Low Libido and Related Symptoms in Women: A Guide for Couples

"Sexual interest deficiency!"

Dear Dr.
Lin,
I have a few questions I would like to ask you:
1.
I am 34 years old, married, and have two children.
About three years ago, I started to lose interest in sex.
Initially, I would avoid my husband, but now I straightforwardly tell him that I have no desire at all.
However, after refusing for a long time, he gets angry.
Sometimes I reluctantly go along with it, but it is dry and painful for me, which is very uncomfortable! My husband often says I have a problem and should see a doctor, but I feel fine; I just lack interest.
However, my close friends also believe there is something wrong with me.
This has made me wonder if I might have "sexual aversion" or "hypoactive sexual desire disorder."
2.
Sometimes after being intimate with my husband, I experience vaginal bleeding about a day later, which is dark and thick, lasting over a week.
3.
Occasionally, during intimacy, I experience severe abdominal pain accompanied by cramping.
4.
In the past few months, about a week before my menstrual cycle, I have been experiencing dark, dirty bleeding (but I am sure it is not my period), which continues until my period ends, lasting about half a month.
I have seen a doctor, but they only prescribed me hemostatic medication.
I have normal Pap smears every year.
I apologize for having so many questions, but I would greatly appreciate your professional insight on these matters.
Sincerely,
Oranges

Juzi, 30~39 year old female. Ask Date: 2006/04/09

Dr. Lin Zhaopei reply Obstetrics and Gynecology

1.
Hypoactive sexual desire disorder can be primary, meaning it is due to psychological factors, or secondary, such as rejection due to abnormal bleeding, abdominal pain, or other factors.

2.
Postcoital bleeding with a normal Pap smear is most likely due to endometrial instability, and with the presence of dyspareunia, it could also be indicative of endometriosis.

3.
Abnormal bleeding one week before menstruation could be due to endometrial instability, but it may also be caused by insufficient progesterone leading to hormonal imbalance.
Once the cause is understood, it is acceptable to ignore it as long as it remains within tolerable limits.

Reply Date: 2006/04/09

More Info

Low libido, or a decreased interest in sexual activity, can be a complex issue for many women, and it often involves a combination of physical, emotional, and psychological factors. In your case, it seems that you have been experiencing this lack of interest for about three years, which has led to significant distress in your relationship with your husband. Here’s a comprehensive guide to understanding low libido and related symptoms, along with some suggestions for addressing these concerns.

Understanding Low Libido
1. Physical Factors: Hormonal changes, particularly those related to the menstrual cycle, pregnancy, breastfeeding, and menopause, can significantly impact libido. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or other hormonal imbalances may also contribute to decreased sexual desire. Additionally, certain medications, including antidepressants and hormonal contraceptives, can affect libido.

2. Emotional and Psychological Factors: Stress, anxiety, depression, and relationship issues can all play a role in reducing sexual desire. If you have been feeling overwhelmed or disconnected from your partner, this could manifest as a lack of interest in sex. It’s important to consider whether there are underlying emotional issues that need to be addressed.

3. Physical Discomfort: You mentioned experiencing dryness and pain during intercourse, which can understandably lead to avoidance of sexual activity. This discomfort can be caused by hormonal changes, lack of arousal, or even anxiety about pain during sex. It’s crucial to address these physical symptoms, as they can create a cycle of avoidance and further decrease libido.

Addressing Your Concerns
1. Consult a Healthcare Provider: It’s essential to speak with a healthcare professional who can evaluate your symptoms comprehensively. They may recommend blood tests to check hormone levels, assess for any underlying medical conditions, and discuss your medications. If you are experiencing significant pain or abnormal bleeding, further investigation is warranted.

2. Consider Therapy: Engaging in therapy, either individually or as a couple, can be beneficial. A therapist can help you explore emotional factors contributing to your low libido, improve communication with your partner, and develop strategies to enhance intimacy.

3. Explore Lubrication and Other Aids: If dryness is an issue, using a water-based lubricant can help alleviate discomfort during intercourse. There are also vaginal moisturizers available that can be used regularly to maintain moisture.

4. Open Communication with Your Partner: It’s important to communicate openly with your husband about your feelings and experiences. Discussing your lack of interest in sex and the discomfort you experience can help him understand your perspective and reduce any feelings of frustration or rejection.

5. Lifestyle Modifications: Regular exercise, a balanced diet, and stress management techniques such as yoga or meditation can improve overall well-being and potentially enhance libido. Additionally, ensuring you have time for self-care and relaxation can help reduce stress and improve your mood.

6. Consider Hormonal Treatments: If hormonal imbalances are identified, your healthcare provider may suggest treatments such as hormone therapy or other medications that can help restore balance and improve libido.

Conclusion
Low libido is a multifaceted issue that can significantly impact relationships and personal well-being. It’s essential to approach this concern holistically, considering both physical and emotional aspects. By consulting with healthcare professionals, exploring therapy, and maintaining open communication with your partner, you can work towards understanding and addressing the underlying causes of your low libido. Remember, you are not alone in this experience, and there are effective strategies and treatments available to help you regain interest in sexual activity and improve your overall quality of life.

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