From the Guidelines
To assess a 38-year-old female with decreased libido, I would begin with a comprehensive history and physical examination, exploring the timeline and nature of her libido changes, and assessing for biological, psychological, and social factors contributing to decreased libido, as recommended by the most recent guidelines 1.
Initial Assessment
The initial assessment would involve a thorough medication review, as many drugs can affect sexual desire, including antidepressants, antihypertensives, hormonal contraceptives, and antihistamines. I would also assess for psychological factors such as depression, anxiety, stress, relationship issues, body image concerns, and past sexual trauma.
Physical Health Evaluation
Physical health evaluation would include screening for medical conditions that can impact libido, such as thyroid disorders, diabetes, cardiovascular disease, and neurological conditions. Laboratory testing would include complete blood count, comprehensive metabolic panel, thyroid function tests, and hormone levels (estradiol, testosterone, prolactin, FSH) 1.
Lifestyle Factors and Relationship Assessment
Assessment of lifestyle factors like sleep quality, exercise habits, alcohol consumption, and substance use is important. I would also sensitively inquire about her relationship status, satisfaction, and any sexual or communication difficulties with her partner.
Treatment Planning
This comprehensive approach allows for identification of biological, psychological, and social factors contributing to decreased libido, enabling appropriate treatment planning whether it involves medication adjustments, hormone therapy, psychological support, or referral to specialists like gynecologists or sex therapists, with discussion of available options including drugs like androgens, bupropion, and flibanserin, as well as topical vaginal therapies and pelvic physical therapy 1.
Ongoing Evaluation
Regular re-evaluation of sexual function is crucial, as recommended by the NCCN guidelines 1, to ensure that any changes or concerns are addressed promptly and effectively.
From the FDA Drug Label
The patients were treated with ADDYI 100 mg once daily at bedtime (n = 1187) or placebo (n = 1188). Most of the trial participants were Caucasian (88. 6%); the remainder were Black (9.6%) and Asian (1. 5%). The mean age of study participants was 36 years old (range 19 to 55 years old); the mean duration in the monogamous, heterosexual relationship was 11 years, and the mean duration of HSDD was approximately 5 years. The change from baseline to Week 24 in the number of monthly SSEs (i.e., sexual intercourse, oral sex, masturbation, or genital stimulation by the partner). In Study 3, the desire domain of the Female Sexual Function Index (FSFI Desire) was the sexual desire co-primary endpoint.
The initial assessments in a 38-year-old female presenting with decreased libido (sexual desire) during a well-woman exam would include:
- Medical History: to identify any underlying medical conditions that may be contributing to the decreased libido
- Relationship History: to assess the duration and quality of her current relationship
- Symptom Assessment: using tools such as the Female Sexual Function Index (FSFI Desire) to evaluate the severity of her symptoms
- Distress Assessment: using tools such as the Female Sexual Distress Scale-Revised (FSDS-R) to evaluate the level of distress associated with her decreased libido 2
From the Research
Initial Assessments for Decreased Libido in a 38-Year-Old Female
The initial assessments for a 38-year-old female presenting with decreased libido during a well-woman exam may include:
- Evaluating hormonal levels, particularly testosterone and dehydroepiandrosterone-sulfate (DHEA-S), as decreased levels of these hormones have been associated with decreased libido in women 3
- Assessing thyroid function, as both hypothyroidism and hyperthyroidism have been linked to sexual dysfunction, including decreased libido, in women 4, 5, 6
- Reviewing menstrual cycle characteristics, as thyroid dysfunction can affect menstrual regularity and fertility 5
- Considering other potential causes of decreased libido, such as adrenal dysfunction or other endocrine disorders 3, 7
Potential Laboratory Tests
Potential laboratory tests to evaluate decreased libido in a 38-year-old female may include:
- Total and free testosterone levels
- DHEA-S levels
- Thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels to assess thyroid function
- Sex hormone-binding globulin (SHBG) and estradiol levels to evaluate sex hormone balance
Clinical Evaluation
A thorough clinical evaluation, including a medical history and physical exam, is essential to identify potential underlying causes of decreased libido in a 38-year-old female. This evaluation should include:
- A detailed sexual history to assess the onset and duration of decreased libido
- A review of medical history to identify potential underlying medical conditions, such as thyroid disease or adrenal dysfunction
- A physical exam to evaluate for signs of hormonal imbalances or other underlying conditions 3, 4