As of Tuesday, August 6, 2013
DEAR DOCTOR K: I’m a woman in my 50s. I’ve always had a healthy sex drive, but lately it’s gone bye-bye. What could be wrong?
DEAR READER: There aren’t a lot of people with a take-it-or-leave-it attitude about sex. We are sexual creatures, and for most of our lives, we are well aware of having sexual desire. So when you notice that it’s just not there, it is upsetting.
Many women report a loss of sexual desire. One huge survey of women in different countries found that more than 30 percent of women report this problem, to the point that it causes them distress. Loss of desire is most frequent among women in the 45-65 age group, and then tapers off after age 65.
There are many reasons for a decline in a person’s sex drive, some physical and some psychological. A decline in the production of estrogen with menopause is one reason, and most U.S. women enter menopause in their early 50s. The “male” hormones, androgens, are also made by women, in lower amounts. They are important in generating sexual desire.
A substantial fraction of female androgens are made by the ovaries. While female androgen levels remain relatively constant after menopause, removal of the ovaries (surgical menopause) can cause testosterone, the main type of androgen, to drop, and with it, sexual desire.
While sexual desire declines somewhat in women after menopause, a sudden drop for no good reason merits a trip to your doctor. He or she will look for physical causes to explain your diminished sex drive. Many chronic medical conditions can impinge on desire. So, too, can treatments for these conditions. Low libido may also stem from chronic pain that causes discomfort during intercourse. A common cause of such pain is the condition called endometriosis.
If there are no obvious physical causes to address, your doctor will explore your attitudes and feelings about sex. For example, has your relationship with your partner changed recently? Your doctor will also ask about depression, self-image, stress and fatigue.
If there may be a psychological or relationship issue, one option is sex therapy. The therapist may suggest that both you and your significant other participate. You will be encouraged to explore any negative feelings that may surround sex. Relationship-building exercises may be recommended to increase trust, communication and sensual awareness. You may also be taught stress-reduction techniques.
Medical treatments are also available. One option is hormone treatment with testosterone. As testosterone levels decline with age, a woman’s sexual interest and responsiveness may also drop off.
Another medical option is bupropion. This antidepressant may increase sexual desire and arousal even if you don’t have depression. It can also counter the negative sexual side effects of other antidepressant medications.
Finally, an experimental drug called flibanserin appears to boost female sexual desire. However, it has not been FDA-approved to treat low libido in women.
Most of my female patients who have experienced distressing lack of sexual desire have been helped by one of more of these treatments.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.