Female Sexual Dysfunction: Hormone-related Causes

Female sexual dysfunction is defined as a lack of interest in or enjoyment of sexual activity that is distressing to a woman. It can result from a loss of sex drive (libido), an inability to become aroused or to reach an orgasm, or painful intercourse.  A combination of many personal, interpersonal, and medical factors may contribute to sexual dysfunction.

Physical causes may include health issues like diabetes, heart disease, nerve disorders, or hormone problems. Estrogen results in increased blood flow to the genitals and vaginal lubrication during arousal, and, because of its impact on mood and sleep, indirectly affects sexual interest. With menopause or menopause-like conditions, estrogen levels drop significantly, leading to physical changes (such as thinning vaginal tissue, dryness), that can dampen a woman’s sex drive. Androgens (male hormones) are also believed, but not proven, to be important for libido in women.

A hormonal imbalance may or may not contribute to any one woman’s low sex drive. But if a woman does have a hormonal cause for sexual dysfunction, treatment might include hormone therapy. Vaginal forms of estrogen— a cream, tablet, or vaginal ring—can improve vaginal tone, elasticity, and lubrication. Estrogen applied directly to the vagina is more effective at a lower dose than estrogen in pill or skin patch form. Also, the small amount of estrogen in these products is believed to pose less risk for heart attack, stroke, and breast cancer than pill or patch hormone therapy, which affects the whole body.

Androgen therapy for female sexual dysfunction is an emerging area of research. Androgens are male hormones, such as testosterone. Women produce testosterone, although in much smaller amounts than men. Like estrogen, testosterone production drops after menopause. Surgically menopausal women (who have had their ovaries removed) have even lower testosterone levels than women who go through natural menopause and are thus more likely to experience sexual dysfunction. To date, however, the U.S. Food and Drug Administration (FDA) has not yet approved testosterone-containing medications for women with sexual dysfunction.

Loss of libido, called hypoactive sexual desire disorder (HSDD), describes low or absent sexual interest or desire that causes marked distress or relationship problems and is not caused by a medical condition or drug.  Currently, there is no FDA-approved treatment for HSDD but several products are being studied.  These include flibanserin, a drug originally developed as an antidepressant; a testosterone gel absorbed through the skin; and DHEA vaginal suppositories.  (DHEA, or dehydroepiandrosterone, is a hormone produced by the adrenal glands that is converted to testosterone and estrogen.)  Although not approved in the U.S., a testosterone patch is available in other countries as a treatment for HSDD.

Editors:
Kathryn Martin, MD
JoAnn Pinkerton, MD

June 2010