Your options include medications, addressing physical issues, therapy, and Kegel exercises. You might even try the “orgasmic diet.” Here's what you should know.”
If you have trouble with your sex drive, you may want to think about why.
Both men and women can experience low desire, but it’s more often a challenge for women. You might associate desire with good health. You might want to please your partner. You might miss the days when sex was easy and now have pain or vaginal dryness.
You’re hardly alone. A third or more of women say they have sexual problems, including lack of interest.
You have options, however. Many women live with problems for years that could have been addressed, at least in part.
If you suffer from pain and dryness
If sex hurts, a first step is to identify a cause. It could simply be dryness. Over-the-counter products can make your vagina moister, and gynecologists recommend using a lubricant specifically for penetration.
After menopause, when levels of estrogen plunge, you may benefit from introducing hormones in your vagina. Your choices include a ring, insertable pills, or cream. Those approaches don’t have the risk of oral estrogen treatment, such as high blood pressure and stroke.
A less commonly used option is prasterone (Intrarosa), a nightly vaginal insert that delivers the hormone dehydroepiandrosterone (or DHEA) directly to your vagina to help ease painful sex. Another medication, ospemifene (Osphena), is a daily pill.
If you have low desire
Lack of desire may have multiple causes.
Women who smoke or drink tend to have more sexual problems of all kinds. Now may be the time to quit cigarettes and alcohol.
Minimize physical challenges like arthritis or back pain. Massage, stretching, physical therapy, and changing sex positions can make a difference.
Sometimes low desire is a symptom of depression, lack of sleep, an unhappy relationship, or even small changes in the way you communicate or spend time with your partner.
Mindfulness-based therapies and cognitive behavioral therapy designed specifically for low desire may help. You may identify underlying issues in the process. For example, if you have ever experienced sexual assault, you are at risk for sexual problems and may need therapy for trauma.
Talk to your doctor and evaluate your medications. Antidepressants, opioid painkillers, blood pressure and heart medicine, and other drugs can affect your sex drive.
The Food and Drug Administration (FDA) has approved two treatments for women before menopause:
- Flibanserin (Addyi), a pill you take once a day at bedtime
- Bremelanotide (Vyleesi), an injection you give yourself just under the skin of your belly or thigh before you expect to have sex
Both medications may cause nausea but seem to work equally well.
Although the FDA has not approved either medication for post-menopausal women, data from three clinical trials revealed benefits from the drug Addyi. More than 40 percent of that group reported it helped them, compared to 29 percent who reported benefits from a placebo.
The “orgasmic diet”
For an overall plan developed by a woman to solve her own issue, consider “The Orgasmic Diet: A Revolutionary Plan to Lift Your Libido and Bring You to Orgasm.”
Author Marrena Lindberg noticed that her libido surged during pregnancy, dipped during breastfeeding, and roared back after weaning. She had changed her diet to boost her fertility.
She took very large doses of fish oil and ate meals with 40 percent carbs, 30 percent protein, and 30 percent fat. The program detailed in her book has not been backed up by a scientific clinical trial.
The orgasmic diet, step by step, includes:
- Take fish oil supplements with meals and a multivitamin. Start slowly, perhaps with one capsule a day for a week, moving up to two a day for the next week. You can spread the capsules throughout the day. The amount Lindberg recommends varies with your weight. If you weigh 130 pounds, you’ll eventually want to take a daily dose of 1,700 mg EPA and 1,300 DHA (EPA and DHA are two forms of omega-3 fatty acids). At 170 pounds, aim for 2,500 mg EPA and 2,000 mg DHA. Note that she’s recommending much more fish oil than you’ll find in standard capsules, so you’ll be swallowing lots of them. Also note that supplements vary greatly in quality; the company labdoor.com, which conducts independent tests, found that EPA and DHA contents could be 33 percent off from the label. Labdoor ranks the brands. Soft-gels are more reliable than liquids, the company reports.
- Cut soy from your diet. That includes soy milk and soy-enriched energy bars and vegetarian burgers.
- Make sure you’re getting the recommended daily allowance of calcium, magnesium, and zinc.
- Eat half an ounce of quality dark chocolate daily.
- Cut down on sugary and starchy foods.
- Eliminate caffeine. That means ditching not only coffee but also tea and colas. Don’t take the herbal stimulants gingko and ginseng either.
- If you are still menstruating, add 27 mg of iron every two to three days.
You can try the steps in a different order and clump them together. Other tips include:
- Drop oral birth control
- Get enough sleep
- Practice deep-breathing
Antidepressants are famously rough on your libido. Lindberg reports that some women have felt so much better on her program that they were able to stop taking medication under a doctor’s supervision.
That may be an effect of taking omega-3 supplements. Some evidence suggests they can help depression, but the amount, quality of pills, and ratio of different acids could be important and specific to you. Overweight women may be the most likely to get mood-boosting benefits.
Lindberg offers sample menus if you want to feel sexual all day, if you just want to feel sexual at night, or if you want to take days off. The sexual-all-day menu consists of:
- Two eggs scrambled in butter, plus a half-ounce of dark chocolate and orange juice for breakfast
- A salad heavy on canola or olive oil dressing with a slice of meat for lunch
- Sirloin steak tips stir-fried with frozen mixed vegetables in a teriyaki sauce for dinner
If the diet boosts your libido, you might be motivated to try a muscle-building program for your pelvic floor or “PC” muscles. You’ve probably heard of Kegel exercises, named for Arnold H. Kegel, who published his recommendations in 1948. Toning those muscles (squeeze, release, squeeze) can help prevent tears during childbirth and save you from leaking urine.
Lindberg suggests going a step further to achieve or intensify orgasms. As with any muscle-building program, you can challenge yourself in stages, building up with devices that add resistance. You can try barbells or weighted cones.
Lindberg’s personal favorite is a device with plastic tongs you insert in your vagina and use your muscles to close. Once you can close one tong easily you can move to the next level, a tong made of stiffer plastic. Lindberg recommends starting with 5 minutes and moving up to 20 minutes at a time twice a week.
October 13, 2023
Janet O’Dell, RN