Navigating Low Libido: Insights & Solutions for Women

Without question, one of the most important factors behind the quality of a woman’s sex life is this: you have to want it.

Unfortunately, 40-70% of women experience low sexual desire - also called low libido - at any given time. According to women’s healthcare nurse practitioner Kelly Tull of Baystate OB/GYN Group, “Low sex drive is very, very common in women and the reasons for it are as varied as the individuals affected by it.”

While it’s common in the first year after childbirth and during both the peri- and post-menopausal stages of life, low libido can occur at any time and to anyone. “The key thing to understand is that a low sex drive doesn’t mean you’re broken,” stresses Tull. “In fact,” she adds, “it’s probably one of the most ‘normal’ experiences in every woman’s life.”

What’s Behind a Low Libido in Women

One of the challenges of addressing sexual dysfunction in women is that sexual arousal has both mental and physical components.

“Unlike the 75% of men who can experience spontaneous sex desire or interest in sex with little to no stimulation,” says Tull, “eighty-five percent of women must receive some type of stimuli to essentially awaken desire within themselves.”

Tull notes that most women begin a sexual encounter in a neutral state. “If they receive the appropriate stimuli in the right context, they can move from a neutral to an aroused state. Many people think stimuli is key to arousal, but I’d argue context comes first.”

As an example, Tull cites two scenarios, the first of which has a woman relaxed and reading a book in a quiet household. “Her partner may stroke her arm or neck. She may be moved to an aroused state by the touch and find herself responding with desire. Now, compare this to the woman who has just gotten home from work, needs to get dinner on the stove, run some laundry, spend time with the kids, and put in another hour or so of work before her own bedtime. The same touch from her partner is not likely to generate arousal in this context. In this context, there’s simply too much noise in her head to allow for being receptive to a sexual advance. Without the right context, there is no sexual response and desire.”

Tull stresses, again, that having periods of low sexual desire in your life is completely normal. “At the most basic level, our brains know that food, shelter, and sleep are non-negotiables for life. Sex, however, is not. When life is busy, it’s completely natural to put sex on the back burner.”

Understanding What Drives—and Stalls—Sexual Arousal

While both men and women experience what Tull refers to as accelerators and brakes to arousal, she notes that men tend to be very sensitive and receptive to accelerators while women are more sensitive to brakes.

Accelerators that drive sexual arousal vary between women and change for individual women over time, but common ones include:

• Wanting to be emotionally close or to express love
• Erotic cues
• Visual and other cues
• Romantic cues such as an increased a sense of commitment and bonding
• Shared physical pleasure
• Validation of one’s sense of attractiveness

Common brakes or obstacles to sexual desire in women include:

• Stress
• Low self-esteem
• Anxiety, depression, and mood disorders
• Fear of unwanted pregnancy or sexually transmitted disease
• Lack of intimacy, communication, or compassion
• Fatigue
• Medication*
• Grief
• Sexual trauma
• Pain with intercourse**
• Issues with approach, initiation, or timing

*Tull notes that managing medication and sexual desire can be a challenge. “Medications including ones taken to address common ‘sexual desire brakes’ can decrease sexual desire. These include medications for anxiety, depression, and even some birth control can lower desire levels.” She adds, “If you’re on these medications and having issues with sexual desire, talk to your doctor about alternative medication options.”

**She also stresses that pain during intercourse is not normal. “It’s no wonder that pain during sex drives down desire levels,” says Tull. “The good news is that there are medications and exercises that, for many women, eliminate pain issues and allow them to once again enjoy having sex. If you’re experiencing any pain, be sure to talk to your OB/GYN about it.”

How to Boost Your Sexual Desire

While not as widely known as many of the male pill options for sexual dysfunction, there are several FDA-approved medications to help with female libido. These include:

Addyi: a daily pill, Addyi is the first FDA-approved medication for low libido in women. Users should not consume alcohol while on Addyi and some may experience side effects including dizziness and low blood pressure.

Vylessi: an injectable to be taken 45 minutes before sexual activity, Vylessi may cause side effects including increased blood pressure, nausea, and vomiting

Other medications commonly taken off-label (to treat a condition other than the one they were developed to address) that may help include testosterone and Bupropion. In addition, Tull says that for some women who deal with painful sex due to vaginal dryness, “Vaginal estrogen can be a real game-changer.” In addition, topical ‘scream creams,’ which work to increase blood flow to the vagina and clitoris can be very effective for some women.

“Obviously,” says Tull, “there is no magic pill. What works for one woman, may not work for the next—kind of like turn-ons. If you’re not finding success with medications, or you prefer not to start on medication, there are other options to consider.”

Non-Pharmaceutical Options for Boosting Libido

As with solving any problem, you need to understand the factors contributing to the issue. Tull says, “Sexual desire is no different. Don’t just dismiss low sexual desire as an unsolvable problem. Spend some time considering and understanding what your brakes are and what you can to help you navigate them.”

For example, for women who can’t get turned on because they have a hard time turning off their thoughts, Tull recommends mindfulness practices like meditation and focused breathing. She notes, “There are tons of videos online and even podcasts on how to engage in this type of mindfulness. These practices can also help with stress management, another common hurdle to good sex.”

If meditation is not your thing, Tull notes that simply taking one hour a week for self-care, that is time that’s truly your own to do whatever you enjoy doing, can reduce stress and help you reconnect with yourself.

Lest you forget there’s another person who contributes to your sexual desire and sexual satisfaction, Tull encourages open and regular communication with your partner. “The funny thing is,” says Tull, “is that people often have trouble talking about sex with the person they’re having sex with! But it’s important to communicate what’s holding you back from engaging in sex or what is or is not bringing you pleasure. As we age, our bodies change and how they respond to touch or stimulation also changes. There’s no blame to be placed. Just a discussion about what may work better for you and your partner. If you can frame it not as a problem but rather an opportunity to discover some new approaches and ways to satisfy each other, it can actually be an experience that brings you closer and leaves you both feeling your needs are met.”

Tull often encourages her patients to explore practices to open the doors to sexual exploration, including mirroring (touching your partner where you want to be touched) and sensual touch (caressing the body without leading to sexual activities to help you become more physically present and mindful during actual sex).

“In the same way that there’s no magic pill, there’s no one magic practice that works for everyone,” says Tull. “The important thing is to be open to trying new things until you figure out what works. Again, millions of women struggle with change in levels of sexual desire. The answers and help you need are out there. Just ask.”