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FDD, (Female Desire Disorder)
Also known as:
Low Libido
HSDD (Hypoactive Sexual Desire Disorder

FDD or low libido is one of the most common sexual complaints, both for women and their partners.

Every time a woman has a sexual encounter, her entire history, her current medical state, her current psychological state, and the surrounding conditions, stimuli, and distractions contribute to determining the success or failure of the encounter. Current medical research identifies testosterone as a very significant component of desire in women as well as men. Normal testosterone levels in women are about ten % those of men. Most of the testosterone is bound and unavailable to exert its effects on the body. A small amount called Free Testosterone (FT) is responsible for the hormone’s actions.

We have classified contributors to FDD into three categories: Pharmacological, Psychosocial, and Physical/Organic.

• Prescribed drugs
  
  
• Psychological issues
• Relationship and trust issues
• Sexual abuse
  
  
• Hormonal imbalance
• Painful sex
• Lack of experience/ knowledge of her body
• Lack of sensation
• Poorly skilled partner / bad sex
  
  

Prescribed drugs:

(Caution: You may find a drug you are taking, which causes or may cause low libido or desire, listed below. We strongly encourage you to consult with your doctor before stopping or modifying the use of any of these drugs. While low libido or other sexual dysfunction may be undesirable, medications such as high blood pressure medications may be vital to your health or even your life. Others, such as hormonal based birth control, may not be necessary, but there are few other temporary birth control methods that are as effective. The risk of pregnancy and delivery are not trivial. We would ask that you first consult with your doctor before changing dosages or discontinuing any medications, or taking any natural or artificial supplements – that includes herbs, vitamins, and minerals, or virtually any supplements found in your local health-food store!)

Anti-depressants
Many of the SSRI (Selective Serotonin Reuptake Inhibitors) class anti-depressants are known to cause decreased desire or libido and also orgasmic or arousal problems in many women. These SSRI medications include Prozac, Paxil, Celexa, and many others. An alternative might be Wellbutrin as it seems to have fewer sexual side effects than many other anti depressants.

Hormone based birth control
Many women complain of hormone shifts from hormonal birth control. It may not cause you any problems, but this could be a factor. There are a couple of issues involved. Many of the low dose pills are mostly or completely progestin based. These can cause loss of libido or other arousal symptoms that can negatively affect your sexuality.

Higher dose or combined pills contain estrogens and progestins. Increased estrogen levels often result in increased SHBG (Sex Hormone Binding Globulin) with binds to testosterone much more easily than estrogen, thereby reducing the amount of available testosterone in your body. This is why testing for free or available testosterone is important. Total testosterone is largely irrelevant if the free testosterone levels are very low. Free Testosterone levels have been shown to be tied to libido in women. For women complaining of low libido, free testosterone levels probably should be measured. We recommend that the lab use equilibrium dialysis (EqD). Many labs use RIA, Radioimmunoassay, which is less sensitive and more prone to error in our opinion. Many of the leading providers in the FSD area use the EqD test exclusively – we recommend that you do the same.

Anti-psychotics and sedatives are also often tied to low libido and possibly low arousal.

High blood pressure medications
Many of the older blood pressure medications, such as diuretics and beta blockers, are known to cause sexual dysfunction in men, and may be prime suspects in women.

Psychological Issues
Stress, anxiety, panic attacks, depression:

All the above can contribute to a low libido. The medical treatments for them can also cause problems. There are medications that are less problematic though. Careful treatment through good medical and psychological treatment can resolve many of these issues.

Even if you must use one of the medications listed that can reduce libido, there’s a good chance that you will not need to take these medications forever. If your depression or anxiety is a temporary thing, you may make great strides and be able to resume life without these drugs in a few months to a year. Every situation is different, so please get counsel from your doctor about any of these issues, and certainly before changing medications or dosages. It can be dangerous to discontinue medications suddenly.

Relationship issues:

Trust, anger, marital infidelity, power and control, along with a host of other factors can cause low libido. If you think that your low libido issues stem from primarily relationship issues, then you should look for help. There are books and counselors available to help you resolve the differences between you and your partner.

Sexual Abuse or Trauma:
Bad sexual experiences such as childhood sexual abuse, rape or coercive sex, may leave powerful after effects. If you have been the victim of one of these, this might be one of the causes for FDD. You may simply not feel comfortable in a vulnerable position, and thus you avoid sexual contacts. Psychological counseling can help you resolve these issues, and very possibly improve the quality of your sexual relationships.

If the abuse is ongoing or recent, we strongly suggest that you contact the proper law enforcement authorities. You may wish to avoid this, but we feel you have a moral obligation to prevent this abuse from occurring to others. Please, contact law enforcement and help stop the abuser from victimizing others too.

Physical Issues

Painful sex:
Painful sex can have a definite effect on your desire levels.

