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Low Libido in Women

Libido, better known as sexual desire or drive
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Libido, better known as sexual desire or drive, indicates an adult woman’s general health [1]. Libidos are instinctual urges, naturally present for all species to procreate and pass their genetic material to future generations. More importantly, libidos are also pertinent in maintaining a healthy relationship and sustaining a romantic bond with your sexual partner. 

Low libido 
Low libido can be understood as the lack of sexual drive or interest.

Multiple pieces of literature [2] have raised the occurrence of lower libido in Asian women. These are often related to conservatism in Asian society. In the case of Singaporean women, however, it may be fair to deduce that they are more sexually empowered to treat lowered libido proactively. 

A recent study [3] indicated that over half of middle-aged women in Singapore are sexually active; however, many are challenged with sexual dysfunction [4], such as loss of libido. A study [5] by  KK Women's and Children's Hospital also revealed low sexual desire and rarely reaching orgasm are commonly reported forms of sexual dysfunction in women. In this article, we take a deep dive into the issue of low libido and how you may overcome it. 

The science of libido

Libido differs from one individual to another, with many factors contributing to the phenomenon. Women exhibit different levels of libido at different ages, some attributed to natural biological changes and others due to factors unrelated to bodily changes. Symptoms of low libido may include:

  • Sudden disinterest in sexual activity 
  • Lack of sexual thoughts or fantasies 
  • Difficulty feeling aroused 
  • Inability to orgasm 

Biologically, changes in libido are often due to changes in hormones, such as the gonadal hormone [6], which plays a primary role in maintaining libido. Additionally, the hormones androgen [7], oestrogen [8], and testosterone [9] also play an important role in sexual function. Regulated hormone is important as it fuels a woman's psychosexual stimulation and increases sensitivity and blood flow (important in pleasure sensory). 

At different ages, the levels of these hormones may fluctuate, providing some rationale for varying levels of libido in women. Below are general characteristics of libido levels at different stages. 

Age groupCharacteristics 
20-30High biological drive to reproduce but modest levels of sexual drive Women tend to be more selective about when and whom to reproduce with within these age groups (high sexual selection cognition) [10]
31-44Decline of fertility begins Women’s sexual desire tends to become heightened Women tend to have more sex in these age groups 
45 and aboveA decrease in sexual drive is observed as oestrogen levels begin to drop Progressive decrease in libido as women undergo perimenopausal symptoms Libido in these age groups is mostly mind-induced versus biologically driven 

Biopsychosocial elements of low libido: What causes low libido among women?

While libido patterns can be explained by age group and biological change, many can testify that these do not hold true. This is because libido is not just a biological occurrence but a culmination of biopsychosocial aspects.

It is natural and expected that most women have fluctuating changes in their sexual desires throughout their lifetime. Apart from naturally occurring biological changes in your body, some factors that may affect your libido include: 

Biological factors: 

  • Pregnancy: lower libido among postpartum mothers is a rising concern. While hormonal changes can rationalise these changes, low libidos can be due to fatigue and heightened stress levels affiliated with lifestyle changes. 
  • Sexual dysfunction: issues such as vaginismus [11] (fear of vaginal penetration) and dyspareunia [12] (painful intercourse) tend also to lower libido and obstruct the ability to orgasm. 
  • Underlying health conditions: low libidos can occasionally be secondary symptoms of chronic conditions, including hypertension, diabetes, rheumatoid arthritis, heart disease, stroke, cancer, and some gynaecological conditions. 
  • Medications: certain medications, such as antidepressants and oral contraceptives, can also reduce sexual drive. 
Postpartum mother
Fatigue and stress among postpartum mothers can be a factor of low libido.

