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Sometimes you want sex, sometimes you don’t. That’s normal. Every woman has her own level of what is considered “normal” based on their own experiences and biological drive. But when a woman has a low libido or low sexual desire and is bothered by this lack of interest in sex, she may have a condition called hypoactive sexual desire disorder (HSDD).

HSDD is defined as the absence of sexual fantasies and thoughts, and/or desire for or receptivity to, sexual activity that causes the personal distress or difficulties in her relationship. This distress is an important component. After all, some women with what is considered a low libido may not have any distress or problems with a partner as a result.

While prevalence rates vary, The Society for Women’s Health Research estimates that about one in ten women have HSDD, making it one of the most common female sexual difficulties.

What causes HSDD?

There are many potential causes, both physical and psychological.

• There are a number of physical conditions associated with HSDD, including breast cancer, diabetes, depression, urinary incontinence, thyroid problems, and multiple sclerosis, among others.
• An imbalance of neurotransmitters (chemicals) in the brain may be the cause, as the chemicals that can cause (or inhibit) sexual desire and excitement may be out of balance.
• Diminished libido may be a side effect of certain medications, including medications used to treat depression, anxiety and high blood pressure, as well as some medications to treat pain.
• Relationship issues may play a role for some women. If there is conflict or a lack of trust in a relationship, women may lose interest in sex with that partner as a result. (Although it should be noted that a woman may experience HSDD and not be in a relationship).
• Some psychological conditions may be associated with the development of HSDD, including depression, anxiety and low self-esteem.

Can HSDD be treated?

HSDD is treatable and can be manageable, so the first step if you are concerned about a lack of interest in sex is to talk to a healthcare provider to see what options are available. The provider may ask a series of questions called the Decreased Sexual Desire Screener (DSDS) to help diagnose HSDD. The first four questions are:

1. In the past, was your level of sexual desire/interest good and satisfying to you?
2. Has there been a decrease in your level of sexual desire/interest?
3. Are you bothered by your decreased level of sexual desire/interest?
4. Would you like your level of sexual desire/interest to increase?

If a woman answers ‘no’ to any of these questions, she likely will not be diagnosed with HSDD. If she answers ‘yes’ to these, she will also be asked about other factors that may be contributing to her low desire, including physical and mental health conditions, recent childbirth, her relationship with her partner, her level of stress and fatigue, and other issues.

Treatment may include sex therapy or counseling, alone or with a woman’s partner, to address any mental health or relationship issues that may be present. Medications may be evaluated as contributing factors, and underlying medical conditions may be addressed.

For women who have not yet gone through menopause, there is a single FDA-approved treatment for HSDD called flibanserin. This drug works on neurotransmitters, or chemicals, in the brain that are related to sexual excitement. When these chemicals in the brain are out of balance, the result can be a diminished level of sexual interest and desire. Flibansarin, taken as a once-daily pill helps to keep these chemicals in balance.

Find a Healthcare Provider

There is help for HSDD. You can use the search tool below to look for providers who specialize in women’s sexual health difficulties, including HSDD. Enter your zip code in the search box to find the closest provider to you, as well as telemedicine options.

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Sex shouldn’t hurt. But for too many women it does. Between 10% and 20% of women in the U.S. experience persistent pain during sex—a condition referred to as dyspareunia. Dyspareunia can have a significant impact beyond a woman’s sex life. It can affect mental health, self esteem, body image, and relationships.

What causes dyspareunia?

There are two types of dyspareunia, classified as entry and deep. Entry dyspareunia refers to pain experienced with initial or attempted penetration of the vagina. Deep dyspareunia refers to is pain with deep vaginal penetration. The cause of dyspareunia differs depending on whether the pain is entry of deep.

