Hypoactive sexual disorder (HSDD), or low sex drive in women, is a common condition affecting almost 9% of women worldwide.

It is natural for your sexual desire to fluctuate over the years, especially with life or hormonal changes. But if you have persistent low sex drive for more than six months that causes personal distress, you may have HSDD. But the good news is that various treatment options ranging from lifestyle modifications to medicines can help you get back your sexual health.

So, if you notice a change in your libido, it is best to consult your doctor. They will help you find an underlying cause and manage the same to solve your problem.

What Is HSDD?

The hypoactive sexual disorder is defined as a condition where there is a loss of sexual thoughts, fantasies, and/or receptivity to or desire for sexual activity in a woman, which causes personal distress or problems in her relationship.

Distress is an essential part of diagnosing HSDD. Not all women with low libido will have problems with their partners or any distress.

What Causes HSDD?

Libido or desire for sex involves a complex interaction of various factors, such as emotional and physical well-being, beliefs, experiences, current relationship, and lifestyle. The problem in any of these areas can affect your sexual desire.

Some causes for HSDD are as mentioned below.

Physical causes

Physical changes, certain conditions, and medications may decrease your sex drive, including:

  • Fatigue: Exhaustion from caring for aging parents or young children may cause low sex drive. Fatigue from surgery or illness can also contribute to low sex drive.
  • Sexual problems: Inability to reach orgasm or pain during sex may reduce your desire for sex.
  • Medications: Certain prescription medicines, especially antidepressants (selective serotonin reuptake inhibitors), can lower your sex drive.
  • Health disorders: Diseases such as cancer, high blood pressure, nerve disorders, arthritis, heart disorders, and diabetes can affect your sex drive.
  • Lifestyle habits: While a glass of alcohol may put you in the mood, too much of it may impede your sex drive. The same holds for street drugs. Besides, smoking reduces blood flow that may affect arousal.
  • Surgery: Any surgery related to your genital tract or breasts may affect sexual function, body image, and desire for sex.
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Hormonal Problems

Changes in your hormone levels may alter your desire for sex. This can occur during:

  • Pregnancy and lactation: Hormonal change during breastfeeding and pregnancy may lower your sex drive. Changes in body image, fatigue, and the pressure of raising a child can also influence your sex drive.
  • Menopause: Estrogen levels drop when you near menopause. This may cause vaginal dryness that may make sex uncomfortable or painful, making you less interested in sex. However, many women can still have satisfying sex during and after menopause.

Psychological Causes

Your state of mind can also influence your sexual desire. Some psychological causes of low sex drive are:

  • Stress such as work or financial stress
  • Low self-esteem
  • Mental health issues such as depression or anxiety
  • History of sexual or physical abuse
  • Poor body image
  • Negative sexual experience in a previous relationship

Relationship Problems

For many, an emotional bond is a prerequisite for sexual intimacy. Problems in a relationship may thus be a crucial factor for low sex drive. Some relationship problems that may affect your libido are:

  • Unresolved fights or conflicts
  • Trust issues
  • Lack of connection with your partner
  • Poor communication of sexual preferences and needs

Symptoms Of HSDD

Some symptoms of HSDD include:

  • Few or absent sexual fantasies or thoughts
  • Difficulty getting pleasure from sex
  • Disinterest in initiating sex
  • No or little interest in sexual activity
  • Absence of pleasurable sensations on stimulating genitals


Your doctor may ask your symptoms to diagnose HSDD. They will ask you about your sexual desire, fantasies, and if lack of sexual drive is causing personal distress.

Your doctor may also run a physical check to check for signs of physical disorders causing low sexual desire such as vaginal dryness, thinning of genital tissues, or pain-triggering spots. 

They may also advise blood tests to check diabetes, hormonal levels, thyroid problems, liver disorders, and high cholesterol. Your doctor may also refer to a specialist, which can be a sex therapist or a specialized counselor, to resolve relationship and emotional factors responsible for low libido.

Treatment For HSDD

While there can be several causes for low sex drive, multiple treatment options are available to manage the underlying problem. 

