Living with libido loco? For a growing number of women, declining hormones, job stress, relationship issues, and other problems are taking their toll in the bedroom. Loss of sexual desire, known in medical terms as hypoactive sexual desire disorder (HSDD), is the most common form of sexual dysfunction among women of all ages. A recent study showed that nearly one-third of women aged 18 to 59 suffer from a lost interest in sex, and it's not all in their heads. Unlike men's main sexual complaint, erectile dysfunction, women's biggest sexual problem is caused by a combination of both mental and physical factors, which aren't likely to be cured by merely popping a pill.

"Women's sexuality tends to be multifaceted and fairly complicated," says sex psychologist Sheryl Kingsberg, PhD. "Although we would love to simplify it so we could have the one-two or even a one-punch treatment, it doesn't tend to work that way." But the introduction of anti-impotence treatments in the last few years has spurred more research into the causes of sexual dysfunction among both men and women, and effective therapies are available to help put the lust back into women's lives.

What Is Low Sexual Desire?

Contrary to popular belief, experts say frequency of sexual intercourse has nothing to do with sexual desire or satisfaction. "One of first things I do in speaking to women who come in with sexual concerns is let them know that there is no normal frequency or set of behaviors and things change with time," says Jan Shifren, MD, an assistant professor at Harvard Medical School. "If it's working for them and/or their partner, there is no problem." But when a woman experiences a significant decrease in interest in sex that is having an effect on her life and is causing distress, then it's considered a problem of low sexual desire or HSDD.

Kingsberg says that sexual desire is more than just an issue of low libido or sex drive. She says sexual drive is the biological component of desire, which is reflected as spontaneous sexual interest including sexual thoughts, erotic fantasies, and daydreams. Kingsberg, who is an associate professor of reproductive biology at the Case Western Reserve School of Medicine says, "It's about your body signaling that it wants to be sexual. Whether or not there is any intention to act on it, we all have a certain level of drive."

That sexual drive declines naturally with age based on physiological factors. But sexual desire also encompasses interpersonal and psychological factors that create a willingness to be sexual. "Above and beyond horniness, it is the sense of intimacy in the relationship," says Kingsberg. "If you are mad at your spouse, you could be horny but you're not going want to be sexual with that particular person." Therefore, all of these aspects of sexual desire must be examined in order to determine the root of the problem.

Common causes for a loss of sexual desire and drive in women include:

• Interpersonal relationship issues. Partner performance problems, lack of emotional satisfaction with the relationship, the birth of a child, and becoming a caregiver for a loved one can decrease sexual desire.
• Sociocultural influences. Job stress, peer pressure, and media images of sexuality can negatively influence sexual desire.
• Low testosterone. Testosterone affects sexual drive in both men and women. Testosterone levels peak in women's mid-20s and then steadily decline until menopause, when they drop dramatically.
• Medical problems: Mental illnesses such as depression, or medical conditions, such as endometriosis, fibroids, and thyroid disorders, impact a woman's sexual drive both mentally and physically.
• Medications: Certain antidepressants (including the new generation of SSRIs), blood pressure lowering drugs, and oral contraceptives can lower sexual drive in many ways, such as decreasing available testosterone levels or affecting blood flow.
• Age. Blood levels of androgens fall continuously in women as they age.

Putting the Desire Back in Women's Sex Lives

Because a loss of sexual desire in women is caused by a combination of physical and psychological factors, it usually requires more than one treatment approach to fix the problem. "For women, it is much more complex. They're not just complaining of one plumbing problem, says Shifren. "So we have to be more thoughtful in our approaches to treatment." Once the factors causing low sexual desire have been determined, potential treatment options may include:

• Sex therapy and/or relationship counseling. "Sex therapy is very effective for individuals and couples, and that is always at the top of my list," says Shifren. Sexual dysfunction usually affects both parties in a relationship and should be discussed together or individually with a mental health professional.
• Changing medications or altering the dose. If the problem is caused by medications, a change of prescription or alternative therapies may be recommended. If an oral contraceptive is suspected as the culprit in lowering testosterone levels, a different formulation or nonhormonal birth control methods may be prescribed.
• Addressing underlying medical conditions. Medical problems contributing to low sexual desire may require surgical treatment, such as the removal of painful fibroids or medication.
• Vaginal estrogens. In postmenopausal women, vaginal dryness may be treated with vaginal estrogen creams.
• Testosterone therapy. Although no hormone or drug has been approved by the FDA to treat sexual problems in women, many gynecologists recommend off-label uses of testosterone therapy for women with low sexual desire to restore testosterone to normal (pre-menopausal) levels.

No Miracle Love Potion No. 9

When evaluating treatments for sexual problems, experts say it's important to recognize that there is an especially large placebo effect, which is based upon the user's expectations of the treatment. That's why drugs must be tested against a placebo (sugar pill) in order to scientifically measure their effect. It also helps explain why many supplements claim to be effective in treating sexual problems, such as low sexual desire. Because expectations play such a large role in sexual desire, over-the-counter products may claim that they're effective, but it's likely just a placebo effect.  "It's really important for women to realize that any of the over-the-counter products they may use have not been tested for efficacy and safety," says Shifren.

SOURCE: Sheryl Kingsberg, PhD, clinical psychologist; associate professor of reproductive biology, Case Western Reserve School of Medicine

Roberta Lester-Britton and Sarah Press specialize in treating women with Hypoactive Sexual Desire Disorder.