Contributions to Low Sex Drive In Women: A Urologic Perspective

If you find it harder to get “turned on” lately with your partner but are turned off by the idea of talking about it, consider yourself among the silent six in 10.

More than 20% of women experience an occasional dip in sex drive at some point and this is normal; it’s also common to have a low sex drive more than once in your life. Family needs, work, lack of sleep, stress, and hormonal changes can cloud your mood and crowd out thoughts of intimacy. 

However, a long-lasting or recurring low sex drive in women may be caused by symptoms of urological issues or hormonal imbalance. These underlying causes can be addressed with a urologist, yet 58% of women who experience problems with sexual functioning do not pursue treatment, the AARP reports.

To understand these changes and how to revive your sex drive, it helps to know how your body’s physiology contributes to sexual desire and pleasure. 

Low Sex Drive in Women: The Anatomy’s Role

While the female urinary tract and sex organs function separately, conditions that affect your urinary system might cause pain, discomfort, and a lack of confidence during sex. 

Consider the key players in the female urinary tract – the bladder, urethra, and pelvic floor muscles. These body parts sit close to the female sex organs in the pelvis. In fact, the urethra, which is attached to the bladder, is also part of a woman’s external genitals (vulva). 

Symptoms of Low Sex Drive in Women

Doctors have assigned a term to describe a long-lasting lack of interest in sex that causes distress: hypoactive (low active) sexual desire disorder. One in 10 women experience at least one episode of sexual desire disorder, and for 32% of women, it may last for several months. 

Among the symptoms:

• A low or absent libido
• No sexual fantasies or thoughts
• Distress at the thought of sex
• Inability or difficulty getting aroused
• Lack of orgasm or pleasure in the act of sex
• Painful intercourse

5 Urinary Conditions that Can Cause Low Sex Drive in Women

If you experience any of the above symptoms, it may be due to a urologic condition. Among those linked to low sex drive in women:

1: A decline in estrogen levels – When women enter menopause, their estrogen levels decline. This can upset their ability to enjoy sex because the female hormone lubricates the vagina and makes it flexible. Without it, sex can be painful, triggering a cycle of avoidance that contributes to vaginal thinning, drying, and inflammation (atrophy). 

Care options you can ask about: Vaginal estrogen therapy, a topical treatment you can apply yourself, and MonaLisa Touch, an outpatient laser procedure that can relieve symptoms in a few treatments. 

2: Weak bladder control – Urinary incontinence or leakage affects an estimated 50% of all adult women and is often a symptom of a weak bladder. The most common types are stress incontinence, triggered by sudden pressure on your abdomen, such as sneezing; and urge incontinence, the immediate need to go (also known as overactive bladder). Women managing incontinence can worry about leaking during sex. 

Care options you can ask about: Prescribed drugs or procedures can relax the bladder muscles (Botox) or strengthen the urethra; nerve stimulation (biofeedback); and estrogen therapy. Surgery might be advised for stress incontinence. 

3: Weak pelvic muscles – The pelvic floor is an assemblage of muscles and ligaments that hold up the uterus, bladder, and bowel. Childbirth, menopause, and advanced age can weaken these muscles, and the organs and tissue they hold in place can drop through the vaginal canal. This is called pelvic organ prolapse, and close to half of all women ages 50 to 79 live with it. 

Care options you can ask about: Kegel exercises, in which you squeeze the pelvic muscles (like holding it in) can strengthen these muscles. Other options include estrogen replacement therapy (to bolster vaginal muscles) and the vaginal insertion of a small disk-like device, called a pessary, that supports the organs. The organs also can be surgically lifted into place and secured with stitches or vaginal mesh.

4: Infections and inflammation – Chronic or frequent pain will naturally make intimacy uncomfortable. Two culprits of pelvic discomfort include urinary tract infections (UTIs) and interstitial cystitis. UTIs are bacterial infections that reach the bladder and potentially kidneys, causing burning and frequent urination. Interstitial cystitis, also known as painful bladder syndrome, is the breakdown of the bladder’s lining, leading to inflammation that can make sex painful. 

Care options you can ask about: Medications – antibiotics for UTIs and multi-symptom drug combinations for interstitial cystitis. Bladder training, physical therapy, and Botox injections also can ease interstitial cystitis symptoms.

5: Hormonal imbalance – Low testosterone in women can also play a role in decreased desire. Replacing testosterone to physiologic doses can help. Systemic hormone replacement therapy through estrogen and progesterone can also help, especially if global symptoms of menopause are impacting libido. 

Care options you can ask about: There are two FDA approved medications to increase libido in pre-menopausal women. Systemic hormone replacement options for testosterone, estrogen and progesterone also exist. 

Non-Physical Contributors to Low Sex Drive in Women

Medications – Several drugs, including those designed to treat cancer, seizures, and depression, can reduce the female libido. Your doctor may be able to prescribe an alternate drug or lower doses.

Your emotional wellness – Stress, fatigue, depression, and low self-esteem affect your relationship with your partner and with yourself, because you don’t feel like yourself. Sex therapy can help. 

Lifestyle – To much alcohol and too little activity can contribute to a low sex drive in women. Reducing alcohol consumption and exercising more (even just walking) can boost your mood, confidence, and libido. 

You Can Improve Your Sex Drive, We Can Help

If you are no longer interested in sex and feeling distressed about it, your urologist can offer support and advocacy. Our urologists talk about and treat sexual desire disorders every day. 

Together, we can stop the silence about low sex drives in women. 

I recorded a webinar on women’s sexual wellness that you can watch right now. You also can read more about women’s sexual health and care options on our website.