And How Can I Increase Mine?

There are real treatments available.

By Alyssa Dweck, M.D.

Not in the mood to get busy tonight? Don’t panic just yet. Libido in women is complicated. There are a whole host of factors that influence sex drive and affect why you might not want to have sex (tonight, this week, or even for the last several months).

But if it’s more of a persistent concern and it’s causing you distress, it’s worth looking into further and discussing with a trusted medical professional; the gyno is the first stop for most women. Your libido could be falling flat from something as common as stress or the birth control you’re taking, or it could be a sign of a bigger health issue. But you won’t know the underlying cause or how to solve it until you bring the issue to your doc’s attention. Okay, now let’s dive deeper.

Libido can ebb and flow for all sorts of reasons.

First, I want to remind you that there’s no such thing as a “normal” sex drive. Take the stats out there about how often other people typically have sex with a grain of salt; it varies for everyone (and, hey, people lie!). Female sex drive is nuanced, and your libido rises and falls naturally.

For example, you might have a higher sex drive around the time of ovulation (the body’s way of telling you to get frisky during your fertile time, even if you’re not actively trying to become pregnant). Or, you may not feel like being sexually active during other times of the month, like when you’re on your period (though if you’re into period sex, it can be enjoyable too).

You can also experience changes in your hormones or neurotransmitter levels from certain medications you’re taking (antidepressants, for example, could lower your drive or alter your ability to orgasm), which, in turn, can mess with your sex urge. The same can happen if you have an underlying hormonal condition like a thyroid disorder or polycystic ovary syndrome (PCOS).

Another player when it comes to sex drive that you might not necessarily expect is hormonal birth control. Most BC pills (or patches and rings) contain the hormones estrogen and progesterone, which are necessary for regulating your cycle. What the pill is doing is preventing ovulation. And as a result, the typical peaks and dips of those hormone levels don’t occur, so you’re not experiencing that surge of estrogen during ovulation, which is typically what makes women want to have sex during that fertile period.

Plus, the amount of testosterone you produce also naturally decreases significantly if you’re on the Pill, which also might make your drive slip a bit. For other women, though, feeling confident and secure in their method of birth control could make them feel more like having sex. It really depends on the person and their particular hormone levels.

Or, major life changes may impact your sex drive, like if you’ve had a death in the family, recently lost a job, or are going through a bout of depression. If your mental health or emotional circumstances could have something to do with it, you may just need to be gentle with yourself and work with a mental health pro to address the issue.

It’s also totally possible that you’re just in a self-esteem rut and aren’t feeling as sexual. The bottom line is, it’s important to be honest with your gyno and/or therapist about alllll of these factors so that they can consider all possible factors that could be affecting your libido.

Or, you may actually have hypoactive sexual desire disorder.

Beyond the typical contributing factors to low libido, you might be showing signs of a well-recognized medical condition called hypoactive sexual desire disorder, or HSDD. It presents as low sex drive, but to the maximum extent. HSDD is characterized by having a pretty much completely absent sexual drive and lack of fantasizing about sex in general.
Most patients who struggle with HSDD compare it to a light switch—they used to have regular sexual desire, but for no identifiable reason, they all of a sudden have *zero* sex drive, no matter the partner or the situation. In cases of HSDD, there’s also always distress associated with low libido, meaning an emotional component of being upset or distraught over the fact that you’re not thinking about sex.

It’s a little bit tricky to diagnose HSDD. Patients fill out a brief questionnaire about their low sex drive and how it’s affecting them emotionally, and doctors screen their responses to diagnose the disorder. If, when docs assess a patient’s answers, it seems the cause of low drive could be related to something like relationship or marital problems, or a different medical or medication issue, your MD will work on addressing and treating that with you first.
But if you do get a HSDD diagnosis, don’t panic. Believe it or not, HSDD is common among young women—one in 10 premenopausal women suffer from it—and it’s not something to be ashamed of at all.

To treat low sex drive, you have a few different options.

Treatment, as you can probably guess, depends on the underlying cause. But your doctor will likely recommend one (or more) of the following courses of action.
1. Consider seeing a sex therapist.2. Revisit books and movies that might help light your flame.
This practitioner will manage the emotional and psychological components of low sex drive and will also address how your drop in libido might be affecting your relationship, or your desire to form a new relationship.

When I work with people suffering from HSDD or low libido in general, I notice that some have a fear that this may cause their partner, if they have one, to stray or leave them. This is also something you can delve into further with a sex therapist, if your low libido is bringing up intrusive thoughts like this. In my practice, I often recommend reconnecting with your partner with a regular date night. Basically, it’s a “prescription” for intimacy.

To find a mental health practitioner with expertise in sexual health in your area, check out Aasect.org.

2. Revisit books and movies that might help light your flame.
You may simply need to do some solo homework to get back in your groove. This can include a variety of different tasks (that you’re comfortable with, of course). For some patients, watching porn or reading erotica does the trick for getting sexual thoughts back on the brain. You can incorporate this during solo time so that you can start fantasizing on your own, and then you can involve your partner in the scenario.

Another thing that helps sometimes is going out on a limb with sexual activity. That could mean a fun role play scenario for some people. For others, that could mean having sex in another room of the house besides the bedroom to keep things interesting.

3. Talk to your doc about medications and supplements that can boost your drive.

If you have HSDD, medication might be necessary to treat the condition. In 2015, a drug called Flibanserin was approved by the FDA to treat HSDD in pre-menopausal women. It’s a daily pill that may have some side effects, like dizziness, nausea, and fatigue, according to the drug’s website.

More recently, another drug called Vyleesi got approved. It is uniquely administered with an auto-injector (it’s like an Epipen) that you can take on demand to get you prepped for sex. Vyleesi works on melanocortin receptors, or energy regulators, in the brain. Studies showed increased desire and decreased distress in those taking Vyleesi. One common side effect is nausea. [Ed note: Dr. Dweck has worked as an HSDD educator with the parent company of Vyleesi.]

Other options include off-label use of testosterone supplementation via prescription or over-the-counter herbal supplements to enhance sex drive.

If months go by and you’re not able to get back to your normal level of sexual desire, that could be the right time to also alert your health-care provider that you’re not feeling like yourself.

But the main red flag is not how long your drive is low (for some people it’s weeks, months, or longer)—it’s the question of whether your low libido is distressing to you. That’s when you should bring it to your gyno’s attention.

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