Management of Decreased Libido in Females

Initial Assessment

The American College of Obstetricians and Gynecologists recommends a comprehensive assessment for menopausal symptoms, psychological factors, and medication side effects, then treats vaginal symptoms with non-hormonal lubricants as first-line therapy, considers flibanserin for premenopausal women with hypoactive sexual desire disorder, and offers psychosexual therapy which achieves success in 50-80% of patients 1
Evaluate for menopausal symptoms, including vaginal dryness and dyspareunia, which directly contribute to decreased sexual desire 1
Assess psychological concerns, including distress, anxiety, depression, body image concerns, and relationship issues, as these are common contributors to sexual dysfunction 1
Review all medications, particularly antidepressants, which commonly impair libido as a side effect 1
In cancer survivors, sexual dysfunction affects at least 50% of women and is often multifactorial, involving treatment effects, body image changes, and psychosocial trauma 2, 3

Vaginal moisturizers, lubricants, and gels are the recommended first-choice treatments for vaginal dryness and dyspareunia that contribute to low libido 1
Atrophic vaginitis affects approximately 50% of postmenopausal women and, unlike hot flashes, symptoms persist indefinitely without treatment 2

Psychosexual therapy demonstrates successful outcomes in 50-80% of patients and can be used alone or combined with physical therapies 1
This approach is particularly valuable given that sexual dysfunction in women is often complex, involving the diagnosis itself, body image changes, psychosocial trauma, and relationship factors 2

Flibanserin (ADDYI) is FDA-approved for acquired, generalized hypoactive sexual desire disorder in premenopausal women 1

DHEA supplementation (10-50 mg daily) can be considered for persistent lack of libido and/or low energy levels in postmenopausal women 1

Sexual health should be included in survivorship care plans, as this is frequently overlooked 1
For breast cancer survivors on aromatase inhibitors, vaginal dryness is significantly more common (18%) compared to tamoxifen (8%), and symptoms can markedly affect quality of life and treatment compliance 2
Young women who undergo bilateral oophorectomy for breast cancer treatment commonly experience severe and long-lasting menopausal symptoms, including sexual dysfunction 2

Do not obtain testosterone levels in women in non-research settings, as this is not recommended 4
Do not prescribe hormonal contraception to breast cancer survivors; use alternative non-hormonal methods 1
Do not overlook medication-induced sexual dysfunction, particularly from antidepressants and endocrine therapies, which have profound impacts on both desire and arousal 3

Consider referral to a specialist menopause service when symptoms are refractory to initial management or when complex hormonal issues are present 2