Lack of sex drive in women (lack of libido)

by Dr. Nadine Antonelli

Posted on March 24, 2022

Low Libido in Women

Spring is just around the corner and with it comes spring fever!  Spring fever is a term used to describe the renewed energy and vitality, positive effect on moods and subsequent increase in libido (sex drive) that many experience with the onset of warmer, brighter days.  Unfortunately, for some women, a change of seasons just isn't enough.   Decreased libido is defined as a lack of interest in and desire for ANY type of sexual activity, including masturbation and sexual fantasies/thoughts.   Decreased libido is a complex issue and usually there are multiple factors at play in any given women’s situation.

It is normal for libido to ebb and flow throughout a woman’s life.  Typically, the hormonal fluctuations experienced during and after pregnancy/breastfeeding, the use of hormonal contraception or the natural decline in reproductive hormones associated with menopause is to blame.  It cannot be overstated that it is absolutely normal for libido to decline with age, especially at menopause, a time after which many women report a markedly diminished or even completely nonexistent sex drive. The drop in reproductive hormones (estrogen, progesterone and testosterone) accompanying menopause influences libido directly and indirectly by failing to provide continued hormonal support of the reproductive tract.  The lack of estrogen, for example, leads to thinner, dryer, less elastic vaginal walls, a phenomenon referred to as atrophy.  Atrophy can result in painful intercourse despite the use of lubricants and can become progressive.  Pain with intercourse negatively reinforces a woman’s desire to engage in future sexual behavior.  Adjusting hormonal/contraceptive medications, “balancing” and replacing hormones systemically (throughout the body) or locally (in the vagina) are strategies that are used by gynecologists to optimize female sexual health.

What are the causes of lack of libido in women?

However, solely addressing hormones would be negligent as there are many other factors to consider when evaluating the possible cause(s) of decreased libido.  It is helpful to remember the following acronym: SPIRIT.

  • S – Stress and fatigue – both financial and work related (including stay at home mothering!)
  • P – Poor body image and low self-esteem which often go along with lack of exercise
  • I – Illness – both medical and mental illness and side effects of the medications that may be used to treat them
  • R – Relationship issues including lack of emotional intimacy, poor communication, infidelity, and trust issues
  • I – Illicit drugs, alcohol abuse and smoking
  • T – Trauma – A history of sexual abuse/physical abuse or negative past sexual experiences.

Discussing decreased libido can be very embarrassing for women.  Often they feel something is "wrong" with them.  Developing a relationship with a physician that specializes in female sexual health should allow a woman to comfortably express her concerns.  The patient, with the help of her trusted physician, can then identify the factors at play and design an optimal treatment approach.

Treatment approaches to decreased libido include both hormonal and non-hormonal options. Hormonal options include conventional FDA approved pills, patches and topical preparations and alternative compounded hormone replacement therapy including compounded testosterone. Non-hormonal options include FDA approved oral Addyi and an “on-demand” injection Vylessi which can be used by a woman only when desired.

The use of a clitoral vibrator to mechanically stimulate the genitalia can also be extremely helpful to help improve blood flow to the genitalia and heighten arousal.


Nadine Antonelli, MD

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