If you’re in your 30s or 40s, you probably know that sexual desire is complex and can be affected by a variety of factors. Hormone fluctuations, life circumstances, age, and history of trauma or abuse can all play a role in an individual’s sexual health. This is why, when someone is struggling with low libido, it can be quite tricky to trace the root cause. 

Struggling with low sex drive is not just a nuisance. It can be challenging on an individual level, impacting self-esteem and general life fulfillment, and it also affects relationships which are crucial to our overall sense of wellbeing.  

Chronic low sex drive can be part of a more complex, holistic disorder called Hypoactive Sexual Desire Disorder (HSDD). Let’s dive into HSDD, learn why it’s different from general low libido, and discuss how it can be treated.

woman in couple suffering from hsdd

What is HSDD?

HSDD is a disorder that can occur in any person, but here we’ll discuss how it pertains to women’s sexual desire. Women with HSDD have a “persistent and distressing lack of interest in sexual activities.” It is surprisingly common, although it is not well known. About 1 in 10 women likely struggle with low sex drive associated with HSDD.

The words “persistent” and “lacking” are key in differentiating HSDD from general low libido, which has situational root causes. People can experience low sex drive in the short term (although it may not feel short term) during periods of grief, relational discord, while taking certain medications, after having children, or due to illness.

HSDD is more comprehensive and longer-term than these situational droughts in sexual desire. When a person struggles with HSDD, it is enduring and has a notable and negative impact on their quality of life. The main areas of wellness that can be affected by HSDD are relational wellness, self-esteem, and fulfillment.  

It is also important to note that women dealing with HSDD often still engage regularly in “duty sex,” sometimes out of a sense of empathy for their partner’s needs. However, they may no longer be the initiator.

How is HSDD diagnosed?

A diagnosis of HSDD for women presents some complexities. Because sexuality is so multi-faceted and lack of interest in sexual activity may stem from the societal and cultural pressures often placed on women, it can be difficult to get a concrete diagnosis.

However, for some women, receiving a diagnosis is an incredibly important step in moving toward a solution, which is why advocating for yourself is key. Typically, diagnosis lies in the keywords “persistent and frustrating.” If low libido has been a constant in your life and relationships and has begun to affect your quality of life, then a good first step is to talk to a healthcare provider about HSDD.

Thankfully, you don’t have to wait for your annual OB/GYN wellness exam to be diagnosed with HSDD — some options exist for a virtual appointment with a healthcare provider who can help.

couple in therapy

What to know

Knowing some of the mechanics of HSDD can be helpful for any woman who wants to understand sexual desire more thoroughly. There are a few key players:

1. Neurotransmitters

Sexual desire relies on a complex orchestra of balanced neurotransmitters in the brain. Some of this is not fully understood. One example of neurotransmitter imbalance that affects sexuality is the relationship between dopamine and serotonin. HSDD is heavily linked with depression. Dopamine, in particular, is responsible for pushing us toward rewarding, pleasurable behavior (like sex). So, an imbalance of serotonin and dopamine, as is the case in depression, can lead to a lack of interest in sex.

2. Hormones 

In women, the three major hormones orchestrating desire and motivation to engage sexually are progesterone, estrogen, and testosterone. Hormonal imbalances, whether due to menopause or the use of oral contraceptives, can contribute to various sexual health issues, including pain during intercourse and HSDD.

3. Cultural components, quality of relationship, or pain

Of course, our bodies exist in the real world. A chemical imbalance in the brain or a hormonal imbalance may be responding to our experiences and stresses. So, we can’t discount the world we live in as a major contributor to our sexual wellness. The way women are made to feel about their bodies, thanks to unrealistic beauty standards, the quality of romantic relationships, and our individual pain experiences relating to pelvic floor health or other gynecological conditions, all will contribute to our desire to engage sexually.

happy couple in bed

Treatment options

There is good news! Thankfully, there are a variety of ways that individuals struggling with HSDD can begin to address their sexual well-being.

Bremelanotide (Vyleesi)

So much research has been poured into helping men to be ready for sex when they want to overcome erectile dysfunction. Now, women have a similar in-the-moment solution. 

Vyleesi is an on-demand injection that mimics certain neurotransmitters in the brain, selectively activating melanocortin receptors. Unlike other treatment options that necessitate ongoing use to see improvements in sexual desire, Vyleesi is designed to be used only when needed. It takes about 45 minutes to work and can last for 8-10 hours. There are also no alcohol restrictions to worry about while on the medication. 

Flibanserine (Addyi)

Addyi is an FDA-approved medication for premenopausal women with HSDD. It targets a different class of brain receptors, namely serotonin receptors. Flibanserin, taken orally once daily, takes several weeks to start working, and it should be discontinued if there is no improvement in 8 weeks. Some alcohol restrictions apply to flibanserin.

Hormone therapy

Addressing hormonal imbalances through appropriate medical interventions could potentially alleviate symptoms and improve sexual well-being. 

It's essential for individuals experiencing such issues to consult with healthcare professionals to explore suitable treatment options tailored to their specific needs and circumstances. The good news is that you can take back control, and HSDD doesn’t have to diminish your quality of life. While the medicalization of sexuality is complicated, the reality is that women deserve support in getting their sex drive back on track. 

Dr. Dorothy Bestoyong, DO, advocates for a team-based approach, “I always tell patients that HSDD treatment/management requires a team. It’s important to seek out providers that will listen to you and realize that it takes teamwork to make treatment/management successful.”

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Johanna Modak is a writer specializing in women's health, nutrition, femtech, and women's sports.

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