Depression, anxiety, stress, relationship problems, past experiences, disorders, drugs, and, sometimes, hormonal changes can reduce a woman's interest in sex.
Doctors diagnose sexual interest/arousal disorder based on the woman's description of the problem and specific criteria.
Improving the relationship and the setting for sexual activity and identifying what stimulates the woman sexually can help.
Psychologic therapies, particularly mindfulness-based cognitive therapy, or sometimes estrogen therapy may be recommended.
(See also Overview of Sexual Dysfunction in Women Overview of Sexual Dysfunction in Women Sexual dysfunction includes pain during intercourse, involuntary painful contraction (spasm) of the muscles around the vagina, and lack of interest in (desire for) sex and problems with arousal... read more .)
A temporary reduction in sexual interest is common, often caused by temporary conditions, such as fatigue. In contrast, sexual interest/arousal disorder causes interest in sexual activity and response to sexual stimulation to be decreased or absent for a longer period of time and to decrease more than would be expected for a woman’s age and the length of the sexual relationship. Lack of sexual interest and inability to be sexually aroused are considered a disorder only if they distress the woman and if interest is absent throughout the sexual experience.
Usually, when women are sexually stimulated, they feel sexually excited mentally and emotionally. They may also be aware of certain physical changes. For example, the vagina releases secretions that provide lubrication (causing wetness). Blood flow to the genitals increases, causing the tissues around the vaginal opening (labia) and the clitoris (which corresponds to the penis in men) to swell, the breasts swell slightly, and these areas may tingle. In sexual interest/arousal disorder, all or some of these responses are absent or significantly decreased.
Sexual interest/arousal disorder is classified as follows:
Subjective: Women do not feel aroused by any type of sexual stimulation, including, kissing, dancing, watching an erotic video, and physical stimulation of the genital area. However, women with subjective sexual interest/arousal disorder may have a physical response to sexual stimulation. For example, blood flow to the clitoris increases (causing it to swell), and the increased blood flow causes vaginal secretions to increase.
Genital: Women feel aroused in response to stimulation that does not involve the genitals (such as an erotic video), but they do not respond to physical stimulation of the genitals. Vaginal secretions and/or sensitivity of the genitals is reduced.
Combined: Women feel little or no aroused in response to any type of sexual stimulation. The physical response (increased blood flow to the genitals and production of vaginal secretions) is minimal or absent. Women may report that they need external lubricants and that the clitoris no longer swells.
Causes
Common causes of sexual interest/arousal disorder are
Psychologic factors, such as depression, anxiety, low self-esteem, stress, distractions, lack of communication between partners, and other relationship problems
Unrewarding sexual experiences, which may occur because one or both partners lack skill or because the woman does not communicate her sexual needs
Physical factors, such as certain chronic disorders, genitourinary syndrome of menopause Symptoms after menopause
, changes in the skin of the vulva (the area around the vagina's opening), changes in sex hormone levels, certain drugs, fatigue, and debility
Certain chronic disorders (such as diabetes Types of Diabetes Complications People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys. (See also Diabetes Mellitus... read more 
or multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more ) can damage nerves, reducing blood flow to and/or sensation in the genital area.
Use of certain drugs, including antidepressants Drug Treatment for Depression Agomelatine, a new type of antidepressant, is a possible treatment for major depressive episodes. Several types of drugs can be used to treat depression: Selective serotonin reuptake inhibitors... read more (particularly selective serotonin reuptake inhibitors), opioids, some antiseizure drugs Antiseizure drugs In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more , and beta-blockers Adrenergic blockers High blood pressure is very common. It often does not cause symptoms; however, high blood pressure can increase the risk of stroke, heart attack, and heart failure. Therefore, it is important... read more , can reduce sexual desire, as can drinking excessive amounts of alcohol.
