Recently I have gotten more questions than usual from my patients about ways to increase sex drive. Libido, or sexual desire, is a complex issue in women, especially compared to men. While in men, arousal disorders are primarily physical problems, treated with medication like Viagra that increase blood flow to the penis allowing for an erection (and solving the problem), in women low libido translates into low desire for sex.
This can have multiple causes: physical, like the vaginal dryness that accompanies menopause; hormonal, or low testosterone; and psychological/emotional, such as discord between you and your partner, or worries about the kids or money or stress from the job, etc. Given this complexity, low sex drive in women can’t be fixed with just a little blue pill.
For menopausal women whose vaginal dryness makes sex painful, treatment with vaginal estrogens can make all the difference in the world. Even using a water-based lubricant or even a household oil like olive or coconut oils can help. For those women who are proven to have low testosterone levels, a very small amount of testosterone can increase desire. The problem with testosterone is there is no FDA-approved medication for women and testosterone can have an adverse effect on cholesterol levels. I feel it is important to check testosterone and cholesterol levels prior to prescribing a supplement. I prescribe a compounded testosterone cream that has fewer adverse effects — and in lower doses — than synthetic testosterones that are available for men.
Counseling can help those women who are having issues in their relationship. Sometimes just talking to your partner and explaining that you are too tired to have sex after working all day, driving the kids to soccer practice all over town, doing laundry and cooking dinner may get you some help with those chores so you have more energy for sex!
There are some drugs that are in development for treating low libido in women. One is called bremelanotide, which is an injection that in a small trial increased arousal and desire. Side effects were fairly mild and included facial flushing, nausea and vomiting — I can see it now, “honey, I want to have sex but first I have to puke!” Two others are Lybrido and Lybridos: both have a low dose of testosterone, with Lybrido containing something similar to Viagra and Lybridos an anti-anxiety type medication. Unfortunately, it will be at least two years before any of these medications have completed the FDA-approval process.
In the meantime, if you are suffering from a case of “not tonight” every night, see your doctor to explore what options are best for you. It isn’t easy as popping a pill, but most of the time a combination of approaches can get you in the mood.
— Dr. Kelly Shanahan is a board-certified gynecologist and owner of Emerald Bay Center for Women’s Health. She can be reached at 530-542-4961 or 775-782-7300 for help in getting your mojo on.