“I don’t want to have sex anymore”
Low sexual desire in women is the most common presenting complaint in our practice. Research indicates that between 10-28% of women experience low sexual desire for a period of 6 months or longer, and experience the following symptoms:
Lack of interest in sex
Reduced or absent erotic thoughts
Lack of initiating or responding to sexual activity
Reduced pleasure during sex
Reduced or absent desire during sex
Reduction in genital and non-genital sensations
“My wife doesn’t want to have sex with me”
The most recent models used to understand and describe women’s sexual desire describe it as resulting from a combination of a sexual response system and effective stimulation to activate the system. This is known as the incentive motivation model of sexual response.
Within this model, both biological and psychological factors interact with sexual stimulation to influence how responsive a woman is. It also accounts for sexual desire occurring after sexual arousal — referred to as responsive sexual desire. This means that a woman doesn’t have to feel desire before she is physically aroused.
“I wouldn’t care if I never had sex again”
Many women with low sexual and their partners wonder if the cause is “hormones”. While hormones can play a role in sexual responsiveness, that is usually not the cause for women seeking treatment for low sexual desire. For example, studies show that although testosterone has been given to women to treat low sexual desire, there is a minimal correlation between testosterone levels and sexual desire.
Other medical factors should be considered and referral to the appropriate medical professional is needed in more complex cases. There are some non-medical causes of low sexual desire in women as well. They are:
Relationship Problems. Low sexual desire can be caused by a lack of emotional intimacy, trust, and respect towards one’s partner. A woman’s feeling towards her partner is a major contributing factor in sexual desire.
Lack of Differentiation in Long-Term Relationships. A married woman’s desire can decrease with overfamiliarity, routine, and enmeshment.
Partner Factors. A woman’s sexual desire can dampen if there is pressure for sex with inadequate stimulation, poor sexual technique, incompatible sexual needs, and lack of sexual attraction or partner sexual dysfunction.
Clinical Depression. Experiencing depression can decrease sexual interest — a ‘loss of interest or pleasure’ is a symptom of Major Depressive Disorder. In addition, women who take SSRI anti-depressant medication frequently experience sexual side effects such as low sexual desire and inability to orgasm.
Sex-Negative Cultural Messages. Women many times receive negative messages about being sexual, for example: “good girls don’t”. In addition, women receive a negative message about masturbation.
Inadequate Sexual Education. In our culture, most people learn about sex through a biological, “the birds and the bees”, medical, or pornographic lens. These narrow viewpoints don’t provide information on sexual pleasure, eroticism, sensuality, connection, sexual self-expression and many other sex-positive aspects of sexuality. Many women lack basic sex-positive education about their female anatomy and sexual response. The lack of education can create a disconnect in a woman’s experience of her sexuality.
Family and Word Demands. Women tend to report lower sexual desire when they are under the demands of a challenging family and work-life balance. Women who are able to take time for themselves and to connect to themselves and their bodies will feel more sexual desire.
Sex-Negative Religious Education. Research has shown that the more fundamental a religion, the more sexual dysfunctions occur. Many women internalize religious constrictions or shame around sexuality, which leads to low sexual desire.
Treating low sexual desire can appear elusive.
There is nowhere to “get” sexual desire, and no medical intervention will cause it to occur. Women’s sexual desire naturally arises when many aspects of a woman’s thoughts, emotions, biology, and relational functioning are working well.
It is important to understand a woman’s perceptions, beliefs, and attitudes toward her own anatomy. If needed, referral to a physician for a physical exam or laboratory investigation can be made.
A gynecological exam will determine:
the level of voluntary control over the pelvic floor muscles and their tone
if there is vaginal atrophy
the presence of discharge, infection or pain
It is also important to rule out low-estrogen or progesterone-only contraceptives that may contribute to low sexual desire.
When a woman enters psychotherapy and sex therapy to treat low sexual desire a structured interview is given to determine the various factors that are contributing to symptoms of low desire.
Some important aspects of the structured interview include:
taking a medical history
learning about her family of origin
understanding past sexual experiences
examining her current relationship and relationship history
learning about what kinds of sexual stimulation she is receiving and how responsive she is to it
to what degree she is able to stay focused during sexual activity
Mindfulness Meditation, CBT, and Masturbation Skills
Once the various contributing psychological, emotional or relational factors are determined, a targeted treatment plan is developed. Sex therapy for low sexual desire is interactive and dynamic, in which homework and exercises are given regularly to be done outside of session.
Mindfulness meditation techniques are often taught to women as a first step in learning how to stay present in their body.
Sex positive education is given to introduce the woman to new and exciting ways of thinking about her body, sexuality and sexual pleasure.
Cognitive behavioral therapy (CBT) can be used to treat anxiety that occurs about any aspect of a woman’s body or sexual experience. It has been found that women with sexual dysfunctions hold more negative beliefs about the influence of age and body image on sexuality.
Masturbation skills training can be implemented to foster a positive relationship between a woman and her body and is often the first step to a woman better understanding how she best receives pleasure.
Partner sex therapy activities can be given and many women are encouraged to invite their partner into the therapeutic process if low sexual desire symptoms occur or persist in the context of a relationship.
And finally, couples counseling is encouraged if relationship problems are the major cause of low sexual desire.