What Is Low Sexual Desire?
Low sexual desire (LSD) is the most common sexual problem reported by females. Although this problem is not sexually dimorphic (affecting only one sex), the prevalence of LSD is much higher in females than in males. A recent study found that 26% to 43% of females report low sexual desire compared to 13% to 28% in males.1 Lack of sexual interest is very common and alone does not constitute sexual dysfunction. Hypoactive Sexual Desire Disorder (HSSD) is medically defined as the “persistent or reoccurring absence of sexual fantasies and desires for sexual activity that cause distress.”2 The distress experienced with HSDD can be caused by differences of libidos between partners or internal feelings of inadequacy. This disorder is recognized by the American Psychiatric Association as a sexual dysfunction, although many individuals experience similar symptoms without qualifying for diagnosis. The term HSDD in this article refers to the actual clinical disorder and the term LSD refers to general feelings of low sexual desire.
Low sexual desire can range from mild to extreme cases. In mild cases, a person may fail to initiate (or desire) sexual intimacy, but they can still respond to sexual advances and enjoy intimacy when it does occur. Moderate cases of HSDD can result in the failure to both initiate and respond to sexual intimacy. Sexual Aversion Disorder is an extreme form of HSDD that results in absolutely no desire for sexual contact: an individual with sexual aversion disorder can actually be repulsed by the mere notion of intimacy. As with many other disorders, HSDD can be primary (i.e., an individual has always experienced low levels of desire) or secondary (i.e., an individual previously experienced desirable levels of arousal and now does not).3 HSDD can become problematic in romantic relationships. If your partner struggles with HSDD, it is important to be patient and supportive, as this disorder can already be stressful for the individual. There are currently no medicinal treatments (that are approved by the Food and Drug Administration) for HSDD, but there are different ways to increase sexual drive without pharmacological intervention.
What causes low sexual desire and how is it treated?
Low sexual desire can have many etiologies (causes) and corresponding treatments:
· Age: As an individual ages, many changes occur in the body that affect sexual desire. Recent findings suggest that although older individuals experience physiological changes that can negatively affect their sex drive, certain nonbiological factors allow for a potential increase in sexual desire. These factors include more free time, strong and lasting romantic relationships, and more privacy.
· Menopause: For females, menopause (the cessation of ovulation) can have drastic effects on one’s libido (sex drive). These changes may include decreased lubrication, lower estrogen levels (the female sex hormone), lower testosterone levels (the hormone believed to be responsible for female sexual arousal), and vaginal atrophy (the thinning and decreasing elasticity of the vaginal walls).
· Other Hormonal Changes: Problems related to the production of the hormones estrogen and testosterone can lead to sexual dysfunction. Because of these hormonal fluctuations (either increases or decreases), one’s sex life can be affected by endocrine disorders, pregnancy and postpartum deficiencies, endometriosis, diabetes, or fibroid tumors. Low testosterone levels also correlate with a low sex drive. Hormone replacement therapies can treat low sex drive caused by these imbalances. Therapy varies and can include the application of medicated vaginal creams, oral pills, or vaginal suppositories (i.e., medication inserted directly into the vagina). In such instances, a medical doctor should be consulted for possible treatment options.
· Gender: Although both males and females experience HSDD and LSD, the prevalence in females is higher. Biochemical differences in sexual hormone levels—primarily testosterone—may be the cause of this disparity.
· Negative sexual experiences: Low sexual desire can result from painful intercourse (dyspareunia), aversive events in childhood, or exceptionally high levels of inhibition. For instance, people who were sexually abused, view sex as a sin, or view sex as primarily for reproductive and not recreational purposes (oftentimes due to certain religious convictions) can experience low levels of sexual desire. Psychotherapy can be beneficial for individuals who have experienced sexual traumas. Treatments for dyspareunia (including sex therapy) can also increase sexual desire.
· Depression: Individuals who suffer from depression oftentimes encounter decreased motivation and anhedonia (the inability to experience pleasure). Clinical depression results in a decreased desire for sexual activity because it is no longer pleasurable or rewarding. General mood deficiencies can also decrease libido. Clinical depression is a serious medical condition that should receive psychological or psychiatric care.
· Anxiety and stress: If an individual suffers from anxiety or stress (or both), they may experience temporary or long-term decreases in sex drive, depending on the amount of stress or anxiety they experience. Stress and anxiety act as cognitive distractors that inhibit the natural sexual response cycle, which in turn affects sexual desire and motivation.4 Stress reduction via meditation, exercise, and other methods can help decrease stress and increase sexual desire. Anti-anxiety medications and psychotherapy can also help in treating anxiety disorders.
