Decreased sexual libido is a very common problem women face. About 24-43% of women complain of low sexual desire. I see a number of women with this problem in my practice. It can become particularly problematic for women during life transitions such as pregnancy, postpartum, and menopause. There are numerous causes of low libido in women. Medical conditions such as diabetes, cardiovascular disease or depression can cause decreased sexual desire. In addition, many medications for treating depression, high blood pressure and stomach problems can cause decreased desire. Hormones used to treat endometriosis or fibroids or for contraception can affect sex hormones causing low libido. A woman's desire for sex can be decreased when there is a history of sexual abuse, current or past relationship issues or life stress as well. Talking with a therapist can be very helpful in these circumstances. If you have issues with libido make sure you have a complete medical and gynecological exam to check for underlying medical conditions. It is important to address underlying health issues because in many cases once they are treated, libido will return.

As you can imagine, it is very challenging to treat decreased libido because there are so many things that can cause it. First, I try to make sure that any untreated conditions such as depression get treated. All medications should be reviewed; some medications can easily be changed to one with less sexual side effects. For instance, birth control pills will occasionally cause decreased desire especially after long term use, this medication can simply be changed or the woman can choose a different method of contraception. We cannot overlook the critical role that stress plays in our lives! Many women live very full lives that leave them not only stressed but exhausted at the end of the day. Taking time to relax (maybe a hot bath), release tension (try some restorative yoga) and focus on yourself (not our children or our work) is imperative. Then you have more energy to nurture your relationship with your partner. Some couples find making a date for sex is a fun way to reconnect. What about spicing it up a little bit with some new massage oil, new lingerie or a new time or place for sex? Being bored with the same routine can lead to decreased sexual desire too.

There are a number of herbs that have traditionally been used to treat low libido such as ginseng, damiana and wild oats milky seed. These herbs can be used in combination with others such as black cohosh and chastetree berry for perimenopausal women. There has been little research done on herbs for libido but they are generally quite safe and have few side effects.

The use of testosterone is very controversial. The North American Menopause Society recently released a practice guideline saying that testosterone deficiency has not been clearly defined in women and we don't know what normal testosterone levels are in women. That being said, some women find testosterone helps so we should discuss the risks and benefits of its use if you are interested in this approach.