Merck Manual

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Sexual Interest/Arousal Disorder

(Low Libido in Women)


Allison Conn

, MD, Baylor College of Medicine, Texas Children's Pavilion for Women;

Kelly R. Hodges

, MD, Baylor College of Medicine, Texas Children's Pavilion for Women

Reviewed/Revised Jul 2023

Sexual interest/arousal disorder in women is lack of or decreased interest in sexual activity (low libido) and sexual thoughts and/or lack of response to sexual stimulation.

  • Many factors can impact a woman's interest in sex and ability to become sexually aroused, including relationship issues, menopause, medications, medical conditions, depression, anxiety, stress, and a history of sexual trauma.

  • Doctors diagnose sexual interest/arousal disorder based on the woman's description of the problem and specific criteria.

  • Improving the relationship and the setting for sexual activity and identifying what stimulates the woman sexually can help.

  • Medications or psychological therapies, particularly mindfulness-based cognitive therapy, may be recommended.

Temporary changes in sexual desire or arousal are common throughout a woman's sexual life. However, sexual interest/arousal disorder causes interest in sexual activity and response to sexual stimulation to be persistently decreased or absent. Lack of sexual interest and inability to be sexually aroused are considered a disorder only if they distress the woman and if interest is absent throughout the sexual experience.

Usually, a woman feels sexually excited, mentally and emotionally, when sexually stimulated. There may also be certain physical changes. For example, the vagina releases secretions that provide lubrication (causing wetness). Blood flow to the genitals increases, causing the tissues around the vaginal opening (labia) and the clitoris (which corresponds to the penis in men) to swell, the breasts swell slightly, and these areas may tingle. In sexual interest/arousal disorder, all or some of these responses are absent or significantly decreased.

Sexual interest/arousal disorder is classified as follows:

  • Subjective: A woman does not feel aroused by any type of sexual stimulation, including, kissing, dancing, watching an erotic video, and physical stimulation of the genital area. However, a woman with subjective sexual interest/arousal disorder may have a physical response to sexual stimulation. For example, blood flow to the clitoris increases (causing it to swell), and the increased blood flow causes vaginal secretions to increase.

  • Genital: A woman feels aroused in response to stimulation that does not involve the genitals (such as an erotic video), but does not respond to physical stimulation of the genitals. Vaginal secretions and/or sensitivity of the genitals is reduced.

  • Combined: A woman feels little or no arousal in response to any type of sexual stimulation. The physical response (increased blood flow to the genitals and production of vaginal secretions) is minimal or absent. She may report that she needs external lubricants and that the clitoris no longer swells.

Causes of Sexual Interest/Arousal Disorder

The cause of sexual interest/arousal disorder is often not known. Known causes are

  • Psychological factors, such as a lack of communication between partners and other relationship problems, depression, anxiety, negative sexual self-image stress, and distractions

  • Unsatisfying sexual experiences

  • Physical factors, such as certain chronic disorders, menopause, genitourinary syndrome of menopause Symptoms after menopause Symptoms after menopause , certain medications, fatigue, and debility

Many women experience a decrease in sexual interest after menopause due to the natural aging process or surgical removal of the ovaries (oophorectomy). Estrogen and progesterone levels decrease significantly after menopause. Testosterone decreases gradually with age but does not change suddenly at menopause.

However, overall, sexual interest/arousal disorder is as common among young healthy women as it is among older women. Still, changes in sex hormones sometimes cause lack of interest. For example, in young healthy women, sudden drops in levels of sex hormones, as may occur during the first few weeks after childbirth Sexual Dysfunction During Pregnancy and Postpartum Several factors (physical and emotional) related to pregnancy and childbirth can make sexual dysfunction more likely. Risk factors for postpartum and pregnancy-related sexual dysfunction include... read more , may cause sexual interest to decrease. In middle-aged and older women, sexual desire may decrease, but a connection between the decrease and hormones has not been proven.

The decrease in estrogen that occurs at menopause can cause genitourinary syndrome of menopause (which causes symptoms affecting the vagina, vulva, and urinary tract). In this syndrome, the tissues of the vagina can become thin, dry, and have difficulty stretching. As a result, intercourse can be uncomfortable or painful. Women with this syndrome may also feel a compelling need to urinate (urinary urgency) and have frequent urinary tract infections. These symptoms make women less interested in sex.

Inadequate sexual stimulation can also contribute to sexual interest/arousal disorder.

Did You Know...

  • Young healthy women are as likely to have sexual interest/arousal disorder as older women.

