AFL’s Dr Mache Seibel
Is your mojo a no-show? You’re not alone. Decrease in desire is the most common sexual problem women report, and it can begin as early as the 30s. One fairly recent solution for women with low libido is a little pink pill called Addyi (flibanserin). The good news is women the FDA finally approved something to improve the libido of women. But it’s getting mixed reviews from both women and their doctors because it has some distinct disadvantages: You can’t just pop a pill just before sex. You have to take it daily and you can’t drink alcohol while you’re on it.
But loss of desire isn’t the only way that sex can decline, and medications aren’t the only answer. Here are five of the most common reasons women may be thinking, “Not tonight, dear,” and some specific ways to deal with them.
Sex hurts.
Consider: A lubricant, a moisturizer, or low-dose estrogen
Vaginal dryness and thinning of the tissues begins in perimenopause and tends to worsen beyond menopause. It’s this lack of lubrication that causes friction, which in turn can cause pain. There are three safe and effective ways to make sex comfortable again which you can use alone or in conjunction with each other, depending on the degree of relief you get from each.
- Lubricants. These are used duringsex to reduce friction when feeling juicy can take a while.
- Moisturizers. These are used in an ongoing way to improve vaginal dryness and reduce any discomforts. Even if a moisturizer is used, many women still use a lubricant at the time of intimacy.
- Vaginal estrogen. You’ll need a prescription for this, which comes in the form of creams, tablets, or rings, but it’s highly effective. Although a little estrogen weeps into the bloodstream, the American College of Obstetricians and Gynecologists recently published a Committee Opinion that even women with estrogen receptor positive breast cancer can take vaginal estrogen safely–it doesn’t increase the risk for recurrence or worsen the outcome. But here’s the thing: Most doctors don’t ask their patients about vaginal pain so you’ll need to speak up if you want relief.
Your mood meds are putting out your flame.
Consider: A non-SSRI antidepressant—or exercise
Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat symptoms of menopause such as depression and anxiety. While they do this effectively, many women who take them also experiences sexual side effects:
…cooling desire and arousal, fewer or less intense orgasms.
In that case, there are other antidepressants, such as bupropion (Wellbutrin) and duloxetine (Cymbalta), which work through a different mechanism and are less likely to affect libido. If your doctor thinks switching meds is a bad idea for you, another option is to pump up the amount of physical activity you get (which isn’t a bad idea in general). Thirty minutes of exercise just before sex has been shown to improve libido and sexual functioning for women on antidepressants. Regular activity also has been found to improve libido in women who are not on antidepressants.
Your mind is wondering instead of wanting.
Consider: Being more “mindful”
Women often find that although their body is in the bedroom, their minds are on work, kids, parents, or some other non-sexy topic—and that can go for women who haven’t yet entered menopause. If you’re given to distraction, it’s important to tune out those thoughts and tune in to your immediate experience. Tell your partner what you experience when you’re being touched and listen when your partner talks to you, whether the touching is in a sexual or non-sexual way. It helps you stay “in the moment.”
You’re never in the mood.
Consider: Low-dose testosterone
After age 30, women’s testosterone levels decrease., and some will benefit from testosterone treatment. Unfortunately, there are no FDA-approved prescriptions for testosterone for women with low desire. But your doctor can still prescribe it for you off-label. It’s important to keep the dose low—about a fifth of what men use. Be sure to have your blood levels tested periodically to avoid side effects.
Sex just isn’t as hot as you remember.
Consider: Adjusting expectations
Over the years, sex simply may not be as thrilling as it once was. This doesn’t mean things aren’t going well or that they aren’t enjoyable. With aging people can’t run as fast or as far, but running a little slower you can enjoy the view more. It’s not settling, it’s setting expectations.
