02/26/2015 04:26 pm ET Updated Apr 28, 2015

A Look Behind the Bedroom Door at What's Causing Your Low Libido

In today's pop culture, sex appears to be everywhere, especially as the 50 Shades of Grey books and movie continue to spur conversation about sexual desires and fantasies. But while our society seems more comfortable with women talking about sex, wanting sex and having sex, many still squirm at the idea of having a conversation with their partners, friends and health care providers.

In my practice, many women bring up their sexual problems with "oh by the way..." when their hand is on the doorknob as they leave my office. What these women may not know is sexual health can have a serious impact on overall health, relationships and mental wellbeing, which is why it shouldn't be an afterthought when talking to your health care provider. They can help you find solutions!

There are different types of sexual dysfunctions, but for women, many of them boil down to one sentiment -- I no longer want to have sex with my partner. The love, the friendship, the partnering in life is still there, but the sexual desire has dwindled or disappeared. While it's normal for libidos to fluctuate, a chronic lack of desire or intimacy can cause significant stress on a relationship and leave you and your partner looking for answers.

For millions of women, an ongoing loss of sexual desire that causes distress can be diagnosed as Hypoactive Sexual Desire Disorder -- or better known as "HSDD." Nearly 1 in 10 American women are affected by this condition, making it the most common form of female sexual dysfunction.

But how do you know if you have HSDD, another form of female sexual dysfunction, or your diminished sexual desire is due to some other factor? To diagnose HSDD, many health professionals use a screening questionnaire called the Decreased Sexual Desire Screener or DSDS, which consists of five simple questions. Let's take a look at the questions and break them down:

1. In the past, was your level of sexual desire or interest good and satisfying to you?

Help your health care provider set a baseline for your past sexual desire and provide a thorough history of your sexual problems. Many women with HSDD had thriving sex lives with their partner in the past but now find themselves without sexual thoughts, fantasies and the overall urge to have sex with their partner. Every woman's personal history and level of desire is different, and there's no need to feel worried or ashamed about your experience. Just explain what was normal for you before you lost sexual desire, including how regularly you wanted to have sex, and had sex, how satisfying it was and how that compares to today.

2. Has there been a decrease in your level of sexual desire or interest?

Once your health care provider has an understanding of your past level of sexual desire, he/she will look at the circumstances around your vanishing libido. You'll discuss whether you've always had a lack of interest in sex or if your desire decreased gradually or fell off suddenly. Some hallmarks signs of a decrease in desire include no longer initiating sex with your partner or only having sex out of "duty" to your significant other. Another sign is avoiding interactions that could potentially lead to sex, such as leaving bed before your significant other awakes or pretending to be asleep when your partner comes to bed.

3. Are you bothered by your decreased level of sexual desire or interest?

This is one of the most important questions to discuss, as distress is a distinguishing factor of HSDD. If you are not bothered by a lack of sexual desire, then that's normal for you and you wouldn't be considered to have HSDD. For some women, low sexual desire can cause interpersonal distress, meaning it causes problems in your relationship with your partner and your life overall. Some women also report that low desire leaves them frustrated, worried or concerned, feeling self-conscious about their bodies, and with a negative self-image.

4. Would you like your level of sexual desire or interest to increase?

While many men and women may automatically say they want to have more sex (even if they aren't experiencing low desire), it's important to answer this question honestly. This question is really in relation to a current low level of desire, and whether an increase in sexual desire (closer to a previously satisfying level) is what you want. You should also talk to your health care provider about your personal expectations and goals around increasing desire.

5. Are there other factors that may be contributing to your low sexual desire?

Experiencing periods of low sexual desire is normal -- your libido will fluctuate throughout your lifetime and this may be due to other medical and social factors. By talking to your health care provider about your medical history, he/she will be able to help you distinguish whether you have HSDD or if your low desire is due to another factor. For example, you will examine a number of items that can contribute to low sexual desire, and examine the temporal relationship to the decline in your sexual desire -- that is, which came first. Possible contributing factors include: medical conditions; medications, drugs or alcohol; menopausal symptoms; pregnancy or recent childbirth; other sexual issues you may be having (pain, decreased arousal or orgasm); your partner's sexual problems; depression, relationship problems that make you not want to have sex with your partner; and more. If your health care provider finds another factor that may be causing your low libido, then you may not have HSDD.

However, if you and your health care provider do come to the conclusion that you have HSDD, there may soon be the first FDA-approved medical treatment available later this year. If you are bothered by your distressing low sexual desire, you should have the conversation with your health care provider. Make it a priority to bring conversations about sexual health out from behind closed bedroom doors. Sex is an important part of our physical, mental and emotional health. Let's talk about it.


Dr. Clayton is interim chair of the department of psychiatry & neurobehavioral sciences, David C. Wilson professor of psychiatry and professor of clinical obstetrics and gynecology at the University of Virginia School of Medicine in Charlottesville. She is distinguished fellow of the American Psychiatric Association and certified by the American Board of Psychiatry and Neurology. Dr. Clayton is consulting editor for the Journal of Sex & Marital Therapy and for 10 years contributed a bi-monthly literature review to The Journal of Sexual medicine. In 2007, her book, Satisfaction: Women, Sex and the Quest for Intimacy, was published for the general public.

Disclosure: Dr. Clayton is a consultant to or on the advisory boards of Arbor Scientia, Euthymics, Forest Research Institute, Inc., Lundbeck, Naurex, Otsuka, Palatin Technologies, Pfizer, Inc., Roche, S1 Biopharmaceuticals, Inc., Sprout Pharmaceuticals, and Takeda Global Research & Development; and receives grant support from Auspex Pharmaceuticals, Forest Research Institute, Inc., Palatin Technologies, Takeda and Trimel Pharmaceuticals.