Diagnosis of Sexual Interest/Arousal Disorder

  • A doctor's evaluation based on specific criteria

Doctors base the diagnosis of sexual interest/arousal disorder on the woman’s history and description of the problem and on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association. These criteria require a lack of or decrease in at least three of the following:

  • Interest in sexual activity

  • Initiation of sexual activity and responsiveness to a partner's initiation

  • Excitement or pleasure during almost all sexual activity

  • Sexual or erotic fantasies or thoughts

  • Physical sensations in the genital area or elsewhere during sexual activity

  • Interest or arousal in response to sexual stimuli—written, spoken, or visual

These symptoms must have been present for at least 6 months and must cause significant distress in the woman.

A pelvic examination is done if penetration during sexual activity causes pain.

Treatment of Sexual Interest/Arousal Disorder

  • Treatment of the cause, if possible

  • General measures

  • Psychological therapies

  • Medications

Care for women with sexual interest/arousal disorder is best managed by a team of several types of health care professionals (a multidisciplinary team). The multidisciplinary team may include primary care doctors or gynecologists, sex counselors, pain specialists, psychotherapists, and physical therapists.

One of the most helpful measures for sexual interest/arousal disorder is for women to identify and tell their partner which things stimulate them. Women may need to remind their partner that they need preparatory activities—which may involve touching or not—to get ready for sexual activity. For example, they may want to talk intimately, watch a romantic or erotic video, or dance. Women may want to kiss, hug, or cuddle. They may want more or different foreplay (their partner touching various parts of their body, then the breasts or genitals) before moving to sexual intercourse or other sexual activity that involves penetration. Couples may experiment with different techniques or activities (including fantasy and sex toys) to find effective stimuli.

Measures recommended to treat sexual dysfunction in general Treatment can also help increase interest in sex. For example, eliminating distractions (such as a television in the bedroom) and taking measures to improve privacy and a sense of security can help. Doctors may recommend using intensely erotic stimuli (such as videos) and fantasizing.

Treatment often focuses on factors that contribute to a lack of interest in sex and lack of response to sexual stimulation, such as depression, low self-esteem, and problems in a relationship.

Psychological therapies, particularly mindfulness-based cognitive therapy, may benefit some women. Mindfulness involves focusing on what is happening in the moment. Mindfulness-based cognitive therapy, usually done in small groups, combines mindfulness and cognitive-behavioral therapy. It can help with arousal, orgasm, and the desire for sexual activity.

Doctors may refer women with sexual interest/arousal disorder to a sex counselor or therapist or a psychotherapist.

Other treatments depend on the cause. For example, if medications may be contributing, they are stopped if possible.

Treatment of contributing factors

Testosterone therapy

Little is known about the long-term effectiveness and safety of testosterone (taken by mouth or as a skin cream). When taken for a short time, a testosterone used at the same time as estrogen (and usually a progestogen) can be effective in postmenopausal women with sexual interest/arousal disorder. However, use of testosterone for this purpose is considered experimental and women should discuss risks and benefits with their doctor.

There are no prescription testosterone medications manufactured for women in the United States. However, some doctors prescribe a compounded skin cream. Women should only be treated with testosterone by doctors with training and experience in female sexual dysfunction.

If testosterone is prescribed, doctors explain the uncertainty of effectiveness and the risks of such therapy. They do blood tests to check kidney and liver function and measure lipid levels before testosterone is started. Testosterone is not prescribed if these test results indicate that the woman is at risk for liver problems or dyslipidemia (for example, too high a level of LDL, the "bad" cholesterol). If testosterone is prescribed, doctors schedule regular follow-up visits to check for side effects such as acne, hirsutism Hairiness In men, the amount of body hair varies greatly (see also Overview of Hair Growth), but very few men are concerned enough about excess hair to see a doctor. In women, the amount of hair that... read more Hairiness , and virilization Virilization Virilization is the development of exaggerated masculine characteristics, usually in women, often as a result of the adrenal glands overproducing androgens (male sex steroid hormones such as... read more .

Other therapies

Flibanserin can be used to treat premenopausal women with female sexual interest/arousal disorder. However, there is little evidence for its effectiveness and safety.

Bremelanotide is used for treatment of low libido in women. It is an injection administered at least 45 minutes before anticipated sexual activity.

Devices such as vibrators or clitoral suction stimulators may help, but there is little evidence to support their effectiveness. Some of these products are available over the counter and may be tried.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Crinone, Endometrin , First - Progesterone MC 10, First - Progesterone MC 5, Prochieve, PROMETRIUM
Androderm, AndroGel, Andro-L.A., Aveed, AXIRON, Delatestryl, Depo-Testosterone, FORTESTA, JATENZO, KYZATREX, Natesto, STRIANT, Testim, Testoderm, Testopel, TLANDO, Virilon, Vogelxo, XYOSTED
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