The Causes and Solutions for the Lack of Sexual Desire in Women

A recent survey (conducted by Laumann and colleagues at the University of Chicago) of American women (ages 18-59) found that the most common sexual problem in women is hypoactive sexual desire disorder (HSDD), more commonly referred to as low sex drive or libido (33.4%), followed by difficulty with orgasm (24.1%). Pain during intercourse--which occurs in 14.4% of women--was the only condition to show a relationship to age -- it decreases as women get older.

HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity, as defined by the American Psychiatric Association (APA). The definition is vague because the APA acknowledges that there can be significant differences in sexual interest levels among women. According to the survey mentioned above, 37% of women think about sex a few times a month and only 33% think about sex 2-3 times a week or more. Happier women seem to think about sex more often than unhappy women.

Difficulty with orgasm, or female orgasmic disorder, is a persistent delay or absence of orgasm. This definition is also from the APA and it again attempts to allow for individual variation by not giving a specific number or percentage to define a "normal" amount of orgasms. The survey states that 29% of women say they always have orgasms during sex and 40% say they are physically satisfied with their partners.

There are wide variations in sexual functioning, and there is no gold-standard that women should feel they must meet for their sexual functioning to be considered 'normal.' If a woman experiences a sexual problem that troubles her, then it is a problem that needs to be addressed and she should be encouraged to talk to her doctor about it to see how it can be improved.

What Causes Decreased Sexual Desire in Women?

Low sex drive can be caused by a range of factors, which vary from one individual to the next. Fatigue, the daily responsibilities and multiple roles women often assume, and many possible psychological causes can impact a woman's sexual appetite. It is also known that certain health conditions and medications can affect a woman's sexual desire. Depression and anxiety disorders can interfere with sexual desire, but so can some of the drugs used to treat these conditions. Many antidepressants, in particular Selective Serotonin Reuptake Inhibitors, also called SSRIs (e.g.., Prozac, Paxil, Zoloft), have side effects that have a negative impact on women's libidos. Wellbutrin SR is a possible alternative, as it does not seem to cause sexual problems. Serzone, Remeron and Luvox may not cause problems with sexual desire either.

In addition, birth control pills, mood stabilizers, tranquilizers and other medications have been shown to decrease libido. If you notice a drop in your sexual desire around the time you start a new medication, talk to you doctor to see if there is a connection. Do not stop taking any medication without talking to your doctor first.

What is the Difference Between Sexual Arousal and Sexual Desire?

In most women who are not experiencing sexual problems, libido and arousal are closely related and difficult to separate. Libido refers to a baseline interest in sex and might be redefined as sexual appetite. Arousal refers to the physiological response to sexual stimuli. Women with higher libidos generally have a greater response to sexual stimuli, or greater arousal. Physical manifestations of sexual arousal include vaginal lubrication and increased blood flow to the labia, clitoris and vagina.

What Can Increase Sexual Arousal in Women?

One of the symptoms of decreased sexual arousal in women, is a reduced amount of vaginal lubrication. Over-the-counter vaginal lubricants can augment lubrication. If a decrease in vaginal lubrication has been caused by menopause, hormone replacement therapy can help. This is the only approved drug therapy for this disorder.

Viagra (sildenafil) and a class of medications called alpha-adrenergic blockers, such as Regitine (phentolamine), can also increase the vaginal lubrication response to sexual stimulation. However, it should be mentioned that study after study of Viagra for various female sexual problems have not shown an increase in sexual pleasure in women.

Aside from pharmacologic solutions, women can also choose behavioral therapy to help increase sexual arousal. Such therapy is aimed at enhancing sexual fantasies and focusing one's attention on sexual stimuli. For women in on-going relationships, the therapist would also look into the possibility of communication problems in the relationship, or lack of sexual stimulation by the woman's partner.

What Can Increase Sexual Desire in Women?

At this time, there are no approved drug treatments for low sexual desire. However, a recent study of 66 women, ages 23 to 65, with HSDD for an average of six years, found that Wellbutrin SR may be an effective treatment. Approximately one third of women experienced doubled interest in sexual activity, sexual arousal and sexual fantasies. Although Wellbutrin SR is an antidepressant, the women in this study did not suffer from depression and they did not have relationship difficulties. More studies are needed to support this preliminary data.

There have also been studies that indicate that testosterone can increase sexual desire in women who's low sex drive is a result of the surgical removal of their ovaries. Continual treatment with testosterone does have side effects and may lead to "masculine" side effects in some women (i.e., lower voice, hair loss, enlarged clitoris).

Another factor to consider is that for some women, feelings of guilt and shame learned in early childhood may interfere with adult sexual function and may affect one or more phases of the sexual response cycle. In these instances, as well as in cases of sexual abuse, psychotherapy may be beneficial. Marriage counseling or couples therapy can also be of value.

What Can Cause Lack of Orgasm?

