Treatment Options for Female Low Libido
The most effective treatment approach for female low libido involves identifying underlying causes and implementing targeted interventions including both pharmacological and non-pharmacological options based on the specific factors contributing to the sexual dysfunction. 1
Assessment and Evaluation
- Comprehensive evaluation should include screening for psychosocial problems (anxiety, depression, relationship issues, body image concerns) that can contribute to sexual dysfunction 2, 1
- Identify medications that may contribute to low libido, particularly hormone therapy, narcotics, beta blockers, and SSRIs 1, 3
- Evaluate traditional risk factors such as cardiovascular disease, diabetes, obesity, smoking, and alcohol abuse 2, 1
- Consider menopausal status and symptoms, as vaginal dryness and other menopausal changes can significantly impact sexual function 1, 4
- Validated screening tools such as the Brief Sexual Symptom Checklist for Women or the Female Sexual Function Index (FSFI) can help assess sexual function 2
Non-Pharmacological Interventions
- Water-, oil-, or silicone-based lubricants and moisturizers can help alleviate vaginal dryness and sexual pain 2, 1
- Pelvic floor muscle training may improve sexual pain, arousal, lubrication, orgasm, and satisfaction 2, 1
- Vaginal dilators are recommended for vaginismus, sexual aversion disorder, vaginal scarring, or vaginal stenosis 2
- Psychotherapy, particularly cognitive behavioral therapy, has shown efficacy for improving sexual function in women 2, 1
- Lifestyle modifications including regular exercise, stress management, adequate sleep, and healthy diet can enhance sexual wellbeing 1, 5
- Sexual aids such as vibrators or clitoral stimulatory devices may help with orgasmic difficulties 1
Pharmacological Interventions
- Flibanserin is FDA-approved for acquired, generalized hypoactive sexual desire disorder in premenopausal women, resulting in approximately one additional satisfying sexual event every two months 2, 3, 6
- DHEA (prasterone) can be considered for improving sexual desire and function, with typical dosing of 10-50mg daily 1, 7
- Bupropion has shown efficacy for improving desire in some women with and without depression 8
- Ospemifene is approved for treating moderate to severe dyspareunia in postmenopausal women without known or suspected breast cancer 2
- Buspirone may be considered as an option for hypoactive sexual desire disorder 2
Special Considerations
- For cancer survivors, treatment should be guided by cancer type and treatments received 2
- Vaginal estrogen (pills, rings, or creams) has been shown to be effective in treating vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal women without a history of hormone-sensitive cancers 2
- PDE5 inhibitors are not recommended for female sexual dysfunction due to lack of evidence regarding their effectiveness 2, 1
- Hormonal treatments should be avoided in survivors of hormone-sensitive cancers 2, 1
Common Pitfalls and Caveats
- Low libido should not be automatically attributed to "normal" aging or to menopause; providers should address biological, interpersonal, social, and psychological factors 4
- When using flibanserin, patients should avoid alcohol consumption due to risk of severe hypotension and syncope 6
- Long-term effects of DHEA replacement therapy are not fully known, so treatment should be used with caution 7
- Multiple factors often contribute to low libido in women, including postmenopausal vaginal symptoms, partner issues, fatigue, bodily pain, life stressors, and body image concerns 4
- Open communication between partners regarding sex is important but can be difficult; referral for couples counseling may be beneficial 4, 9