“How’s your libido?” A common question functional medicine practitioners will often ask women, but there is often confusion on how to answer because the term is frequently misinterpreted.
Low libido is defined as the absence or deficiency of sexual interest or desire.
And a literature review over fifty years found that approximately 24–43% of women complain of low sexual desire in the preceding year. The most common condition affecting libido is hypoactive sexual desire disorder (HSDD), affecting nearly 1 in 10 women.
Many women suffer without knowing that their symptoms could be resolved with a functional medicine approach. Functional Medicine allows treatment of the underlying causes instead of managing or masking the symptoms.
This article will define the term low libido and its possible causes, review some of the functional medicine labs that can be useful, and explore the functional medicine approach to treatment.
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Low Libido in Women Signs & Symptoms
Low libido is a low desire for sex. However, there is no defined measurement. What’s considered low is up to the individual. According to the Mayo Clinic, symptoms of low sex drive in women include:
- Having no interest in any type of sexual activity
- Never or only seldom having sexual fantasies or thoughts
- Being concerned by your lack of sexual activity or fantasies
Other common symptoms associated include diminished vaginal lubrication, discomfort upon intercourse, decreased sense of arousal, and difficulty achieving orgasm.
Low Libido in Women Possible Causes
The etiology of HSDD has not been holistically agreed upon, although scholars and researchers agree that the condition is multifactorial with physical and psychological factors. The following are possible causes of low libido in women.
Oral Contraceptives
A large proportion of birth control pill users experience decreased sexual desire. Hormonal contraceptive use seems to reduce circulating androgen, estradiol, and progesterone levels and inhibit oxytocin functioning.
A study from the Journal of Sexual Medicine found that women on the pill have sex hormone-binding globulin (SHBG) levels 4x higher than never-users. Sex hormone-binding globulin is a protein that binds to sex hormones in the body and therefore controls the amount in circulation. If SHBG levels are high, fewer sex hormones are available. Moreover, even after six months of being off the pill, SHBG remained 2x more elevated, which may explain the long-term libido issues some women experience after birth control pill use.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Decreased libido is one of the most common side effects associated with Selective serotonin reuptake inhibitors (SSRI) use.
Hormones Fluctuations and Imbalances
There is conflicting evidence concerning which particular sex hormones correlate to poor sexual function, but a loss of estrogen and testosterone reduction contribute to a decreasing sex drive.
A decline in estrogen can cause vaginal dryness and painful intercourse, leading to decreased desire.
Additionally, low testosterone levels are associated with a decline in libido, arousal, genital sensation, and orgasm.
Decreased Exercise/Physical Activity
A 2018 literature review identified key relationships between exercise and libido. It found “improvements in physiological sexual arousal following acute exercise” and increased sexual well-being due to chronic exercise.
Sleep/Fatigue/Stress Levels
High-stress levels and cortisol shifts can all contribute to fatigue levels. Obtaining sufficient sleep is vital to the promotion of healthy sexual desire as well as the likelihood of engaging in partnered sexual activity. In a 2015 study, a 1-hour increase in sleep length corresponded to a 14% increase in odds of engaging in partnered sexual activity.
Iron Deficiency
The relationship between iron deficiency and decreased libido has been demonstrated. Since Iron Deficient Anemai can cause anxiety and fatigue in women, these can be influential factors in sexual function. Our results in the clinic showed that women with iron deficiency anemia had lower scores of sexual function and satisfaction.
Vitamin D Deficiency
Low vitamin D is associated with abnormal female sexual function. A small study of women with low vitamin D levels was given Vitamin D supplementation over six months. The results were improved sexual desire as well as mood.
Zinc Deficiency
In one study, postmenopausal women with a chief complaint of low sexual function and serum zinc levels below 62μg/dL were supplemented zinc. The results showed significantly improved sexual desire, arousal, orgasm, satisfaction, and vaginal moisture. They also reported less pain during intercourse, and the overall score of sexual function increased.
Hypothyroidism
Hypothyroidism can deteriorate libido and sexual function. Pasquali et al.’s study showed that the prevalence of female sexual dysfunction in women with hypothyroidism was nearly 50%. Many hypothyroidism symptoms like fatigue and weight gain may also impact the desire for sex.