Because levels of sex hormones such as estrogen and testosterone decrease with age, sexual desire might be expected to similarly decrease with age. However, overall, sexual interest/arousal disorder is as common among young healthy women as it is among older women. Still, changes in sex hormones sometimes cause lack of interest. For example, in young healthy women, sudden drops in levels of sex hormones, as may occur during the first few weeks after childbirth Postpartum and Pregnancy-Related Sexual Dysfunction Several factors (physical and psychologic) related to pregnancy and childbirth can make sexual dysfunction more likely. Risk factors for postpartum and pregnancy-related sexual dysfunction include... read more , may cause sexual interest to decrease. In middle-aged and older women, sexual desire may decrease, but a connection between the decrease and hormones has not been proved.
The decrease in estrogen that occurs at menopause can cause genitourinary syndrome of menopause (which causes symptoms affecting the vagina, vulva, and urinary tract). In this syndrome, the tissues of the vagina can become thin, dry, and inelastic. As a result, intercourse can be uncomfortable or painful. Women with this syndrome may also feel a compelling need to urinate (urinary urgency) and have frequent urinary tract infections. These symptoms make women less interested in sex.
As women age, levels of testosterone decrease, possibly contributing to a decrease in the libido (sex drive).
In younger women, removal of both ovaries causes a very sudden drop in sex hormones (estrogen, progesterone, and testosterone), as well as infertility. Also, the cause for removal may be ovarian cancer. All of these effects may decrease their interest in sex. Even when these women take estrogen, interest in sex may be minimal.
Inadequate sexual stimulation or the wrong setting for sexual activity (for example, not private enough) can also contribute to sexual interest/arousal disorder.
Diagnosis
A doctor's evaluation based on specific criteria
Doctors base the diagnosis of sexual interest/arousal disorder on the woman’s history and description of the problem and on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association. These criteria require a lack of or decrease in at least three of the following:
Interest in sexual activity
Initiation of sexual activity and responsiveness to a partner's initiation
Excitement or pleasure during almost all sexual activity
Sexual or erotic fantasies or thoughts
Physical sensations in the genital area or elsewhere during sexual activity
Interest or arousal in response to sexual stimuli—written, spoken, or visual
These symptoms must have been present for at least 6 months and must cause significant distress in the woman.
A pelvic examination Pelvic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to... read more is done if penetration during sexual activity causes pain.
Treatment
General measures
Psychologic therapies
Treatment of the cause
Hormone therapy
Care for women with sexual interest/arousal disorder is best managed by a team of several types of health care practitioners (a multidisciplinary team). The multidisciplinary team may include sex counselors, pain specialists, psychotherapists, and physical therapists.
One of the most helpful measures for sexual interest/arousal disorder is for women to identify and tell their partner which things stimulate them. Women may need to remind their partner that they need preparatory activities—which may involve touching or not—to get ready for sexual activity. For example, they may want to talk intimately, watch a romantic or erotic video, or dance. Women may want to kiss, hug, or cuddle. They may want their partner to touch various parts of their body, then the breasts or genitals (foreplay) before moving to sexual intercourse or other sexual activity that involves penetration. Couples may experiment with different techniques or activities (including fantasy and sex toys) to find effective stimuli.
Measures recommended to treat sexual dysfunction in general Treatment can also help increase interest in sex. For example, eliminating distractions (such as a television in the bedroom) and taking measures to improve privacy and a sense of security can help. Doctors may recommend using intensely erotic stimuli (such as videos) and fantasizing.
Treatment often focuses on factors that contribute to a lack of interest in sex and lack of response to sexual stimulation, such as depression, low self-esteem, and problems in a relationship.
Psychologic therapies, particularly mindfulness-based cognitive therapy (MBCT), may benefit some women. Mindfulness involves focusing on what is happening in the moment. MCBT, usually done in small groups, combines mindfulness and cognitive-behavioral therapy. It can help with arousal, orgasm, and the desire for sexual activity.
Doctors may refer women with sexual interest/arousal disorder to a sex counselor or therapist or a psychotherapist.
Other treatments depend on the cause. For example, if drugs may be contributing, they are stopped if possible.
