What is the most common cause of decreased libido in women?

Most Common Causes of Decreased Libido in Women

Psychosocial factors, particularly relationship issues, are the most common cause of decreased libido in women, followed by hormonal abnormalities, especially those affecting estrogen and testosterone levels.

Primary Causes of Decreased Libido in Women

Psychosocial Factors

• Relationship issues: Dissatisfaction with relationship or marriage is the most common factor in patients with depressed desire 1
• Psychological factors:
  • Depression and anxiety
  • Chronic stress
  • Negative body image
  • Poor self-esteem
  • Communication problems with partner 2

Hormonal Factors

• Estrogen deficiency:

  • Natural menopause
  • Surgical menopause (oophorectomy)
  • Premature ovarian failure
  • Medications that reduce estrogen levels 2

• Androgen deficiency:

  • Declining testosterone levels with age
  • Surgical removal of ovaries (which produce approximately 50% of female androgens)
  • Adrenal insufficiency 3, 4

Medical Conditions

• Chronic illness:
  • Advanced liver disease - disrupts the hypothalamic-pituitary axis with low follicle-stimulating hormone and luteinizing hormone 2
  • Chronic pain conditions
  • Fatigue-related disorders

Medication Effects

• Medications that commonly reduce libido:
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Spironolactone
  • Beta-blockers
  • Endocrine therapies (e.g., tamoxifen, aromatase inhibitors) 2

Evaluation of Decreased Libido

Screening Tools

• Brief Sexual Symptom Checklist for women 2
• Sexual function checklists included in the NCCN Guidelines for Survivorship 2

Key Assessment Components

1. Sexual history:

   • Onset and duration of decreased desire
   • Relationship context
   • Previous sexual function

2. Medical history:

   • Conditions associated with sexual dysfunction (depression, diabetes, hypertension)
   • Medication review
   • Hormonal status (menopausal state)

3. Laboratory evaluation:

   • Sex hormone levels (estrogen, testosterone)
   • Thyroid function tests 2

Management Approaches

For Psychosocial Causes

• Psychotherapy or sex therapy
• Relationship counseling
• Treatment of underlying depression or anxiety

For Hormonal Causes

• For menopausal symptoms:

  • Vaginal moisturizers and lubricants
  • Topical estrogen therapy (when not contraindicated)
  • Ospemifene for dyspareunia (not for breast cancer survivors) 2

• For low testosterone:

  • Testosterone therapy may be considered in selected cases 3

For Medication-Related Causes

• Medication adjustment when possible
• Change to alternative medications with fewer sexual side effects

Important Considerations and Pitfalls

• Relative nature of libido: Decreased libido is relative and depends on the patient's definition, not on an absolute standard 1

• Multiple contributing factors: Sexual dysfunction is often multifactorial, requiring attention to biological, psychological, and relationship factors 3

• Age-related changes: The role of hormones in sexuality declines with age, and sexuality becomes more mind-induced, though some aspects remain hormone-dependent 4

• Special populations: Women with chronic conditions like liver disease or cancer survivors may have unique contributing factors to decreased libido that require specialized approaches 2

• Avoid assumptions: Do not assume that all sexual dysfunction is psychological in nature; always consider potential organic causes

By addressing the most common causes of decreased libido in women through a structured evaluation and targeted interventions, clinicians can help improve sexual function and quality of life for their patients.