Whole-Self Wellness: Magnolia’s Guide to Sexual Health for Women

Whole-Self Wellness: Magnolia’s Guide to  Sexual Health for Women

Low libido, or decreased sexual desire, is a common concern affecting many women at different stages of life. This handout will help you understand the causes and what you can do about it.

What Causes Low Libido?

Hormonal Changes

As women approach midlife and menopause, estrogen and testosterone levels naturally decline, leading to decreased desire, vaginal dryness, and painful intercourse.

Medications- Several medications can affect sexual desire:

- Antidepressants (especially SSRIs like sertraline, fluoxetine, paroxetine)

- Blood pressure medications (beta-blockers like metoprolol, atenolol)

- Birth control pills

- Antihistamines (diphenhydramine), opioid pain medications

- Spironolactone (for blood pressure, acne, fluid retention)

- Finasteride (for hair loss)

Birth Control Pills vs. Hormone Therapy

Birth control pills can lower libido by suppressing testosterone production and increasing a protein (SHBG) that binds testosterone, making less available to your body. In contrast, menopausal hormone therapy can improve libido by relieving hot flashes, night sweats, and vaginal dryness, while improving blood flow and sensation in vaginal tissues.

Physical Causes

- Vaginal dryness and pain during intercourse

- Pelvic organ prolapse

- Diabetes and nerve damage

- Clitoral adhesions or phimosis

- Chronic pain or illness

Vitamin Deficiencies

Low levels of vitamin D, B vitamins, and iron can contribute to fatigue and low libido.

Psychological and Relationship Factors

- Stress, anxiety, and depression

- Relationship difficulties

- Past trauma or abuse

- Religious or cultural beliefs about sexuality

- Poor body image and lack of sleep

What to Expect During Your Visit

-Discussion: Your provider will ask about symptoms, medical history, medications, stress levels, and relationship factors.

-Laboratory Tests: May include hormone levels (thyroid, testosterone, estrogen), vitamin levels (vitamin D, B12, iron), and blood sugar.

-Physical Examination: A pelvic exam may be needed to check for vaginal dryness, clitoral adhesions, prolapse, infection, or sources of pain.

What You Can Do

Lifestyle Changes

- Exercise regularly to improve blood flow, mood, and energy

- Prioritize 7-9 hours of sleep per night

- Manage stress: Take 30 minutes before intimacy to relax and allow your body's relaxation response to take over

- Self-stimulation: Regular stimulation improves blood flow to the genital area

Lubricants and Moisturizers

- Lubricants (used during sexual activity): Silicone-based (Uberlube), water-based (Aloe Cadabra, Sliquid - safe with condoms), coconut oil-based (Coconu - NOT safe with latex condoms)

- Vaginal moisturizers (used regularly): Replens and similar products

Foods and Nutrition

Eat a balanced diet rich in fruits, vegetables, whole grains, and healthy fats.

Educational Resources

- Books: "Come As You Are" by Emily Nagoski, "Reclaiming Desire" by Andrew Goldstein and Marianne Brandon, "You Are Not Broken" by Kelly McDaniel

- Spicy novels: Romance or erotic literature can help reconnect with your sexuality

- Rosy app: Sexual wellness content, education, and audio stories

- Counseling: Individual or couples therapy for relationship issues, stress, anxiety, or past trauma

Medical Treatments Your Provider May Recommend

For Vaginal Dryness and Pain

- Vaginal estradiol: Low-dose estrogen cream, tablet, or ring

- Intrarosa (prasterone/DHEA): Vaginal insert for dryness and pain

- Osphena (ospemifene): Oral medication for vaginal dryness and painful intercourse

- Vaginal dilators: Help gently stretch vaginal tissues that become drier, less elastic, narrower, and shorter after menopause

For Low Desire - FDA Approved

- Testosterone supplementation: For postmenopausal women with low desire and low testosterone levels

- Hormone therapy: For postmenopausal women to relieve hot flashes, improve sleep, and treat vaginal dryness

- Addyi (flibanserin): Daily pill for premenopausal women with hypoactive sexual desire disorder (HSDD). Side effects: dizziness, sleepiness, nausea. Cannot be combined with alcohol.

- Vyleesi (bremelanotide): Injectable medication for premenopausal women with HSDD, given as needed before sexual activity. Side effects: nausea, flushing, headache.

For Pelvic Floor Issues

- Kegel balls or pelvic floor exercises: Strengthen weakened pelvic muscles

- Pelvic floor physical therapy: For pain or muscle dysfunction

Medication Adjustments

Your provider may adjust medications contributing to low libido or add medications to counteract sexual side effects.

Supplements

If vitamin deficiencies are found, your provider may recommend specific supplements.

Remember

Low libido is common and treatable. Many factors can contribute, and addressing them takes time. Open communication with your healthcare provider and partner is important. Treatment is individualized—what works for one person may not work for another. You deserve to feel comfortable and satisfied in your sexual health.