· Medicinal or psychoactive drug dependence: Certain medications, especially psychoactive drugs (for instance, drugs used to treat depression) often decrease sexual desire. A new line of antidepressant medication is now being offered that limits this side effect. An individual can consult their physician if they experience any sexual dysfunction side effects—an alternative medication may be available.
· Nonsexual medical issues: Diseases, such as diabetes, arthritis, migraine headaches, and cancer, can also affect sexual desire. These diseases are often extremely debilitating and cause general fatigue, which may inhibit an individual from desiring or participating in sexual activities. Chronic pain can also be a detriment to one’s libido.
· Habituation to one's partner: Sexual interest may decline as the duration of the relationship increases. This is due to decreased novelty in the relationship and can be ameliorated by introducing new and erotic concepts into sexual activity (e.g., sex toys, roleplaying, light BDSM, etc).
· Relationship problems: LSD can stem from unresolved conflicts in a relationship. Individuals often experience low sexual desire when they are upset or angry with their partner. Proper communication is essential for improving relationships and resolving discord that can trigger or exacerbate HSDD. Family and relationship counseling can be helpful if the turmoil is causing distress to both partners and their loved ones.
What are the Signs and Symptoms?
Individuals who experience HSDD or LSD may exhibit particular signs and symptoms. For the symptoms to qualify as HSDD, they must also cause apparent distress in the person’s life and cannot result from certain medical and psychological conditions such as cancer or depression, respectively. Symptoms caused exclusively by the effects of a drug or substance does not qualify for HSDD diagnosis. The following are examples of common signs and symptoms. Psychological or psychiatric consultation is necessary for proper diagnosis.
· Little or no interest in sexual activity
· Decreased frequency in sexual activity
· Decreased frequency in sexual activity becomes a problem in the relationship and causes conflict
· Apathetic feelings during sex, despite attempting to please one’s partner
· Habituation to his/her partner that results in decreased desire to engage in sexual activity with that person
· Selective desire deficiency, in which an individual may be physically aroused but emotionally absent.
· No interest in pursuing sexual interaction
· Physical signs may include vaginal dryness, weakened erections, decreased genital sensation, difficulty achieving orgasm, and/or genital pain with or without sexual contact
The American Psychiatric Association states that bupropion hydrochloride sustained-release tablets, a common treatment for depression, are reportedly effective in treating HSSD in females. Almost one-third of females treated with these tablets reported an increase in the number of episodes of sexual arousal, sexual fantasy, and interest in engaging in sexual activity. Results were seen in as early as two weeks from the start of treatment. Reported side effects of the drug include insomnia, tremor, rash, hives, and urticarial (a rash caused by an allergic reaction).
A non-pharmaceutical option has also been given to females suffering from any type of female sexual dysfunction. One current device being investigated is the clitoral therapy device called the EROS-CTD. The device works by creating a gentle suction over the clitoris and surrounding tissue, with the goal of increasing blood flow to that area. This device is meant to enhance sensation and lubrication and eventually increased overall clitoral blood flow over time.5
Recent biochemical research suggest that HSDD can be treated by regulating certain neurotransmitter levels. Increasing dopamine and decreasing serotonin activity levels can result in increased sexual desire. The new drug, Lorexys, works by combining two antidepressant medications that together cause synergistic effects on the central nervous system that can treat HSDD. This drug is currently still being researched and is not yet available.6
Other treatments include the use of sensate focus, masturbation, and Kegel exercises.
One of the most basic therapies used to help the partner who is experiencing the low sex drive is to encourage sexual self-exploration. That person is instructed to follow the seven-step model illustrated below in privacy with soothing music playing in the background.
1. Look at his/her own body( in private, perhaps after bathing)
2. Feel his/her own body
3. Touch parts that feel arousing
4. Try to get sexually aroused
5. Extend masturbation until orgasm
6. Allow partner to watch his/her masturbation
7. Allow partner to imitate his/her techniques
This technique, along with the other treatments, may help to increase a female’s sexual desire. If you are experiencing any symptoms associated with this disorder, it is important to seek medical attention first. The cause may be an underlying medical issue that can be alleviated by a physician. Seeking therapy for nonmedical etiologies can also be beneficial. Finally, open and effective communication in a romantic relationship is just as important as seeking external care. It is important to find the root of your low sex drive whether it be physiological, psychological, or interpersonal. Proper identification of the cause is essential for successful treatment.
5. LeVay, Simon, Janice I. Baldwin, and John D. Baldwin. Discovering Human Sexuality. Sunderland, MA: Sinauer Associates, 2012. Print
Last Updated 21 October 2014.