In the privacy of the exam room, I get many a patient complaining that her sex drive is low. They are sometimes embarrased to bring this up but studies show that up to 40% of women in the U.S. report some type of sexual concern so there is no reasoned to be ashamed.

In bringing this up to me, there is often a hope that there is a quick fix - a female viagra or perhpas testosterone - but low libido has many different possible causes. To figure out what may contributing to a particular patient’s situation, we need to spend time discussing her individual circumstances. For instance, there are medications that can depress a woman’s sex drive such as antidepressants or hormonal contraceptives. The patient and her partner may be having conflicts and her decreased desire could be a result of her relationship issues rather than any physical issue. Perhaps her partner is also having decreased desire or sexual arousal issues - this can certainly affect her desire as well. If a woman has pain with sex due to other medical issues, this pain would first need to be addressed and then she may see her libido improve as a result. There are, of course, medical conditions that could contribute to this problem such as thyroid imbalance or “hormone imbalance”. This latter diagnosis is a tough one to make because in pre-menopausal women, the estrogen and progesterone levels fluctuate everyday so we cannot easily determine what levels are normal for any individual women. Testosterone testing is a common request and may be useful to help determine whether testosterone supplementation is worth a try but historically we have counselled women that there is no good data to support prescribing testosterone to treat low libido. Just recently, however, there was a large review of many of the best quality studies on the subject of using testosterone to treat low libido in women and the findings show that there is a significant improvement in libido in the women given testosterone vs. placebo. (https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30189-5/fulltext). This is promising, but the FDA still has not approved testosterone for this purpose so it is important to first try to rule out all other modifiable causes of low libido in a patient before prescribing testosterone.

As you can see, this is a complex subject so I encourage you to make a specific appointment with your doctor to figure out what “treatment” plan might be right for you.