Functional Medicine Labs to Test for Low Libido in Women
Decreased libido is often multifactorial, with potential causes emanating from several organs, glands, and various hormones. A comprehensive root case approach that utilizes functional medicine testing to identify individual needs can be useful to ensure a targeted treatment plan.
Adrenal/Sex Hormone Testing
The DUTCH Complete™ uses dried urine samples to evaluate sex hormones, adrenal hormones, and cortisol to provide a useful comprehensive picture of hormones. While there is conflicting evidence as to which particular hormones cause low libido, the value of a test such as the DUTCH is a comprehensive picture of hormones that may be relevant to a patient’s symptoms.
Comprehensive Stool Testing
A GI health stool test can evaluate the gut microbiome and any markers for inflammation, digestion/absorption deficiency.
A well-functioning gut is essential for overall health and to keep hormones in balance. 90% of serotonin and approximately 50% of dopamine (neurotransmitters related to mood balancing) are produced in our gut.
Micronutrient Testing
A Micronutrient Test can measure vitamins, minerals, and other nutrients to determine any nutritional deficiencies.
Comprehensive Thyroid Panel
Additionally, the thyroid should be evaluated as it impacts mood, energy, and other hormones. A complete thyroid panel is recommended to rule out thyroid disorders.
Annual Labs
Other serum lab tests to check include a Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), and Iron panel, which can assess iron and ferritin levels, electrolytes, blood glucose, and kidney and liver health.
Functional Medicine Treatment for Low Libido in Women
Medications
The FDA has approved two medications to treat Hypoactive sexual desire disorder in premenopausal women: flibanserin (a daily pill) and bremelanotide (an injection). There are questions surrounding the efficacy of each, and the side effects noted.
In my clinical experience, successfully treating women with low libido often requires a comprehensive integrative approach. The first step in improving your lifestyle is to make sure you have a healthy lifestyle.
Lifestyle Changes
While hormonal shifts are a normal part of a woman’s life, incorporating strategies to balance lifestyle can mitigate symptoms. Incorporating an anti-inflammatory diet, prioritizing sleep, avoiding excessive alcohol, practicing consistent physical activity, and using stress management techniques can be helpful before proposing medication.
Nutrition and Digestive Support
A well-functioning gut is essential not only for overall health. An inflamed gut cannot produce the serotonin and dopamine that help us balance our mood or keep our hormones in check. With the detailed results from a comprehensive stool test, practitioners can create personalized protocols to include recommendations for nutrition, probiotics, and supplements that address gut dysfunction.
Estrogen, progesterone, and testosterone are all made from dietary cholesterol, a dietary fat. If you don’t absorb fat well or eat enough healthy fat in your diet, making the proper amount of hormones may be difficult.
Hormone Therapy
Some treatments may include hormone replacement therapy such as testosterone to improve libido, well-being, and mood. However, a primary concern in testosterone therapy is the long-term side effects, including hirsutism, acne, and masculinization. It’s important to discuss all the pros and cons with your provider and develop a comprehensive plan that suits your needs.
Comprehensive Medical Support
The first step is to talk to your practitioner if you think any of the medications you are on are contributing to your decreased libido.
*Note This article focuses more on physiological vs psychological and if you suspect your low libido is more psychological, please discuss with your doctor. The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) has a referral directory of licensed therapists to provide support.
Supplements That Improved Sexual Desire in Women:
Tribulus: A small 2014 study of 144 women were treated with tablets containing 250 mg Tribulus Terrestris extract (an aphrodisiac herb) at the dose of 1 tablet three times per day for 90 days. Improvement was noted on assessment scores in 88.33% of the subjects.
- Ginkgo biloba was found to be 84% effective in treating antidepressant-induced sexual dysfunction predominately caused by selective serotonin reuptake inhibitors
- Maca has been claimed to improve libido in women. A literature review of 88 articles found limited evidence from four small trials that suggested that maca effectively improves sexual desire after at least six weeks.
- Vitamin D: A 2021 study demonstrates the importance of vitamin D metabolites related to hormonal regulation in postmenopausal women.
*Note: It’s important to not supplement without first talking with your provider, as some supplements and herbs can interfere with prescription medication.
Summary
There is no universally recognized “normal” libido level. And normal levels may not be optimal. What’s considered low libido for a woman is up to her. Causes of low libido can be a wide range of physical and psychological factors. Uncovering what’s happening at the cellular level with specialty testing and a functional medicine approach can help patients restore the body and provide sexual desire improvements.
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