Causes of Entry Pain Include:

• Vulvodynia, which involves chronic pain and irritation around the vaginal opening
• Vulvar vestibulitis, a subset of vulvodynia that involves pain and redness of the vulvar vestibule
• Vaginismus, a condition where the muscles around the vaginal opening involuntarily contract and make penetration difficult or impossible
• A previous injury such as an episiotomy (cut made during childbirth to enlarge birth canal)
• A skin problem in the genital area, such as lichen planus, lichen sclerosus

Causes of Deep Pain Include:

• Endometriosis
• Pelvic inflammatory disease
• Uterine fibroids
• Pelvic adhesions, as a result of previous surgery
• A retroverted uterus (i.e. the uterus is tipped backward)

Some causes are associated with both entry and deep dyspareunia, such as vaginal dryness (either because of a lack of arousal or vaginal atrophy) or vaginal infections.

How can it be treated?

Since dyspareunia can have so many different causes, the suggested treatment will depend on the underlying issue. For example, lubricants may be recommended if the issue involves vaginal dryness, while any underlying causes of dryness would also be addressed. For women with fibroids or endometriosis, a provider might suggest new sexual positions that can increase a woman’s comfort during sex. In cases of vestibulitis, a biopsy may be required. And for women with endometriosis or pelvic adhesions, laparoscopic surgery may be recommended. For cases where the cause is unexplained, a provider may recommend counseling or sex therapy to help explore a woman’s attitude toward sex and better understand the source of the sexual pain.

The important thing to remember is that there are options to deal with dyspareunia, no matter the cause. The first step is to talk to a provider to determine what might be behind the problem and learn what can be done to solve it.

ASHA has developed a short, information tutorial for women experiencing painful sex after menopause, in partnership with WedMD. “Painful Sex: Getting Your Groove Back During Menopause” is for women who may have pain during sex due to of vaginal changes from menopause. It is also for their partners, as well as others who want to learn more about this condition. It discusses how hormonal changes affect your vagina over time, ays to ease vaginal pain during and after sex, which over-the-counter products and prescription medications may help, and ways to talk about your symptoms with your doctor.

Problems reaching orgasm are fairly common among women. About 3 out of 4 women say they can’t orgasm through vaginal penetration alone. But there is a difference between an occasional issue and a more persistent problem—female orgasmic disorder, or FOD.

What makes the problem rise to the level of FOD? There are specific criteria for diagnosing the disorder in women:

• A woman will rarely—or never—be able to reach orgasm, even when she is sexually aroused
• These symptoms last for six months or more
• The problem causes significant distress and problems in her relationships
• Orgasm difficulties are not exclusively caused by another medical condition or medication

The problem affects a sizable number of women. In the largest US study of female sexual dysfunction, including responses from over 30,000 women, the prevalence of FOD was approximately 21%.

What causes FOD?

There are many physical and psychological factors that may be involved in FOD.

• As mentioned above, there are medical conditions that can make it more difficult for a woman to achieve orgasm. In particular, conditions that affect the nervous system such as multiple sclerosis or spinal cord injuries that affect the nerves of the pelvis can make reaching orgasm more difficult. Arthritis, thyroid problems, and asthma have also been associated with FAD. But research has found that is often isn’t the medical condition alone—it’s also the stress of managing a chronic illness and pain the effect of this on a woman’s emotional wellbeing.
• Certain medications can affect a woman’s ability to reach orgasm. Antidepressants (serotonin reuptake inhibitors, or SSRIs, in particular) antipsychotics, antihistamines and drugs high blood pressure are some of the medications who may inhibit orgasm in women.
• There are a number of psychological factors that may affect a woman’s ability to orgasm. Fatigue, stress, anxiety, and depression all can contribute to the problem. Poor body image can also cause anxiety and discomfort and affect a woman’ ability to reach orgasm.
• Relationship issues are another common cause. Problems in the relationship, including anger and mistrust, communications problems, or other sexual problems can interfere with sexual pleasure and orgasm.
• A woman’s cultural or religious beliefs may be factor. For example, a woman may have been raised with the belief that a woman shouldn’t seek out or enjoy sex, and may feel embarrassed or guilty about enjoying sex.

How can it be treated?

Treatment will depend on the cause of the problem. If a medical condition or medication is to blame, a healthcare provider can look at ways to address the underlying issue or explore a medication change. When psychological or relationship factors are the cause, therapy or counseling may be the answer. Sex therapy can teach you to understand your own body better and learn what gives you pleasure. Couples counseling can also help couples improve communication skills and address any conflicts that may be entering with trust and intimacy. Couples might also explore a technique called sensate focus, which involves a series of exercises that focus on both nonsexual and sexual touching to improve intimacy and understand what produces pleasure in each partner.

