What are the ways to improve female libido?

Improving Female Libido: Evidence-Based Approaches

For women experiencing low libido, a multidimensional treatment plan addressing physiological, psychological, and interpersonal factors is recommended, with options including DHEA supplementation, flibanserin for premenopausal women, and various non-pharmacological interventions.

Understanding Female Sexual Dysfunction

• Low sexual desire is the most common female sexual dysfunction and can significantly impact wellbeing and relationship satisfaction 1
• Causes are multifactorial and may include physiological changes, psychological factors, relationship issues, medications, and lifestyle factors 2, 3
• Sexual dysfunction is often characterized by problems related to desire, arousal, orgasm, and pain 4

Assessment Considerations

• Identify prescription medications that may contribute to sexual dysfunction, particularly hormone therapy, narcotics, beta blockers, and SSRIs 4
• Evaluate traditional risk factors such as cardiovascular disease, diabetes, obesity, smoking, and alcohol use 4
• Consider menopausal status and symptoms, as vaginal dryness and other menopausal changes can significantly impact sexual function 4, 3
• Assess for psychological factors including anxiety, depression, body image concerns, and relationship issues 4, 3

Pharmacological Interventions

For Premenopausal Women:

• Flibanserin (Addyi) is FDA-approved for acquired, generalized hypoactive sexual desire disorder in premenopausal women 5
  • Dosage: One 100mg tablet daily at bedtime 5
  • Mechanism: Acts on serotonin receptors (5-HT1A agonist and 5-HT2A antagonist) 5
  • Limitations: Not indicated for postmenopausal women or to enhance sexual performance 5
  • Caution: Avoid alcohol use due to risk of severe hypotension and syncope 5

For All Women:

• DHEA (prasterone) can be considered for improving sexual desire and function 6

  • Typical dosing: 10-50mg daily, with 25mg as a common starting dose 6
  • Has shown significant improvements in sexual desire, arousal, pain, and overall sexual function 6, 4
  • Use with caution in survivors of hormone-sensitive cancers, particularly those on aromatase inhibitors 6

• Other medications that may be considered for low desire include 4:

  • Androgens
  • Bupropion
  • Buspirone
  • Bremelanotide (newer option)

Non-Pharmacological Approaches

Addressing Vaginal Symptoms:

• Vaginal moisturizers and lubricants for vaginal dryness and sexual pain 4

  • Water-, oil-, or silicone-based options available
  • Can be used regularly (moisturizers) or during sexual activity (lubricants)

• Topical treatments for vaginal health 4:

  • Vaginal gels, oils, topical vitamin D or E
  • Topical anesthetics for pain during sexual activity

• Vaginal dilators for pain with sexual activity or vaginal stenosis 4

• Pelvic physical therapy (pelvic floor muscle training) to improve sexual pain, arousal, lubrication, orgasm, and satisfaction 4, 6

Psychological and Behavioral Interventions:

• Cognitive behavioral therapy (CBT) has shown effectiveness for improving sexual function, particularly in cancer survivors 4, 7

• Integrative therapies including yoga and meditation may help alleviate anxiety and improve sexual function 4, 1

• Mindfulness and psychoeducation have excellent evidence for improving low sexual desire 7

• Lifestyle modifications that can enhance sexual wellbeing 1:

  • Regular exercise
  • Stress management
  • Adequate sleep
  • Healthy diet

• Sexual aids such as vibrators or clitoral stimulatory devices may help with orgasmic difficulties 4

Special Considerations

• For postmenopausal women: Consider transdermal testosterone for low desire, which has supporting evidence 7

• For cancer survivors: Treatment should be guided by cancer type and treatments received, with caution regarding hormone therapies for survivors of hormone-sensitive cancers 4

• For women with partners: Address partner-related issues, including erectile dysfunction in male partners, which can contribute to low libido 3

• For women with psychological distress: Treat underlying anxiety, depression, or other psychological concerns that may be contributing to sexual dysfunction 4

Common Pitfalls to Avoid

• Attributing low libido solely to "normal aging" or menopause without addressing treatable underlying causes 3
• Failing to address the multifactorial nature of sexual dysfunction 4
• Not discussing sexual health concerns during medical appointments, which can be isolating for patients 1
• Using hormonal treatments without considering contraindications in patients with hormone-sensitive cancers 4, 6
• Neglecting the importance of open communication between partners regarding sexual concerns 3