Ashlee Williams, MD: Low libido is more common than most people realize, and it can affect everything from your mood and energy, to your relationships. Things like hormone changes, certain medications, stress, mental health and relationship issues can all play a role in lowering your sex drive.

Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams, and today I'm joined by Dr. Carolyn Gorman, a Board Certified OBGYN, and sexual health expert here at Kaiser Permanente about some of the most common causes of low libido in women and what you can do about it. Dr. Gorman, thank you so much for joining us today.

Carolyn Gorman, MD: Thanks for having me. I'm excited to talk about this.

Host: Yes, such an exciting topic.

Dr. Gorman, let's just start with the basics. What is low libido and how common is it in women?

Carolyn Gorman, MD: Sure. Low libido is the lack of desire for sexual intimacy with your partner, and it's very common. At some point, roughly 40% of women will have some concerns of low libido during their lives.

Host: So what are the most common causes of low libido in women?

Carolyn Gorman, MD: Libido is very multifactorial. So we can look at the biologic concerns such as health changes, hormonal status, medications such as antidepressants. We can also look at how you're feeling psychologically. Are you anxious? Are you depressed? Do you have a history of trauma. And then of course there are relationship issues. There's stress in the environment. All of these things can really influence and impact your low libido.

Host: What should a woman do if she's concerned about her sex drive? When should she talk to a doctor?

Carolyn Gorman, MD: Sure. Well, I really want to make the important point that if it's not a problem for you, then it's not a problem for me. Meaning that, low libido, lots of women can have low libido and it not be an issue. But if it's distressing to you, if it's causing problems in your relationship, then that's something that we want to work on.

And I encourage all women to bring that up with their gynecologist. If they don't know about next steps, then they can always refer you to somebody that specializes in sexual health, like me.

Host: Like you. So we always hear about the medications that can help men with their sexual health. Are there any treatment options for women to help with their libido?

Carolyn Gorman, MD: There are. There are two FDA approved medications for low libido in women, in premenopausal women. The two medications are called flibanserin, which is a nightly pill or bremelanotide, which is an on demand injection. Think of it like an EpiPen that you can give yourself about an hour before you want to have sex.

So those are FDA approved. Now, a lot of doctors in the sexual health realm do use medications that are off-label as well. So for perimenopausal or menopausal women, we often employ testosterone as a hormone for those women. As their testosterone levels decline, they may also notice a decline in their libido, which can be distressing to them.

Host: So testosterone can not only be used for men, but also women. That's good to know.

How important is communication with your partner in addressing low libido?

Carolyn Gorman, MD: Very important. So, it's good to let your partner know that you're concerned about your libido and that it's not really about them, right? That you're not disinterested in them. It's really the intimacy, the sexual intimacy that you're not interested in right now, and that there may be things that they can do to help you, but really the most of it is in your court, right?

They can be perfect in every way, and if you're just not open to intimacy, then you're really not going to have a big libido. So a lot of what I do outside of giving medication, if indicated, is having you kind of reflect on those things that can excite you or things that can maybe turn off the excitement.

And then we try to address those. I like to use the analogy from a woman called Emily Nagoski, that we all have our brakes and accelerators. So I often give women homework to kind of look at what might be some of their accelerators, what might be some of their brakes, and how can we address them.

Host: So speaking of homework, are there any self-care tips or daily habits that you recommend to help improve libido?

Carolyn Gorman, MD: So a lot of things that just keep us generally healthy can also keep our libido up. So exercising, getting enough sleep. Who wants to have sex at 10 o'clock at night when you are just fully exhausted from your whole day? Also, maybe not always keeping sex to be at the end of the day at 10 o'clock when you are exhausted. Maybe mixing it up a little bit.

The other thing that can really help a lot of women is mindfulness meditation. There is a book by Lori Brotto that looks at mindfulness and how that can improve libido. And I think of it as an exercise of the brain to really try to stay focused on the present and try to not to get distracted with all of our laundry that needs to get done or the project at work that's stressful. Really just trying to be there with your partner in that intimate moment. And, noticing what feels good and what doesn't feel good and try not to get distracted.

Host: Thanks for sharing this thoughtful insight, Dr. Gorman. Here are some key takeaways from today's episode. One, libido is a common concern among women and can be influenced by a combination of physical, emotional, and relationship factors. Two, hormonal changes, mental health and certain medications are all common causes of low libido. Stress can also affect low libido. Three, treatment options range from lifestyle changes and FDA approved medications and hormone therapy. Four, open communication with your partner and your doctor is key and five, prioritizing rest, reducing stress and focusing on self-care can help support healthy libido.

For more expert advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcasts. If you found this episode helpful, don't forget to subscribe and share it with others. Thank you, and from all of us at Kaiser Permanente, be well.