The inability to achieve orgasm (anorgasmia) can be caused by a number of factors, both physical and psychological in nature. Lack of adequate stimulation, acute stress, anxiety, as well as depression, pain during sexual intercourse, and relationship problems can all interfere with the ability to experience orgasm. Other health conditions, such as incontinence, can cause problems too.

Everyday stress and the many roles and responsibilities women deal with can result in distractions, making orgasms more difficult to achieve. In addition, cultural and religious prohibitions may result in anorgasmia (possibly related to a heightened sense of guilt).

Fortunately, there are very good self-help books available to assist women in developing skills that will improve their ability to reach orgasm.

Medications can also interfere with the ability to experience orgasm. Many antidepressants, including Prozac, Zoloft and Paxil have a high propensity to cause such problems. In addition, antipsychotic drugs such as Haldol, Thorazine and Mellaril can cause inability to reach orgasm and Valium may delay orgasm. Fortunately there are other antidepressants (Wellbutrin SR) and antipsychotic drugs (Zyprexa and Seroquel), which don't seem to cause inability to experience orgasm. Antihypertensive drugs may also interfere with orgasm.

Any disease, such as multiple sclerosis, that interrupts the nerve supply to the genitals may cause lack of orgasm.

Why Is Sexual Intercourse Painful

There are many treatments available. Your doctor will work with you to find a solution to your problem.

A number of conditions may cause pain and /or discomfort during sexual intercourse. These conditions include:

Vaginal Infection

Certain vaginal infections such as vaginal yeast infections and trichomoniasis are often present without noticeable symptoms. However during sexual intercourse, the rubbing motion of the penis against the vagina and genitalia sometimes causes the symptoms of these vaginal infections to intensify causing stinging and burning. Genital herpes sores are another frequent cause of pain during sex.

Vaginal Irritation

Many products contain irritants which can cause vaginal irritation leading to discomfort or pain during vaginal sexual intercourse. These include:

Any contraceptive foams, creams, or jellies
Allergic reactions to condoms, diaphragms, or latex gloves
Vaginal deodorant sprays
Scented tampons
Deodorant soaps
Laundry detergents in sensitive individuals
Excessive vaginal douching

Vaginal Dryness

Vaginal dryness often causes painful sexual intercourse. Normal vaginal lubrication is a given for most women; however, during certain times the vagina may be dry and make vaginal penetration painful. Lack of vaginal lubrication can be caused by several factors including:

Trying to achieve vaginal penetration too fast before enough stimulation has occurred to allow normal vaginal lubrication to take place;
Feeling nervous or tense about the sexual experience can slow down the release of vaginal lubrication;
Using a condom may make vaginal intercourse difficult without the addition of a vaginal lubricant such as AstroGlide, K-Y Jelly, and other products. Saliva is an acceptable for vaginal lubrication; however, never use a petroleum-based product such as Vaseline (petroleum products can cause deterioration of condoms and also may create a breeding ground for vaginal infections)
Hormonal imbalance during menopause or the years preceding menopause can cause vaginal dryness, as can hormonal imbalance following childbirth. This hormonal imbalance is caused by a decrease in normal estrogen levels which can cause the walls of the vagina to become dry. Women experiencing vaginal dryness for these reasons should use one of the vaginal lubrication methods listed above. Women in menopause with severe vaginal dryness should talk to their health care provider about a prescribed estrogen cream to be used vaginally.

Vaginal Tightness

Occasionally this happens when you feel tense, or are not fully relaxed when penetration occurs. Difficulty penetrating a tight vagina can happen even when vaginal lubrication is not a problem. Often, the first few times you engage in sexual intercourse, the vagina may be tight due to an unstretched hymen and cause pain at the time of penetration.

Sometimes a more severe condition called vaginismus is responsible for vaginal tightness; women with vaginismus experience strong, involuntary muscle spasms of the vaginal muscles during sexual intercourse or vaginal penetration by any object including fingers and tampons.

Pain of the Clitoris

The clitoris is the most sensitive part of the female genitalia. Gentle touching or rubbing of the clitoris is extremely pleasurable for some women, while for others it is unbearably painful. Clitoral pain may also occur due to poor hygiene; vaginal secretions may collect under the clitoral hood and if not carefully washed away may lead to pain.

Pelvic Pain

Occasionally a women will experience pelvic pain upon deep, thrusting penetration. Many conditions may cause this pain including:

Tears in the ligaments that support the uterus (causes include problems during childbirth, inappropriately performed abortion, previous violent sexual intercourse or rape)
Cervical, uterine, or tubal infections such as pelvic inflammatory disease (PID)
Pelvic adhesions (often the result of previous pelvic surgery or PID)
Endometriosis
Ovarian cysts
Uterine fibroid tumors

Vulvodynia is a painful, and often hard to diagnose, chronic condition that causes a burning and/or stinging sensation of the vulva and vagina.

Pain and / or discomfort is never part of normal sexual intercourse. If you experience pain during sex, don't be afraid to tell your partner who has no way of knowing that you're uncomfortable unless you talk about what you're feeling. Also make sure to see your doctor for diagnosis and treatment of the underlying cause.

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