Treatment

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling, and sometimes medication and hormone therapy.

Sex education and counseling

Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sex drive. Therapy often includes education about sexual response and techniques. Your therapist or counselor likely will provide recommendations for reading materials or couples' exercises. Couples counseling that addresses relationship issues may also help increase feelings of intimacy and desire.

Medications

Your doctor will want to review the medications you're already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as paroxetine (Paxil) and fluoxetine (Prozac, Sarafem) may lower sex drive. Switching to bupropion (Wellbutrin SR, Wellbutrin XL) — a different type of antidepressant — usually improves sex drive and is sometimes prescribed for women with sexual interest/arousal disorder.

Along with counseling, your doctor may prescribe a medication to boost your libido. Food and Drug Administration (FDA)-approved options for premenopausal women include:

• Flibanserin (Addyi), a pill that you take once a day at bedtime. Side effects include low blood pressure, dizziness, nausea and fatigue. Drinking alcohol or taking fluconazole (Diflucan), a common medication to treat vaginal yeast infections, can make these side effects worse.
• Bremelanotide (Vyleesi), an injection you give yourself just under the skin in the belly or thigh before anticipated sexual activity. Some women experience nausea, which is more common after the first injection but tends to improve with the second injection. Other side effects include vomiting, flushing, headache and a skin reaction at the site of the injection.

These medications aren't FDA-approved for use in postmenopausal women.

Hormone therapy

Dryness or shrinking of the vagina, one of the hallmark signs of genitourinary syndrome of menopause (GSM), might make sex uncomfortable and, in turn, reduce your desire. Certain hormone medications that aim to relieve GSM symptoms could help make sex more comfortable. And being more comfortable during sex may improve your desire.

Possible hormone therapies include:

• Estrogen. Estrogen is available in many forms, including pills, patches, sprays and gels. Smaller doses of estrogen are found in vaginal creams and a slow-releasing suppository or ring. Your doctor can help you understand the risks and benefits of each form. But, estrogen won't improve sexual functioning related to hypoactive sexual desire disorder.
• Testosterone. The male hormone testosterone plays an important role in female sexual function, even though testosterone occurs in much lower amounts in women. Testosterone isn't approved by the FDA for sexual dysfunction in women, but sometimes it's prescribed off-label to help lift a lagging libido. The use of testosterone in women is controversial. Taking it can cause acne, excess body hair, and mood or personality changes.
• Prasterone (Intrarosa). This vaginal insert delivers the hormone dehydroepiandrosterone (DHEA) directly to the vagina to help ease painful sex. You use this medication nightly to ease the symptoms of moderate to severe vaginal dryness associated with GSM.
• Ospemifene (Osphena). Taken daily, this pill can help relieve painful sex symptoms in women with moderate to severe GSM. This medication isn't approved in women who have had breast cancer or who have a high risk of developing breast cancer.