What are the treatment options for female low libido?

Treatment Options for Female Low Libido

The management of female low libido should follow a multidimensional approach including psychosexual counseling, lifestyle modifications, and pharmacological interventions based on the specific type of sexual dysfunction identified. 1

Evaluation of Female Sexual Dysfunction

Before initiating treatment, a thorough evaluation should include:

• Assessment of potential underlying causes:

  • Psychosocial factors (anxiety, depression, relationship issues)
  • Medications that affect sexual function (especially hormone therapy, narcotics, SSRIs)
  • Traditional risk factors (cardiovascular disease, diabetes, obesity, smoking, alcohol use)
  • Menopausal status and symptoms
  • Physical examination to identify points of tenderness, vaginal atrophy, or anatomical changes

• Validated assessment tools:

  • Brief Sexual Symptom Checklist for Women
  • Female Sexual Function Index 2

Non-Pharmacological Interventions

First-Line Options:

• Lifestyle modifications:

  • Regular physical exercise to improve sexual function 1, 3
  • Stress reduction techniques including yoga and meditation 2, 3
  • Addressing relationship issues through open communication

• Vaginal moisturizers and lubricants:

  • Water-, oil-, or silicone-based products for vaginal dryness and sexual pain 2
  • Regular use of non-hormonal moisturizers for transient improvement in vaginal symptoms 2

• Psychotherapy:

  • Cognitive behavioral therapy has shown efficacy in survivors of breast, endometrial, and cervical cancer 2, 1
  • Sexual/couples counseling when relationship factors contribute to low libido

• Pelvic floor physical therapy:

  • May improve sexual pain, arousal, lubrication, orgasm, and satisfaction 2
  • Particularly beneficial for women with concurrent pelvic floor dysfunction 1

Pharmacological Interventions

Hormonal Options:

• Vaginal estrogen (pills, rings, or creams):

  • Effective for treating vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal women 2
  • Consider risks/benefits in women with history of hormone-sensitive cancers 2, 1

• DHEA (prasterone):

  • FDA-approved for vaginal dryness/pain 2, 1
  • May be considered for women with low libido 1

• Testosterone therapy:

  • May be effective for postmenopausal women with low desire 1
  • Not FDA-approved for women but may be used off-label 1
  • Limited long-term safety data available

Non-Hormonal Medications:

• Flibanserin (Addyi):

  • FDA-approved for premenopausal women with acquired, generalized hypoactive sexual desire disorder 2, 1, 4
  • Must be taken daily at bedtime 4
  • Side effects include dizziness, somnolence, nausea, and fatigue 2, 4
  • Contraindicated with alcohol use and certain medications (CYP3A4 inhibitors) 4

• Bremelanotide:

  • Injectable medication for premenopausal women with HSDD 1

• Other medications to consider:

  • Bupropion for low desire 1
  • Buspirone for hypoactive sexual desire disorder 1
  • Ospemifene for dyspareunia in women without hormone-sensitive cancer history 1

Treatment Algorithm

1. Start with non-pharmacological approaches:

   • Address lifestyle factors and relationship issues
   • Provide vaginal moisturizers and lubricants for vaginal symptoms
   • Consider pelvic floor physical therapy if appropriate

2. For persistent symptoms, consider pharmacological options based on menopausal status:

   For premenopausal women:

   • Flibanserin if no contraindications exist
   • Bremelanotide as an alternative

   For postmenopausal women:

   • Vaginal estrogen for vaginal dryness/pain (if no history of hormone-sensitive cancers)
   • DHEA (prasterone) for vaginal symptoms
   • Consider off-label testosterone therapy for low desire

3. For women with concurrent psychological issues:

   • Refer for psychotherapy or sexual/couples counseling
   • Consider medications that may help both mood and sexual function (e.g., bupropion)

Special Considerations

• Cancer survivors:

  • Carefully evaluate risk/benefit ratio of hormonal treatments 2, 1
  • Consider non-hormonal options first
  • For breast cancer survivors, decisions about estrogen therapy should be made by a fully informed patient 1

• Medication review:

  • Consider stopping or switching medications that may contribute to sexual dysfunction, particularly SSRIs/SNRIs 1

• Partner involvement:

  • Include partner in treatment discussions when appropriate and with patient consent 1
  • Address partner's sexual health issues that may impact the relationship

Regular follow-up is essential to monitor treatment efficacy and side effects, particularly with hormonal therapies.