For any woman having problems reaching orgasm, there are also some steps they can take toward a more satisfying sex life:

• Communicate. Make sure to tell your partner what you like and what feels good.
• Experiment. See what turns you on and what kind of clitoral stimulation feels best. Most women need some direct clitoral stimulation to reach orgasm. Try sex toys or vibrators as part of the experiment, with or without a partner.
• Use mental imagery and fantasy. Fantasy can be a powerful motivator and help bring about orgasm.
• Let go of expectations. While reaching orgasm is great and an important goal, focusing on orgasm exclusively can create pressure and anxiety and make it more difficult to achieve. Instead, focus on mutual pleasure and intimacy as a goal.

Listen to ASHA’s three-part conversation with sociologist and sexual health expert Dr. Pepper Schwartz on female sexual difficulties. She discusses the range of female sexual difficulties, the impact of sexual difficulties on a relationship, and offers practical advice and resources for women (and their partners). You can listen on ASHA’s website or via iTunes.

When a woman becomes sexually aroused, her body will respond with physical changes—vaginal lubrication, swelling and tingling in the genitals. Typically, she’ll experience emotional or mental excitement as well. For some women, though, this arousal response doesn’t happen as expected. The desire may be there, but the body or the mind (or both) don’t respond.

What causes arousal disorder?

This type of sexual difficulty, referred to as sexual arousal disorder, can happen for many reasons. Some of these are emotional in nature, such as stress and anxiety, or problems in a relationship. Behavior factors like alcohol or smoking could also be to blame, as could certain medications. For example, some antidepressants have been linked to sexual difficulties including decreased desire or sexual arousal.

Sometimes an underlying medical condition may contribute to the problem. Vascular and neurological problems can create issues with arousal, so women with diabetes or multiple sclerosis may experience arousal disorder related to their chronic illness. Hormonal changes that come with aging may also play a role.

How can it be treated?

Whatever the cause, problems with sexual arousal can be addressed. A trusted healthcare provider can help determine what may be behind the problem and indemnify any underlying medical issues that could contribute. (Click here for some questions that can help start a conversation with a provider). Therapy may also be an answer. Couples therapy can aid with relationship issues. A sex therapist can help with finding and fixing sexual problems. And one-on-one therapy can work to build sexual confidence and explain how past or recent sexual experiences may be affecting you currently.

In addition to seeking professional help, there are some steps that you take that may help your ability to become sexually aroused:

• Experiment. It may be helpful to try new stimuli such as sex toys or erotic videos to see if they help with arousal.
• Spend more time on foreplay. Couples can concentrate on pleasurable touch and stimulation that doesn’t involve penetration.
• Use lubricant. Some women may benefit from additional lubricant or estrogen therapy, if recommended by a provider.
• Focus on intimacy and trust. Strengthening the bond between partners can be helpful as you work toward new ways to provide pleasure and stimulation.

Listen to ASHA’s three-part conversation with sociologist and sexual health expert Dr. Pepper Schwartz on female sexual difficulties. She discusses the range of female sexual difficulties, the impact of sexual difficulties on a relationship, and offers practical advice and resources for women (and their partners). You can listen on ASHA’s website or via iTunes.

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Funded with a grant from the National Library of Medicine (NLM), the One-Two Punch: Knocking Out HIV and Syphilis Co-infection initiative is designed to educate North Carolinians, especially those in the Raleigh/Durham/Chapel Hill and surrounding areas, about our state’s higher risk for HIV and syphilis and the need to talk with health care professionals about testing for both infections.

The campaign is suitable for all audiences and special care was taken to include populations that are too often overlooked, including men-who-have-sex-with-men and African-American women.

The posters and video are free to download and use on your websites and social media platforms. Each item has a link to NLM’s AIDSource and clinic locator tool to find local free/low-cost care across North Carolina and the U.S.

Just click here or use the form below to fill in your organization’s name and email address to get instant access to all campaign materials. #HealthisPower #NC!