Want, we all want something! Not desiring sex can be an unmeasurable burden. Decreased libido effects an astounding 30-60% of women between the ages of 18-55¹. This shows the broad range of age groups affected by decreased libido and the chronicity of the problem through the decades. This decreased libido causes distress to 40-50% of women¹. That means half of all women are stressed about their sex drive, that’s terrible! Today we will look at an overview of decreased libido, including how to fix it.

The causes of decreased libido are multifactorial. Libido has three main dimensions: Biological/hormonal, emotional, and cognitive (thoughts and fantasies).

Hormonal Imbalance: Testosterone is a driving force for libido in women. Other factors include estrogen, progesterone, and prolactin. While menopause and the loss of estrogen are important factors in changes in libido, it is important to get a hormonal evaluation. This includes your thyroid and prolactin levels along with your testosterone levels and estrogen levels.

Emotional and Cognitive: Anxiety, depression, and relationship distress are one of the most common causes of decreased libido and sexual disfunction². Untreated, these issues affect your self-image creating a barrier for intimacy. Being Partnered, sharing a deep and collaborative relationship, is the basis for a healthy relationship that will lead to improved sexual desire. Additionally, sexual abuse is all too common, leading to sexual dysfunction.

Medications: Anti depression medications are a frequent culprit³. These medications are important for your mental health, but look to switch your depression medication to one that both manages your mental health and has the least effect on your libido. Beta blockers for high blood pressure and other cardiac issues can also lower your libido. We cannot forget about birth control! Each birth control effects your libido differently, some increase libido and others decrease it. We will discuss it in more detail below.

Chronic Conditions: If you are dealing with chronic pelvic pain, pelvic organ prolapse, or abnormal menstrual cycles, your libido may be effected¹. Other conditions affecting libido include lupus and multiple sclerosis.

Let’s discuss treatment options! Treatment options vary based on your health history. Each treatment may have side effects that need discussed further with your physician.

Hormonal Therapy: Hormonal balance is one of the three dimensions of libido. Testosterone is the key driving factor for sexual desire. Testosterone cream is typically placed on the inner thigh daily. Your provider should continue to monitor testosterone levels and side effects. Certain Birth Controls can lower your testosterone, decreasing your libido¹. Progesterones that lower your testosterone include Drospirenone, Dienogest, and Cyproterone Acetate to name a few. Changing your birth control to a birth control that does NOT affect your libido or one that may increase your libido is key. Progesterones that improve libido include Levonorgesterel, Norgesterel, and Norethindrone. For those with estrogen insufficiency, hormone replacement therapy increases libido by resolving symptoms such as vaginal dryness, painful intercourse, and improves mood.

Stop/Change Libido Reducing Medications: Antidepressant medications such as SSRI’s reduce libido. To control your depression but increase your libido consider switching to medications such as Bupropion or Nefazodone. Those with high blood pressure may want to evaluate other options besides beta blockers to control their blood pressure. These simple switches could bring back your libido but be sure to get the help of a medical expert.

Treating Chronic Conditions: It is difficult to have a vivacious libido with conditions such as chronic pelvic pain or pelvic organ prolapse. It is highly recommended to see a specialist for your pelvic pain and discuss libido and intercourse improving options such as Pelvic Floor Physical Therapy. This PT can be done in the comfort of your own home and can help not just improve your pelvic pain but improve your libido by increasing your body comfort and self-image. Controlling chronic conditions such as high blood pressure and diabetes are also pivotal to improving your sex drive.

Psychotherapy: One of the most effective ways to treat decreased libido is therapy. Therapy options include Cognitive Behavioral Therapy and Mindfulness-based Therapy, or a combination of the two⁴. The effects of therapy are long lasting. Therapy concentrates on challenging negative thoughts and reconnecting you with your body. This improves self-compassion, reduces rumination, increases body connection, and decreases self-consciousness.

Flibanserin and Bremelanotide: These are prescription medications used for hypoactive sexual desire disorder (HSDD). Flibanserin is taken daily at bedtime. It increases dopamine and norepinephrine while decreasing serotonin⁵. Bremelanotide is a subcutaneous injection taken as needed before sexual activity. It also increases dopamine levels⁶. The results are ‘statistically significant’ in randomized control studies for both medications. But the frequency of intercourse (less than one sexual event increase per month) and the fact that these meds improve desire but do not increase the number of satisfying sexual events, arousal and/or orgasm; make them less than ideal with side effects that include dizziness/passing out, nausea, flushing, and headache.

Supplements: Tribulus terrestris shows the strongest evidence among natural supplements at increasing libido by boosting testosterone. Studies showed Tribulus terrestris had positive effects on arousal, orgasm, sexual desire, and overall sexual function⁷. In postmenopausal women, Panax ginseng with or without Vitamin E showed increased libido compared to placebo⁷.

Lifestyle: The Look AHEAD study demonstrated that lifestyle intervention significantly improves sexual function¹. For women with obesity and diabetes lifestyle interventions produced statistically significant improvements in libido and sexual function. Even exercise such as walking showed improvement in libido. Combine your daily walks with a healthy diet and studies show drastic improvements in your libido.

Far too many women of all ages suffer from decreased libido, and even worse, they go untreated. Do not suffer! Through an evaluation of your health, hormones, and medications you can increase your libido using treatments like hormone replacement therapy, natural supplements, and a diet/exercise plan fit for you.

Work Cited

1. Davis, S. R. (2024). Sexual dysfunction in women. The New England Journal of Medicine, 391(8), 736–745. https://doi.org/10.1056/NEJMcp2313307

2. Tetik, S., & Yalçınkaya Alkar, Ö. (2023). Incidence and predictors of low sexual desire and hypoactive sexual desire disorder in women: A systematic review and meta-analysis. Journal of Sex & Marital Therapy, 49(7), 842–865. https://doi.org/10.1080/0092623X.2023.2208564

3. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. (2019). Female sexual dysfunction: ACOG Practice Bulletin No. 213. Obstetrics & Gynecology, 134(1), e1–e18. https://doi.org/10.1097/AOG.0000000000003325

4. Toledo, R. G., Winkelman, W. D., Reyes-Gonzalez, D., Bergeron, S., Fladger, A., Hacker, M. R., & Anand, M. (2025). Female sexual desire, arousal, and orgasmic dysfunctions: A systematic review and meta-analysis of treatment options. Journal of Minimally Invasive Gynecology. Advance online publication. https://doi.org/10.1016/j.jmig.2025.06.004

5. Jaspers, L., Feys, F., Bramer, W. M., Franco, O. H., Leusink, P., & Laan, E. T. M. (2016). Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: A systematic review and meta-analysis. JAMA Internal Medicine, 176(4), 453–462. https://doi.org/10.1001/jamainternmed.2015.8565

6. Kingsberg, S. A., Clayton, A. H., Portman, D., Williams, L. A., Krop, J., Jordan, R., Lucas, J., & Simon, J. A. (2019). Bremelanotide for the treatment of hypoactive sexual desire disorder: Two randomized phase 3 trials. Obstetrics & Gynecology, 134(5), 899–908. https://doi.org/10.1097/AOG.0000000000003500

7. Sha’ari, N., Woon, L. S.-C., Sidi, H., Das, S., Bousman, C. A., & Mohamed Saini, S. (2021). Beneficial effects of natural products on female sexual dysfunction: A systematic review and meta-analysis. Phytomedicine, 93, 153760. https://doi.org/10.1016/j.phymed.2021.153760