in menopausal women: a survey of Western European women. Journal of Sexual Medicine, 3, pp. 212-222.
- Toates, F. (2009). An integrative theoretical framework for understanding sexual motivation, arousal, and behaviour. Journal of Sex Research, 46, 168-193.
- Sweatt, J.D. (2016). Neural plasticity and behavior: sixty years of conceptual advances. Journal of Neurochemistry, http://dx.doi.org/10.1111/jnc.13580.
- Shifren, J.L., Monz, B.U., Russo, P.A., Segreti, A., Johannes, C.B. Sexual problems and distress in United States women: prevalence and correlates, Obstetrics and Gynecology, 112, pp. 970-978.
- Meana, M., Hall, K.S.K., Binik, Y.M., (2014). Sex therapy in transition: Are we there yet? In: Binik, M., Hall, K.S.K (Eds.), Principles and Practice of Sex Therapy, fifth ed. Guilford, New York, NY, pp. 541-557.
- Brotto, L.A., Basson, R., Luria, M. (2008a). A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. Journal of Sexual Medicine, 5, 1646-1659.
- Brotto, L.A., Erskine, Y., Carey, M., Ehlen, T., Finalyson, S., Heywood, M., et al. (2012a). A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecology and Oncology, 125, 320-325.
- Brotto, L.A., Basson, R., Carlson, M., Zhu, C. (2013). Impact of an integrated mindfulness and cognitive behavioural treatment for provoked vestibulodynia (IMPROVED): a qualitative study. Sexual and Relationship Therapy, 28, 3-19.
- Brotto, L.A., Basson, R., Smith, K.B., Driscoll, M., Sadownik, L. (2015). Mindfulness-based cognitive therapy for women with provoked vestibulodynia. Mindfulness, 6, 417-432.