From the Guidelines
The medical workup for low libido in females with normal menstrual cycles should begin with a comprehensive history and physical examination to identify potential underlying causes, and initial laboratory tests should include complete blood count, comprehensive metabolic panel, thyroid function tests, prolactin level, and sex hormone levels including estradiol, testosterone, and sex hormone-binding globulin, as recommended by the most recent guidelines 1. The workup should also address psychosocial factors, as stress, relationship issues, and past trauma significantly impact sexual desire, often requiring referral to a sex therapist or psychologist for optimal management.
- Initial steps in the workup include:
- Comprehensive history and physical examination
- Laboratory tests: complete blood count, comprehensive metabolic panel, thyroid function tests (TSH, free T4), prolactin level, and sex hormone levels including estradiol, testosterone, and sex hormone-binding globulin
- Screening for depression using validated tools like the PHQ-9
- Assessment of relationship factors
- Evaluation for medication side effects, particularly from hormonal contraceptives, antidepressants, or antihypertensives
- If testosterone levels are low, a trial of testosterone therapy might be considered, typically starting with transdermal testosterone 300-450 mcg daily, though this remains off-label in many countries 1.
- For patients with depression contributing to low desire, appropriate antidepressant therapy should be initiated, potentially considering bupropion (150-300 mg daily) which has fewer sexual side effects than SSRIs 1.
- Flibanserin 100 mg daily at bedtime may be prescribed for premenopausal women with hypoactive sexual desire disorder, though its efficacy is modest and side effects include hypotension, especially when combined with alcohol 1.
- Other options for survivors with low or lack of desire, libido, or intimacy include off-label use of bupropion and buspirone, as well as pelvic physical therapy and integrative therapies like yoga and meditation 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medical Workup for Low Libido in Females with Normal Menstrual Cycles
The medical workup for low libido in females with normal menstrual cycles involves a comprehensive approach to identify the underlying causes of the condition. Some key points to consider include:
- A complete history and physical examination are essential in evaluating women with sexual complaints or concerns 2
- Laboratory evaluation is rarely helpful in guiding diagnosis or treatment, but may be indicated in women with abnormal physical examination findings or suspected comorbidities 2
- The PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) or ALLOW (Ask, Legitimize, Limitations, Open up, Work together) method can be used to facilitate discussions about sexual concerns and initiation of treatment 2
Potential Underlying Causes
Some potential underlying causes of low libido in females with normal menstrual cycles include:
- Hormonal imbalances, such as thyroid disorders 3
- Psychopharmacological factors, such as the use of certain medications 4
- Other medical conditions, such as hypothyroidism or hyperthyroidism 3
Diagnostic Approach
The diagnostic approach for low libido in females with normal menstrual cycles may involve:
- A thorough medical history and physical examination 2
- Laboratory tests, such as thyroid function tests 3
- Assessment of psychopharmacological factors, such as the use of certain medications 4
Treatment Options
Treatment options for low libido in females with normal menstrual cycles may include: