Overview, Causes, & Risk Factors

A woman of any age can become less interested in sex or have a decreased sex drive. This condition is called sexual dysfunction. It is most common in women before, during, and right after menopause has ended.

What is going on in the body?

In 1999, a national survey of people between the ages of 18 and 59 showed that sexual dysfunction was common among 43% of women and 31% of men. Women and men with poor physical and mental health are more likely to have a decreased sex drive. Someone who has had problems in sexual relationships is also more likely to have this condition.

Moreover, sexual dysfunction is closely linked with overall well-being because the female sexual response is more complicated than the male response. It is influenced to a greater degree by psychological and cultural factors.

A woman's sex drive is guided by a complex system of signals between the brain, the ovaries, and other reproductive sexual organs. A healthy brain, more than a healthy body, dictates a woman's desire for sex. Any disruption in this complex interaction may cause a woman to be less interested in sex.

What are the causes and risks of the condition?

Sexual dysfunction in women rarely has a single cause. The factors that may cause this condition include both physical and psychological causes. Physical causes include:

diabetes

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urinary tract infections

heart disease

neurological disorders, such as stroke

pelvic surgery or trauma

side effects of drugs, such as antidepressants, narcotics, and illicit drugs

chronic liver disease

chronic kidney disease

menopause

alcoholism

heavy smoking of nicotine or marijuana

drug abuse

breastfeeding

recovery after childbirth

Psychological causes may include:

stress from work, family, or relationships

chronic anxiety

concern regarding sexual dysfunction

marital discord

religious or cultural beliefs

unresolved sexual orientation

depression

previous traumatic sexual experience, including rape

history of incest or sexual abuse

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Symptoms & Signs

What are the signs and symptoms of the condition?

There are many different types of sexual dysfunction, including:

a lack of interest in sex, known as decreased libido

the inability to attain or maintain adequate vaginal lubrication and swelling response. This is called female sexual arousal disorder.

painful intercourse, known as dyspareunia

painful, involuntary contractions of the vaginal muscles, known as vaginismus

a delay or absence of orgasm

A woman with a decreased libido may:

enjoy sex less than she used to

avoid having sex

have a previously functional partner who is now unable to have an orgasm

ignore her own personal hygiene to avoid having sex

have fewer erotic dreams

have fewer sexual fantasies

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Diagnosis & Tests

How is the condition diagnosed?

A healthcare provider will ask the woman about her medical and social history. Depending on the medical history, the following may be performed:

physical exam

pelvic exam

screening tests for depression

complete blood count, or CBC

urinalysis

a blood test to measure follicle-stimulating hormone, or FSH

a blood test to measure luteinizing hormone, or LH

serum estradiol test

serum testosterone levels

cultures of the vaginal discharge

Most cases of decreased libido are not related to physical problems, except for menopause. Usually there are other problems, like depression, marital discord, spousal abuse, alcohol dependence, or drug problems.

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Prevention & Expectations

What can be done to prevent the condition?

Since sexual dysfunction in women is often linked to depression or menopause, it may help to see a healthcare professional before it becomes a serious problem. Many of the underlying causes of sexual dysfunction are not preventable, but early treatment may minimize the woman's problems.

What are the long-term effects of the condition?

The long-term effects of sexual dysfunction may be poor interpersonal relationships, marital discord, separation, and divorce. Poor self-esteem and a sense of failure may lead to chronic depression and anxiety.

What are the risks to others?

Sexual dysfunction poses no risk to others. But it may cause a partner mental stress or lower self-esteem if he does not understand the underlying cause of his partner's sexual dysfunction.

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Treatment & Monitoring

What are the treatments for the condition?

Treatment depends on the cause. It may include:

anti-depressants

treatment for diabetes

hormone replacement therapy

androgen therapy

sildenafil

herbal remedies

psychotherapy

marriage counseling

What are the side effects of the treatments?

Side effects depend on the therapy used. They may include:

excessive hair, acne, dry or greasy skin, and elevated cholesterol in women using androgen therapy

vaginal bleeding, breast tenderness, weight gain, abdominal bloating, and headaches in women using hormone replacement therapy

diarrhea, sleep disorders, headaches, irritability, and sexual dysfunction in women using antidepressants

What happens after treatment for the condition?

A woman's sex drive is a complex matter. It cannot be cured by taking a pill or talking about the problem. There are subtle stressors in a woman's life that may make her less interested in sex. These stressors are warning signs that she may be feeling emotional and psychological turmoil. This turmoil should be addressed in order to prevent future physical problems.

How is the condition monitored?

Teaching a woman to look for decreased sexual function, stress, and health problems is an important part of treating sexual dysfunction. A woman should report any new or worsening symptoms to her healthcare provider.

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