Estrogen therapy
Estrogen therapy Hormone Therapy for Menopause Menopause is the permanent end of menstrual periods and thus of fertility. For up to several years before and just after menopause, estrogen levels fluctuate widely, periods become irregular... read more can be used to treat sexual interest/arousal if women have genitourinary syndrome of menopause. Estrogen taken by mouth or applied as a patch or gel to an arm or a leg may be recommended. These forms of estrogen affect the whole body and can thus help improve mood, lessen hot flashes and sleep problems, keep the vagina healthy, and maintain adequate lubrication for sexual intercourse. All of these effects may make women more likely to be interested in sex. Estrogen patches or gels are preferred over pills taken by mouth for postmenopausal women. If women who have a uterus (that is, they have not had a hysterectomy) take estrogen by mouth or in a patch or gel, they are also given a progestogen (a version of the hormone progesterone) because taking estrogen alone increases the risk of cancer of the lining of the uterus Cancer of the Uterus The most common type of cancer of the uterus develops in the lining of the uterus (endometrium) and is called endometrial cancer. Endometrial cancer usually affects women after menopause. It... read more 
(endometrial cancer). Low doses of estrogen are used. Estrogen therapy may be started at menopause or within the next few years.
However, doctors usually recommend that postmenopausal women use forms of estrogen that affect mainly the vagina. For example, estrogen may be inserted into the vagina as a cream (with a plastic applicator), as a tablet, or in a ring (similar to a diaphragm). These forms of estrogen can keep the vagina healthy but do not help with mood, hot flashes, or related sleep problems. When these forms contain a low dose of estrogen, women who have a uterus do not need to take a progestogen. But when these forms contain a high dose of estrogen, women with a uterus need to take a progestogen.
Estrogen has risks as well as benefits, so women should talk to their doctor about its risks and benefits before starting to take it.
Testosterone therapy
Little is known about the long-term effectiveness and safety of testosterone (taken by mouth or in a patch). When taken for a short time, a testosterone patch can be effective in postmenopausal women with sexual interest/arousal disorder. Testosterone is occasionally prescribed in addition to estrogen therapy if all other measures are ineffective. However, doctors must regularly check women for side effects such as acne, excess hair growth (hirsutism Hairiness In men, the amount of body hair varies greatly (see also Overview of Hair Growth), but very few men are concerned enough about excess hair to see a doctor. In women, the amount of hair that... read more 
), and development of masculine characteristics (virilization Virilization Virilization is the development of exaggerated masculine characteristics, usually in women, often as a result of the adrenal glands overproducing androgens (male sex steroid hormones such as... read more ).
Testosterone can also be applied directly to the area around the vagina's opening and the vagina. These forms may have no side effects.
Testosterone taken by mouth is not recommended.
If testosterone is prescribed, doctors explain the uncertainty of effectiveness and the risks of such therapy. They do blood tests to check kidney and liver function and measure lipid levels before testosterone is started. Testosterone is not prescribed if these test results indicate that the woman is at risk for liver problems or dyslipidemia (for example, too high a level of LDL, the "bad" cholesterol). If testosterone is prescribed, doctors schedule regular follow-up visits to check for side effects such as acne, hirsutism Hairiness In men, the amount of body hair varies greatly (see also Overview of Hair Growth), but very few men are concerned enough about excess hair to see a doctor. In women, the amount of hair that... read more , and virilization Virilization Virilization is the development of exaggerated masculine characteristics, usually in women, often as a result of the adrenal glands overproducing androgens (male sex steroid hormones such as... read more .
Other therapies
In postmenopausal women, a synthetic form of dehydroepiandrosterone (DHEA) called prasterone, inserted into the vagina, can relieve dryness due to genitourinary syndrome of menopause Symptoms after menopause Menopause is the permanent end of menstrual periods and thus of fertility. For up to several years before and just after menopause, estrogen levels fluctuate widely, periods become irregular... read more and thus help make sex less painful. Relieving these symptoms may increase a woman's interest is sex and in her ability to be aroused. Prasterone may also make the genital area more responsive to stimulation and improve orgasm.
Flibanserin can be used to treat premenopausal women with female sexual interest/arousal disorder. However, there is little evidence for its effectiveness and safety.
Devices such as vibrators or clitoral suction stimulators may help, but there is little evidence to support their effectiveness. Some of these products are available over the counter and may be tried.
