Management of Low Libido in Women

Assessment and Treatment

• The National Comprehensive Cancer Network recommends assessing for symptoms of menopause, including vaginal dryness, dyspareunia, and other vaginal issues that may contribute to decreased sexual desire, and evaluating for psychological concerns, including distress, anxiety, depression, body-image concerns, and relationship issues, in women with low libido 1, 2
• The American College of Obstetricians and Gynecologists suggests considering medication side effects, particularly from antidepressants, which may negatively impact libido, in women with low libido 2
• Vaginal moisturizers, lubricants, and gels are recommended as first-choice treatments for vaginal dryness and dyspareunia that may contribute to low libido, according to the National Comprehensive Cancer Network 1, 2
• Psychosexual therapy has shown successful outcomes in 50-80% of patients and can be used alone or in conjunction with physical therapies, as reported in the BMJ 3
• Flibanserin is FDA-approved for acquired, generalized hypoactive sexual desire disorder in premenopausal women, according to the National Comprehensive Cancer Network 1
• DHEA supplementation (10-50 mg daily) can be considered for persistent lack of libido and/or low energy levels in postmenopausal women, as suggested by the Praxis Medical Insights 4
• The Annals of Oncology recommends that sexual health should be included in survivorship care plans for cancer patients, as this is often overlooked 2
• The National Comprehensive Cancer Network and the Annals of Oncology suggest that hormonal contraception is generally contraindicated in breast cancer survivors; alternative non-hormonal contraception methods should be used 2, 5

Evaluation and Management of Low Libido in Women

Initial Assessment and History Taking

• The American College of Physicians recommends documenting alcohol consumption, recreational drug use, and smoking history in patients with low libido 6
• A thorough medical history should be taken to review for chronic illnesses, including diabetes, cardiovascular disease, thyroid disorders, and liver disease that can affect sexual function 7, 8

Physical Examination and Laboratory Workup

• Blood pressure measurement should be performed as part of the physical examination 6
• A gynecologic examination should be conducted to assess for vaginal atrophy, anatomic changes, and points of tenderness 8
• Morning testosterone testing is recommended when there is clinical suspicion of hypogonadism or to reassure the patient, with free testosterone or androgen index preferred over total testosterone 9
• Thyroid function tests (TSH, free T4) should be obtained if thyroid dysfunction is suspected 10
• Prolactin level should be checked if there is loss of libido with low testosterone 9
• Fasting glucose or HbA1c should be screened for diabetes 9
• A complete metabolic panel should be obtained if renal or hepatic impairment is suspected 9

Validated Assessment Tools and Referral Indications

• The Journal of the National Comprehensive Cancer Network recommends using the Brief Sexual Symptom Checklist for Women as a primary screening tool and the Female Sexual Function Index (FSFI) for more comprehensive evaluation 8
• Referral to appropriate specialists is indicated when multiple endocrine abnormalities are identified 10 or when initial screening reveals important abnormalities requiring specialized evaluation 6