This condition affects the sex drive of millions of women.
Maybe you’ve always had the kind of libido that deserves its own sexy Netflix movie. Or maybe your sex drive isn’t quite that robust, but you’ve been aware of it since first seeing Leo in Titanic, Isis in Bring It On, or whoever first sparked your sexual awakening. Although there are many places you can fall on the sex-drive spectrum, many times, your libido going poof can throw you for a loop. And you’re not alone in that.
Of course, it’s normal for your sex drive to ebb and flow. But millions of women are struggling with female sexual dysfunction, a collection of conditions that essentially lay their sex lives to waste out of nowhere.
Female sexual dysfunction is an umbrella term for various issues that can impact women’s sexual well-being.
FSD is divided into four categories: arousal issues, problems reaching orgasm, pain during sex, and desire problems, Leah S. Millheiser, M.D., clinical assistant professor of obstetrics and gynecology and director of the Female Sexual Medicine Program at Stanford University Medical Center, tells SELF.
At least 40 percent of women will experience FSD during their lifetimes, according to a large 2008 study in the American Journal of Obstetrics and Gynecology.
Hypoactive sexual desire disorder, the most common kind of FSD, is marked by having a low libido that causes negative emotions.
The exact number of women HSDD affects is hard to pin down. A landmark 2008 study estimated that 4 million U.S. women ages 30 to 70 were affected. Other studies put the number around one in 10 women, and according to a 2016 Harris Poll Survey, 48 percent of premenopausal women aged 21 to 49 say their sex drive is lower now than it used to be. (The poll was conducted on behalf of the American Sexual Health Association and Valeant Pharmaceuticals North America, the latter of which produces a drug aimed at targeting one kind of female sexual dysfunction.)
No matter the specific number, the problem is real.
“[HSDD] is this persistent, chronic low sex drive that lasts longer than six months and causes personal distress,” Dr. Millheiser says. While normal libido changes often stem from life circumstances, HSDD isn’t related to medication, relationship issues, or health conditions.
“We did research at Stanford on this—it’s an imbalance in the hormone levels in brain,” Dr. Millheiser says. In some people, the neurotransmitters that govern sexual arousal and desire—dopamine, norepinephrine, and serotonin—get out of whack, she says. Their dopamine and norepinephrine decline, their serotonin rises, and this leads to a lowered libido.
HSDD can also lead to common sex drive killers, thus creating a vicious cycle. “It’s a multidisciplinary problem,” Dr. Millheiser says. “Women who have longstanding sexual dysfunction oftentimes develop self-esteem issues, relationship issues, and quality-of-life issues.”
There is one FDA-approved drug to treat hypoactive sexual desire disorder, but it’s not a magic bullet.
Meet flibanserin (Addyi), also known as “the little pink pill” in a cheeky nod to Viagra’s blue-tinged nickname. It’s a false equivalency, mainly because drugs like Viagra work by pumping blood into the penis. Voila, erection! For people with vaginas, it’s not that simple.
“Your sexual desires really come from your brain,” Sherry Ross, M.D., ob/gyn and women’s health expert in Santa Monica, California, and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period, tells SELF. “It’s about the great organ above the shoulders, rather than the one below the waist.”
Flibanserin, which was originally meant to be an antidepressant, was FDA-approved to treat HSDD in August 2015. Its passing was mired in debate around how efficient it really is.
A large systematic review of the drug found that on average, women taking flibanserin had 0.5 additional “satisfying sexual events” per month, according to an April 2016 study in JAMA Internal Medicine. The research also found that the drug significantly increased study subjects’ risk of side effects like dizziness, nausea, and fatigue.
The buzz around flibanserin’s potential side effects isn’t new. In fact, it’s part of why the drug was rejected twice by the FDA, in 2010 and 2013, before finally nabbing that approval. Even then, the FDA’s statement about the drug passing muster highlights that it can cause severely low blood pressure and loss of consciousness, especially when combined with alcohol or taken with certain medicines.
Combined with the dearth of research showing that flibanserin greatly increases sexual desire, some doctors think it’s a lackluster solution. Others think any progress is good progress. “To focus on the controversy takes away from the fact that there are millions of women suffering,” Dr. Millheiser, who is on the advisory board of Valeant Pharmaceuticals North America, says. Many of those women are thrilled by whatever sexual progress they can make, she explains.
“When you give [women] that opportunity to be sexual again, it has such an important impact on their lives,” she says, adding, “many of us in my field feel that the side effects were overblown,” and that can be hard to measure sexual function in scientific tests because of its subjective nature.
In any case, other drugs targeting HSDD are in the works. “The research is looking really promising,” Dr. Millheiser says.
If you’re experiencing a lowered sex drive and it bothers you, it’s time to see a medical practitioner.
It doesn’t matter if you’ve been dealing with this for a couple of weeks or a couple of months—if something is wrong, you should get help. “The first thing is to try to identify the cause, then the treatment will be based on that,” Dr. Ross says.
When Dr. Ross is discussing this with a patient, she often starts by asking about the patient’s relationship, if they’re in one. “If you’re not in a good space with your boyfriend or girlfriend, the last thing you’re going to want to do is be intimate,” Dr. Ross says.
If that’s the case, you can talk about how to improve your relationship, whether it’s by having an open discussion with your partner, heading to couples therapy, or evaluating whether this is the right relationship for you. Your doctor may also be able to pinpoint a specific issue, like an imbalance in your estrogen or testosterone levels, in which case they might decide hormone-based therapy is the right way to go.
Although speaking with a doctor is your best option, sometimes that can be intimidating. Dr. Millheiser recommends checking out the website FindMySpark.com (it was launched by the American Sexual Health Association with support from Valeant). You can take a quiz to see whether you might have HSDD, or some other form of female sexual dysfunction. That can give you the courage to see a doctor, which is really the best first step in finding relief.