DEAR DOCTOR K:
I’m a woman in my mid-50s. Lately I haven’t been able to become sexually aroused. What could be wrong?
Sex is complicated, but you probably already know that. Sexual desire surely resides in the head, but other parts of the body can affect desire as well. In particular, the genital organs communicate with the brain. Likewise, the brain communicates with the genital organs. Desire in the brain causes changes in the pelvic organs. Perceiving these changes can, in turn, enhance sexual desire.
There is a condition called sexual arousal disorder. Normally, a woman becomes aroused through thoughts and fantasies, touch, or a combination of these things. In response, blood flows to her pelvic area. This causes the genital tissues to swell and the vagina to moisten in readiness for sexual activity. With sexual arousal disorder, your mind desires sex, but your body does not follow suit.
Many things can cause or contribute to this disorder. Medical conditions such as hypothyroidism and diabetes can dampen sex drive. Medications, including antidepressants and anti-seizure drugs, can have sexual side effects. Emotional and psychological issues also can profoundly affect sexual desire — and performance.
Sexual arousal disorder in women often occurs after menopause, when estrogen levels drop. This can cause vaginal tissue to thin and secretions to decrease. Sex may become painful, resulting in less arousal. But even if sex is not painful, a woman may notice the absence of the pelvic changes that occur with increased blood flow and vaginal moistening. That can put a further damper on desire.
What treatments are available to improve sexual desire and sexual function? For years, drug companies have been in search of a “female Viagra.” The idea is that increased blood flow to the genital area will translate into greater sexual desire. So far, studies have not found this to be the case.
Another issue might be vaginal dryness. For many women, over-the-counter lubricants and vaginal moisturizers are enough to relieve vaginal dryness. If these products don’t help, low-dose vaginal estrogen products are available by prescription. They come as creams, tablets or rings inserted into the vagina. These raise estrogen levels in the vagina, making vaginal tissue thicker and more elastic. Unlike higher-dose hormone replacement therapy, they do not significantly increase blood levels of estrogen.
The most widely studied treatment for boosting female sexual desire is testosterone. Most studies have found a benefit. Even though testosterone is described as a “male” hormone, women also make testosterone — but in much lower amounts than men. It does stimulate desire in women as well as men, along with arousal and orgasm.
Another option, if your problem is not just physical, is sex therapy. A therapist can help you identify thoughts, feelings and behaviors that might be interfering with your sexual enjoyment. A therapist will also help you communicate your needs and enhance feelings of intimacy between you and your partner.
A loss of sexual desire and function after menopause is reasonably common. Fortunately, there are therapies that can help.
(This column ran originally in October 2014.)