Decreased Sexual Desire in Women

Epidemiology and Impact

• The National Comprehensive Cancer Network recommends screening all women at regular intervals about sexual function concerns, distress regarding sexual activity, and impact on relationships 1, 2

Diagnostic Approach

• The European Heart Journal suggests using the Female Sexual Function Index for comprehensive assessment of sexual dysfunction 3
• The European Heart Journal recommends assessing depression and anxiety before sexual activity engagement, as these conditions have detrimental effects on sexual desire and are strongly associated with sexual disorders 4, 5, 6
• The Journal of the National Comprehensive Cancer Network : JNCCN suggests evaluating psychiatric comorbidities, such as depression, which is a major contributing cause of decreased libido, difficulty with arousal and orgasm 5, 6
• The Journal of the National Comprehensive Cancer Network : JNCCN recommends evaluating medications, such as serotonin reuptake inhibitors, narcotics, and hormone therapy, which can suppress desire 7
• The European Heart Journal suggests evaluating medical conditions, such as cardiovascular disease, diabetes, thyroid disorders, and obesity, which are traditional risk factors for decreased sexual desire 4, 7

Treatment Algorithm

• The European Heart Journal recommends treating coexisting depression and anxiety first, as these psychological conditions directly impair sexual desire and function 4, 5, 9
• The Journal of the National Comprehensive Cancer Network : JNCCN suggests optimizing control of cardiovascular disease, diabetes, and thyroid disorders to improve sexual function 4, 7
• The European Heart Journal recommends addressing relationship issues through couples counseling to improve sexual function 4, 9
• The Journal of the National Comprehensive Cancer Network : JNCCN suggests using vaginal estrogen therapy for vaginal atrophy and dyspareunia to improve sexual function 8
• The Journal of the National Comprehensive Cancer Network : JNCCN recommends using cognitive behavioral therapy (CBT) to improve sexual functioning, particularly in cancer survivors but applicable broadly 6, 8
• The European Heart Journal suggests using patient education and therapeutic communication to improve sexual function 4, 6
• The Journal of the National Comprehensive Cancer Network : JNCCN recommends using pelvic floor physical therapy for associated pelvic floor dysfunction to improve sexual pain, arousal, lubrication, orgasm, and satisfaction 8

Treatment Requires Multidimensional Planning

• The Journal of the National Comprehensive Cancer Network : JNCCN suggests that sexual dysfunction is multifactorial, requiring plans that address physiologic, psychologic, medication-induced, and interpersonal issues 8