Loss of Sexual Desire in Women

Causes of reduced sexual desire in women

Disorders of sexual drive and desire are the most common sexual problem, possibly affecting up to 35% of women. Often there may be more than one sexual dysfunction present. Many women with this condition can respond to their partner's sexual approaches and may become sexually aroused and experience orgasm. An absence of desire for sex does not mean that intimacy is unwanted, and not dealing with this problem can cause conflict within the relationship.

Inhibited Desire Disorder is defined as the persistent or recurrent deficiency or absence of sexual fantasies, thoughts and/or desire, or receptivity to sexual activity, which causes personal distress. An attempt to distinguish it from sexual drive disorder is often necessary. Often situations where energy levels are low can affect sexual desire. This is commonly seen as a consequence of a busy job, childcare, depression, stresses in life, and difficulties within the relationship, low thyroid levels, and drug or alcohol misuse.

Sex is safe during pregnancy and intercourse does not harm the fetus, but there may be reduced sexual activity. Once the baby is born there will be a marked change in hormone levels, a time of poor sleep and increased demands from the mother and perhaps also a healing episiotomy scar, all of which affect sexual desire.

Androgen deficiency in women can bring about a global loss of sexual drive and desire, decreased sensitivity to sexual stimulation in the nipples and clitoris, decreased arousability and capacity for orgasm, loss of muscle tone, diminished vital energy, thinning and loss of pubic hair and dry skin. Differential diagnosis of major depression or marked relationship problems is necessary.

Medications can affect desire.

Other chronic conditions such as diabetes, multiple sclerosis, arthritis and cardiovascular disease can affect sexual function, both directly through disease processes in the pelvis and psychologically with an effect on body self image and feelings of attractiveness to others.

Conflicts or difficulties within a relationship can often contribute or cause loss of sexual desire and these may need addressing before a couple can begin to focus on the sexual side of the relationship. Loss of sexual desire may also be secondary to another sexual problem in either partner. For example, a postmenopausal woman may experience pain during intercourse with reduced sexual pleasure and secondary reduction in sexual desire. In particular, associated psychological problems within the partner, including depression and substance misuse, can decrease intimacy.

Treatments available

A thorough assessment is necessary to establish the role played by physiological, pharmacological, psychological and relationship elements in the development and maintenance of the desire disorder.

The first part of any management plan should include sharing with the patient that this is a common condition. Education about the sexual response cycle and provision of books and leaflets can be beneficial in making an understanding of the problem possible. Likewise education about pelvic anatomy and physiology can be very helpful.

Encouragement to share the problem with their partner is promoted whenever possible. Likewise, the partner should be helped to understand more about the sexual problem. This can lessen the woman feeling under pressure and guilty, and reduce the chance of the partner feeling rejected and hurt. If there are difficulties within the relationship or there is lack of emotional intimacy, couples therapy may be helpful; it can be available through the practice counselor or specialist clinics or agencies.

Psychosexual therapists can help re-ignite affection and intimacy through techniques of touching, stroking, relaxation, self-focus work and other training exercises in the privacy of the couple's home. A focus on pleasuring for the woman, both non-sexually and then sexually, is helpful, with a stated aim of increasing sexual intimacy for both partners. Techniques, including sensate focus, can be helpful for some of this experience. Learning distraction techniques can be useful alongside specific relaxation exercises that should be practiced before any sexual activities are attempted. The use of sexual fantasies or daydreams may be helpful by increasing arousal and keeping the mind sexually focused, thus preventing negative and unhelpful thoughts. The change of 'sexual scripts' and alleviating sexual boredom through encouraging the use of erotica, vibrators and change of sexual positions can also be helpful.