Psychological factors: 

  • Mental health: mental health issues such as depression and anxiety tend to significantly lower libido in women. This is also commonly seen among mothers dealing with postpartum depression [13].
  • Low self-esteem: physical insecurities such as body dysmorphia can lower libido. New mothers tend to also have reduced self-esteem from self-consciousness of their post-partum bodies. 
  • Infidelity and trust: women tend to have reduced libido when trust is breached [14] in relationships. Even if one may want to emotionally overcome prior infidelity events, mental resistance tends to be persistent unconsciously. 
  • Sexual oppression: shame and guilt attached to sex [15] due to negative connotations with sex lowers libido in women even if there are no significant biological changes. Oppression can come from sexual trauma, sexual disempowerment, and former sexual abuse. 
Infidelity
Issues such as prior infidelity can lower libido among women.

Social factors: 

  • Career and education: in their 20s, women tend to feel more insecure about their career and education prospects. These insecurities tend to be transmuted [16] as a lack of sexual desire. Simply put, prioritising personal development manifests as a lack of sexual enthusiasm in younger women. 
  • Sexual conservatism: one may even observe a lack of libido among those who practice conservatism in their sexual lives. These are usually conscious choices by individuals. Sexual conservatism is also prevalent in more religious communities and societies. Often a choice, sexually conservative women are not phased by lowered libido. 

Is there treatment for women with low libido?

Depending on the exact cause of your low libido, the approach to remedy your sexual drive varies. Low libido in women is usually a complex case. Your healthcare provider may offer multifaceted treatment and management upon understanding your condition. Below are some approaches you may take to solve libido issues: 

1. Medical intervention for low libido: How is low libido diagnosed?

Women must conduct routine screening and gynaecological health check-ups to truly understand if there are biological changes in their bodies. For instance, regular screening may reveal thyroid disorders as a source of hormone dysregulation and lowered libido. Similarly, you may also obtain insight into other underlying health conditions or medications masking as a lowered libido issue. 

Sexual dysfunction issues can also be addressed at your nearest sexual health clinic under the surveillance of a registered medical professional. Issues may include fear of penetration, painful sex, and inability to orgasm. With a health professional such as a gynaecologist, you can reduce trial-and-error roulette and get to the crux of the issue. 

Where biological issues are present, your partner may also be able to empathise if they are provided with rational justification of what is behind your lowered sexual interest. This will also avoid straining romantic relationships. 

2. Addressing mental barriers pertaining to lowered libido: Can therapy help libido?

Psychological factors can be just as detrimental to your libido and need not be a life sentence.  Therapies such as Cognitive Behavioural Therapy (CBT) [17] and mindfulness-based therapy (MBT) [18] have been proven scientifically efficient [19] in addressing low libido. If you have not been diagnosed with mental health conditions, one can also perceive this as an opportunity to seek psychological intervention. 

It is essential for mothers with postpartum depression to seek psychological help. Whilst lower libido may strain your relationship, there are also risks to your child's development. Interventions [20] may include pharmacological, psychotherapeutic, and nonpharmacologic options. 

If infidelity issues have occurred, you and your partner may attempt couple counselling or marital counselling for assistance in repairing the relationship. A study [21] has shown that whilst couples with infidelity are significantly distressed and depressed initially, couple therapy intervention induced improvement for up to 6 months posttherapy with optimistic results. 

Couple therapy
Couple therapy can be a powerful tool in addressing low libido issues.

3. Holistically improving your libido: Can food and lifestyle increase sex drive?

There are some lifestyle changes you may attempt to address low libido at home. We suggest implementing these changes only if no significant medical or psychological issues impact your libido. Lifestyle changes includes: 

  • Aphrodisiac diets: increase the consumption of food that increases female libido. Also known as aphrodisiacs [22], these are foods rich in vitamins, antioxidants, magnesium, zinc, iron, and other microminerals. Scientifically backed aphrodisiacs include maca, ginkgo biloba, saffron, fenugreek, and red ginseng. 
  • Stress management: incorporating healthy stress management techniques [23] such as exercising, uptaking yoga and meditation, journaling, and spending more time in nature can improve your mood dramatically, promising an improved libido. 
  • Prioritising sleep: poor sleep will undeniably drive lower sex [24] even if other aspects of your life are in order. There are various tips on improving sleep quality that you can attempt, especially if you are a parent of a newborn [25]. Try getting quality sleep before self-diagnosing with lowered libido.  
Aphrodisiacs
Foods such as fenugreek and maca are scientifically proven to increase libido.