Vaginismus: Vaginismus involves involuntary muscle spasms involving the outer approximately one third of the vagina, during penetration, or simply in anticipation. The pain can be quite severe, and can even be sporadic. The causes can be physical and/or psychological.

Vulvar Vestibulitis, Vulvodynia and Dyspareunia: These are basically several forms of painful sex, generally from penetration of some kind. The sensations are often described as stinging, burning (“I feel like I’m on fire!”) itching etc. There’s quite a bit of disagreement over the causes and treatments. Some believe they’re only psychological in nature, others physical/medical. We suggest that treatment that includes specialists in both medical and psychological should be strongly considered. Dyspareunia is usually a catch-all term for painful sex that isn’t Vulvar Vestibulitis or Vulvodynia.

Lack of Sensation
Lack of sensation can cause a diminished desire for sex, much in the same way that painful sex can. There are many causes for lack or diminished sensation. These include but are not limited to medications, hormone effects, injury (surgery, childbirth, bicycle riding, etc.), diabetes, spinal trauma, and others. Low testosterone levels can have an effect. Surgery such as a hysterectomy, can also lead to low sensation, and even loss of orgasm. (See our Orgasm Disorder page – coming soon.) Injury to the pelvic region could also lead to diminished sensation. If you suspect that your diminished sensation problems are from injury or surgery, we strongly suggest that you see an FSD specialist. They have the tools and diagnostic equipment to investigate this properly. This also isn’t a trivial problem. If you don’t see a real specialist, your chances of actually finding a solution are much poorer in our opinion. In some cases, the loss of sensation may be the first clue to a serious underlying disease.

Poorly skilled partner / bad sex / lack of experience / knowledge of body
Perhaps you (or your partner) simply don’t know how to stimulate you. If you fall into this category, you should be aware that there are some very good books that will help you and your partner learn about your bodies. Get one of these, talk about what you like and want, and explore each others bodies. Check out Passionate Marriage in the book section. It won’t tell you about your or your partners body, but it will help you learn to communicate and emotionally connect – very important skills.

(We Need some good book suggestions here…)

Hormonal imbalance:
We’ve covered this last, as it’s the one section that everyone wants to read, but is probably the least important. The big hype is behind testosterone levels. And we’re not here to tell you that it’s bunk – because, in our opinion, it’s not. But it’s not a “silver bullet” either. A quote we once heard was – “It’s never just one thing.” and we think that’s really right.

Testosterone has been shown to have quite a powerful effect on libido. But the temptation is to simply rush out and start taking DHEA or Testosterone. This really isn’t a good idea.

First, check out the blood-work section. Make sure you, at minimum, get a reliable blood test for free testosterone. We recommend that you get an equilibrium dialysis test. This really is the only validated assay method that we think is sensitive and accurate enough for women who may have really low free testosterone levels.

There are a whole set of other tests that you should probably have done too, but work with your physician on that. You’ll find more information on this in the blood work section.

There are three factors in testosterone levels. There is the total testosterone, free testosterone and SHBG (Sex Hormone Binding Globulin.) Total testosterone is the amount of total testosterone in your blood.

Most of the total testosterone is bound by SHBG and has almost no effect. SHBG levels are driven up by estrogen. So, the pill (oral contraceptive) and HRT (hormone replacement therapy) or even natural estrogen will tend to increase the levels of SHBG. Higher SHBG levels will generally cause lower free testosterone levels, as SHBG binds much more easily and strongly to testosterone than toestrogen. Low free testosterone levels probably will tend to decrease sensation, lubrication, arousal, orgasm and libido or desire. (Obviously all these things are also affected by other factors such as relationship problems, sexual skill, psychosocial issues and much more. This is why we state so strongly that testosterone treatment shouldn’t be viewed as a “silver bullet.” It may be one part of a whole solution, but it’s rare that it’s the only part.)

We should point out, that testing the total testosterone levels, without also testing free testosterone doesn’t make much sense. If your SHBG levels are high, your free testosterone levels will probably be low. We recommend all three tests. These will give you much more information to determine if HRT or hormonal birth control, or even something else may be playing a role in your testosterone levels.

You may be asking yourself, why would testosterone levels be low in the first place. There are many answers. First, if you are into menopause, naturally or because your ovaries were removed, your production of testosterone is dramatically reduced. As you age, your levels of testosterone drop quite dramatically. This loss peaks when you reach menopause. Your ovaries are responsible for half or more of your testosterone production. Your adrenal glands may or may not compensate for the loss that occurs with menopause or removal of the ovaries. Additionally, body fat has a powerful effect on conversion of testosterone to estrogen. If you are significantly overweight, your total and free
testosterone may be very low.

Other factors:
Often several of the factors in low libido are present. Each needs to be addressed and taken seriously. Sometimes it can be partially relationship driven, and partially hormonal imbalance. Don’t simply disregard any of the above factors in your search for an answer.

Topics/Sections not yet complete
Post menapause/post hyst loss of T and E and/or sensation, which might impact desire levels.