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.
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 a diagnosis of HSDD tends to focus more on the psychological lack of sexual interest rather than problems with physical arousal.
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 — you can book a virtual appointment with a healthcare provider directly on the Vyleesi website.
Causes of HSDD
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:
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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. Imbalances in these hormones can lead to irregularities in the menstrual cycle and also disrupt some of the natural peaks and valleys of sexual interest that occur throughout the month.
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.
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.
Cognitive Behavioral Therapy (CBT)
Because neurotransmitters and neural pathways are so intricately involved in human sexuality, therapy can help to “rewrite” some of these pathways and create new positive associations with sexual experiences.
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 targets neurotransmitters in the brain called melanocortin receptors. While CBT, hormone therapy, and SSRI drugs are needed on an ongoing basis to make improvements in sexual desire, Vyleesi is used only when you want to use it. 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.
SSRIs
SSRI drugs work to increase serotonin in the brain, which may or may not be effective in increasing interest in sex. Still, because SSRI drugs target serotonin rather than dopamine, the biological mechanism is a bit indirect and, therefore, can have mixed results.
Hormone Therapy
If a hormonal imbalance appears to be at the root of an individual’s diagnosis of HSDD, it may be possible to use hormone therapy to find balance and eventually “turn on” the sexual desire function of the body. Testosterone, primarily, can be supplemented topically. However, it can be tricky for women to find it in the correct dosage as it is typically intended for men.
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 self-image and relationships on track.
Using some long-game solutions such as CBT or hormone therapy in combination with Vyleesi may be the best way to support overall sexual wellness for women struggling with HSDD. 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.