Can women take the blue pill to improve low libido?

There has been a rise in women attempting to self-medicate for lowered or loss of libido. This includes an increased demand for blue pills also known as sildenafil (Viagra) [26]. Sildenafil is approved by the FDA (US Food and Drug Administration) and permitted for use for erectile dysfunction in men. However, it is not approved for use by women in Singapore due to associated risks and complications, which include: 

  • Headaches
  • Nasal congestion
  • Flushing
  • Visual disturbances
  • Indigestion
  • Palpitations
Blue pills
Blue pills known as Viagra are not medically approved to treat low libido in women.

Should I see my doctor if I struggle with libido loss?

It would be necessary for you to seek a doctor when libido loss becomes a persistent issue (over a month) and is causing you distress. Loss of libido may mean an increase in the possibility of a Hypoactive Sexual Desire Disorder [27] (HSDD) diagnosis. The key difference between low libido and HSDD is that the latter causes significant distress and lowered quality of life. Additionally, HSSD patients may even feel distressed at the thought of sex and can be averse to even self-pleasing. 

If suspected of HSDD, you will be referred to a gynaecologist and sexual health clinic. Further investigations will be conducted to identify the classification of libido loss, which includes genito-pelvic pain/penetration disorder (GPP/PD), sexual interest or arousal disorder, or a female orgasmic disorder.

Conclusion 

If you are struggling with a loss of libido, visit your nearest sexual health clinic for appropriate medical intervention. Attempting to self-medicate may worsen your condition or delay detection of serious health conditions. Remember, working to address your libido is healthy and should not be associated with guilt or shame. 

We hope this article has empowered you to make the best choices for your sexual health. Our vision is that issues pertaining to lowered libido or libido loss garner greater momentum in Singapore and other Asian nations. Contrary to traditional beliefs, a great sexual life is as important to women as to men. 

