libido

Here’s a topic nobody ever really talks about: low libido in women. Although many moms go through a dry spell after childbirth, I’m talking about a diagnosed sexual dysfunction — a problem that goes much deeper and can last much, much longer. Isabella O., a small business owner in New York City,  says she had low sexual desire for 8 years before receiving the proper treatment. “I knew something was wrong because I have always really loved sex,” she says. “My partner could tell right away, too.” Isabella says she scheduled sex with her husband at least twice a week, despite her low libido, but it wasn’t until her doctor put her on hormone therapy and gave her a new FDA approved drug called Addyi that she started feeling turned on again. “Sex is now more basic, simple, natural, spontaneous, lustful and raw,” she says. “I feel more alive and connected to love, which is a feeling I have longed to feel for a very long time.”

We spoke with Leah Millheiser, MD, Clinical Assistant Professor and the Director of the Female Sexual Medicine Program in the Department of Obstetrics and Gynecology at Stanford University Medical Center, to find out a little bit more about what hypoactive sexual desire disorder is and what the treatment options are. If you are experiencing symptoms and wonder if you might be among the 1 in 15 women affected, please take a look at the information below.

What is hypoactive sexual desire disorder (HSDD)?

HSDD is a chronic sexual dysfunction characterized by a lack of (or significant decrease in) sexual desire, in women who previously had a normal sex drive. “It is not a disease, but an imbalance in the brain,” says Dr. Millheiser, specifying that the neurohormones (hormones that are produced by nerve cells and released into the blood) are out of balance. It all comes down to three hormones: dopamine, norepinephrine, and serotonin. The higher those hormone levels are the more sex drive a woman is likely to have. 

Who is most affected by HSDD?

“It can affect anyone,” says Dr. Millheiser. “Women who are married or not. Women of all ages, races, and ethnicities. Women who are pre- or post-menopausal. It doesn’t discriminate.” Men can also be affected by HSDD, however, men are more likely to experience erectile dysfunction whereas about 1 in 15 women are affected by HSDD. One of the first side effects of SSRIs (antidepressants) is that the sex drive will diminish, and that can lead to HSDD. Nursing moms can be affected, due to the fact that breastfeeding can cause dryness and low libido. Dr. Millheiser makes a point of clarifying that this is more than a simple case of women feeling stressed out and tired from work and having the occasional decrease in sexual appetite. “This is a woman who, for 6 months, is experiencing a lack or significant decrease in sexual desire. It doesn’t get better with flowers or jewelry. It is a persistent problem.”

What are the symptoms?

Symptoms are centered on a decrease in sexual desire. When a woman has HSDD she’s not only not in the mood for sex, but also doesn’t think about it, fantasize or initiate sex, and may be disgusted by the idea of sex. Women experiencing HSDD may also find intercourse physically painful, boring, or traumatic.

What are the results of HSDD?

It can impact the overall quality of life. “A woman experiencing HSDD doesn’t perform as well at work, nor have the same relationship with friends and family,” explains Dr. Millheiser. Her body image changes.”  What starts out as a woman having little interest in sex gradually develops into a feeling that her body isn’t waking up to sexual arousal. This lack of sexual desire can cause friction in relationships as well as impact self-esteem and confidence.

How is HSDD treated?

With an in-depth interview (used to rule out external factors such as relationship issues, medications, or medical conditions), your doctor will determine if you have HSDD or just low desire. If it is truly HSDD, ask your doctor about natural estrogen treatments, as some women respond well to hormonal therapies, but many doctors are recommending Flibanserin, or Addyi, (a drug approved by the FDA in the fall of 2015). Addyi is very successful in treating pre-menopausal women with HSDD, says Dr. Millheiser. It will regulate your neurotransmitters and thereby increasing your sexual mood, with a low chance of side effects, she explains. Addyi is sometimes referred to as “the female Viagra,” however, Dr. Millheiser explains that Viagra works by increasing the blood flow to the genitals whereas Addyi treats the brain. 

What if it’s just low desire?

Low desire must be treated with a multidisciplinary approach. “Some women in a relationship for 25 to 30 years just aren’t excited anymore,” says Dr. Millheiser. She suggests that couples find ways to spice things up by using sex toys, changing up the location for sex, and making sure they’re reconnecting by going on dates.

Here’s the thing: A lot of women are affected by hypoactive sexual desire disorder. Nobody wants to experience low (or no) sexual appetite or have to talk about it, but if HSDD is something you are going through, you have to be proactive about it. “Don’t wait for the doctor to ask you,” urges Dr. Millheiser. “Feel empowered to bring up your low desire.” Even if it may be an uncomfortable interview with your doctor, it could significantly increase your quality of life.

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