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Some treatment options include:

Sex Counseling

Talking to a sex counselor or therapist can help manage low sex drive. This therapy may include education about sexual techniques and response. Your therapist may advise couples’ exercises and reading materials. Couples counseling addressing relationship problems also help improve intimacy and sexual desire.


Your physician will review the medicines you are taking to see if they have any sexual side effects.

For instance, antidepressants such as fluoxetine and paroxetine may lower sex drive. In such cases, switching to a different type of antidepressant, such as bupropion, may improve sex drive and is prescribed in women with low sex drive.

Your doctor may also advise medicines to boost libido. Food and Drug Administration (FDA) approves the use of the following medication for premenopausal women:

  • Flibanserin: This medicine is usually advised to be taken once a day at bedtime. Some side effects of the drug include dizziness, fatigue, low blood pressure, and nausea. Taking fluconazole or drinking alcohol can make side effects worse.
  • Bremelanotide: It is available as an injection to be given under the skin in the thigh or belly before sexual activity. Some women may feel nausea, which usually settles after the second injection. Other side effects may include flushing, skin reaction at the site of injection, vomiting, and headache.

However, these medicines are usually recommended in postmenopausal women.

Hormone Therapy

Shrinking or dryness of the vagina may indicate genitourinary syndrome of menopause (GSM), which makes sex painful and comfortable, lowering your sexual desire. Hormonal medicines may help relieve GSM symptoms.

Hormone therapies include:

  • Estrogen: It is available in various forms, including patches, gels, pills, and sprays. A smaller dose is present in a slow-releasing ring or suppository and vaginal creams. You can discuss the pros and cons of each form with your doctor.
  • Ospemifene: It is available as a pill to help relieve symptoms of moderate to severe GSM. The use of this medicine is not approved in women who are at a high risk of breast cancer or who have had breast cancer.
  • Prasterone: It is available as a vaginal insert that releases the hormone dehydroepiandrosterone (DHEA), helping ease painful sex. This medicine is usually used to resolve symptoms of moderate to severe vaginal dryness associated with GSM.

Best Practices

Besides medicine and counseling, the following can help in improving your sexual desire.

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Lifestyle Changes

The following are seen to improve sexual health:

  • Regular exercise helps improve your stamina, mood, body image and boosts libido.
  • Manage stress level through yoga or meditation.
  • Try and communicate openly with your partner. This will help to improve emotional connection, leading to better sex.
  • Set time for cuddling and intimacy.
  • Add spice to your sex life by trying different sex positions or a different location for sex. You can tell your partner to spend more time in foreplay. You can also experiment with fantasy and sex toys to rekindle your sexual desire.
  • Ditch bad habits of smoking, excess alcohol consumption, and illegal drugs.

Alternative Medicine

Discussing sexual drive may be difficult for some women, and they may thus turn to herbal supplements that are available over-the-counter. While the FDA doesn’t regulate these medicines, certain studies have shown their benefits.

Some of them are:

  • Avlimil: It has estrogen-like effects and is seen to boost your sex life. However, it may also increase the risk of breast cancer.
  • Zestra: It is a botanical massage oil to be applied on the labia, clitoris, and vagina. Side-effects include mild burning in the area of application.

As these options may not be safe for all women, it is best to consult your doctor before planning to take one.


Low libido can be frustrating for you as well as your partner. You may feel frustrated as you may not be able to be as sexy as you were before. Besides, your low sex drive may make your partner feel rejected. 

In such cases, it is essential to understand that fluctuations in sex can be a normal part of all relationships and different stages of life. Try and spend time nurturing relationships and not just diverting all attention on sex.

Final Thoughts

Hypoactive sexual desire disorder is a common condition that causes distress in your relationship. While the symptom is sexual, it can indicate an underlying mental or physical health disorder, such as stress and nerve disorders.

Thankfully, many treatment options are available, ranging from counseling to medicines. So, if you notice any change in your sex drive, it is best to consult your doctor in person or virtually with the help of online pharmacies.

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