Reference 

  1. Meštrović, Dr.T. (2021) What is libido?, News Medical. Available at: https://www.news-medical.net/health/What-is-Libido.aspx (Accessed: 01 September 2023).
  2. Ganesan , A. et al. (2019) Ethnic differences in visual attention to sexual stimuli among Asian and white heterosexual women and men, Science Direct . Available at: https://www.sciencedirect.com/science/article/abs/pii/S0191886919305628 (Accessed: 01 September 2023).
  3. Logan, S. et al. (2021) Sexual inactivity and sexual dysfunction in midlife Singaporean women ..., MATURITAS.ORG. Available at: https://www.maturitas.org/article/S0378-5122(21)00122-5/fulltext (Accessed: 01 September 2023). 
  4. Hatzimouratidis, K. and Hatzichristou, D. (2007) Sexual dysfunctions: Classifications and definitions, The Journal of Sexual Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/17233791/#:~:text=The%20four%20major%20categories%20of,%2C%20orgasm%2C%20and%20sexual%20pain. (Accessed: 01 September 2023).
  5. Loy, S.L. et al. (2021) Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: A prospective preconception cohort study - BMC pregnancy and childbirth, BMC Pregnancy and Childbirth . Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03892-5 (Accessed: 01 September 2023).
  6. Hines, M. (2009) Gonadal Hormones and Human Sexuality’. Available at: https://academic.oup.com/book/9978/chapter/157345062 (Accessed: 01 September 2023).
  7. Wåhlin-Jacobsen , S. et al. (2015) Is there a correlation between androgens and sexual desire in women?, The journal of Sexual Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/25475395/ (Accessed: 01 September 2023).
  8. Nichols , H. (2023) Estrogen: Functions, uses, and imbalances, Medical News Today. Available at: https://www.medicalnewstoday.com/articles/277177 (Accessed: 05 September 2023).
  9. Testosterone therapy for women: Can it improve your sex life? (2019) Women’s Health . Available at: https://www.health.harvard.edu/womens-health/testosterone-therapy-for-women-can-it-improve-your-sex-life#:~:text=But%20testosterone%20is%20also%20a,%2C%20depression%2C%20or%20vaginal%20dryness. (Accessed: 01 September 2023).
  10. Maner, J.K. and Ackerman, J.M. (2015) Sexually selective cognition, Science Direct . Available at: https://www.sciencedirect.com/science/article/abs/pii/S2352250X14000359 (Accessed: 01 September 2023).
  11. Vaginismus (2021) NHS choices. Available at: https://www.nhs.uk/conditions/vaginismus/#:~:text=What%20is%20vaginismus%3F,have%20no%20control%20over%20it. (Accessed: 01 September 2023).
  12. Mayo Clinic Staff (2022) Painful intercourse (dyspareunia), Diseases and Conditions . Available at: https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967 (Accessed: 01 September 2023). 
  13. Mayo Clinic Staff (2022) Postpartum depression, Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617 (Accessed: 01 September 2023). 
  14. Rokach, A. and Chan, S.H. (2023) Love and infidelity: Causes and consequences, U.S. National Library of Medicine I. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10002055/ (Accessed: 01 September 2023). 
  15. Woo, J.S., Brotto, L.A. and Gorzalka, B.B. (2011) The role of sex guilt in the relationship between culture and women’s sexual desire, U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/20349208/#:~:text=A%20large%20body%20of%20literature,constructs%20such%20as%20sex%20guilt. (Accessed: 01 September 2023). 
  16. Domenighetti , G. et al. (2009) Impact of job insecurity on sexual desire: An exploratory analysis, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/19705309/ (Accessed: 01 September 2023). 
  17. Cleveland Clinic Medical Professional (2022) Cognitive behavioral therapy (CBT): What it is & techniques, Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/treatments/21208-cognitive-behavioral-therapy-cbt#:~:text=Cognitive%20behavioral%20therapy%20(CBT)%20is,coping%20with%20grief%20or%20stress. (Accessed: 01 September 2023). 
  18. Schimelpfening, N. (2023) How mindfulness-based cognitive therapy works, Verywell Mind. Available at: https://www.verywellmind.com/mindfulness-based-cognitive-therapy-1067396 (Accessed: 01 September 2023). 
  19. Meyers, M., Margraf , J. and Velten, J. (2023) Subjective effects and perceived mechanisms of change of cognitive behavioral and mindfulness-based online interventions for low sexual desire in women, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/37260167/ (Accessed: 01 September 2023). 
  20. Fitelson, E. et al. (2010) Treatment of postpartum depression: Clinical, psychological and  pharmacological options, U.S. National Library of Medicine . Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003/ (Accessed: 01 September 2023). 
  21. Atkins, D.C. et al. (2010) Outcomes of couples with infidelity in a community-based sample of couple therapy, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/20438197/ (Accessed: 01 September 2023).
  22. Petre, A. (2023) 7 aphrodisiac foods that boost your libido, Healthline. Available at: https://www.healthline.com/nutrition/aphrodisiac-foods#1.-Maca (Accessed: 01 September 2023).
  23. Scott, E. (2022) 18 highly effective stress relievers, Verywell Mind. Available at: https://www.verywellmind.com/tips-to-reduce-stress-3145195 (Accessed: 01 September 2023).
  24. Kalmbach, D.A. et al. (2015) The impact of sleep on female sexual response and behavior: A pilot study, U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/25772315/ (Accessed: 01 September 2023).
  25. Garone, S. (2019) Sleep consultants tell us how to survive the newborn days, Healthline. Available at: https://www.healthline.com/health/sleep-consultants-share-tips-for-new-parents (Accessed: 01 September 2023).
  26. Sildenafil: Medlineplus drug information (2023) MedlinePlus. Available at: https://medlineplus.gov/druginfo/meds/a699015.html (Accessed: 01 September 2023).
  27. Sissons, B. (2023) Hypoactive sexual desire disorder (HSDD): What to know, Medical News Today. Available at: https://www.medicalnewstoday.com/articles/hypoactive-sexual-desire-disorder (Accessed: 01 September 2023). 

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