Low desire is common and only becomes a clinical concern when it causes distress. Evaluation looks at health, medications, hormones, mood and relationships first; FDA-approved medications exist for specific, diagnosed cases.
Low sexual desire in women is common, it has many possible causes, and it is only considered a medical problem when it causes personal distress. A good evaluation starts with the whole picture: physical health, medications, hormonal stage, mood, stress and the relationship. When low desire persists and is distressing after those factors are addressed, a licensed provider may diagnose hypoactive sexual desire disorder (HSDD) and discuss options that include counseling and, for some women, FDA-approved medication.
A 2008 study in Obstetrics & Gynecology surveyed 31,581 US women aged 18 and older. The age-adjusted prevalence of any sexual problem was 43.1%. But only 12.0% of women reported a sexual problem that was also accompanied by personal distress, and this was more common in women aged 45 to 64 (14.8%) than in younger (10.8%) or older (8.9%) women.
That gap matters. Desire naturally varies between people and over time, and a lower level of interest is not a disorder on its own. The 2018 process of care from the International Society for the Study of Women's Sexual Health (ISSWSH) notes that women with lifelong low desire who are not bothered by it should not be considered for treatment. The same document estimates that HSDD affects about 10% of adult women.
Desire rarely has a single cause. The ISSWSH process of care recommends a biopsychosocial assessment, meaning a look at the body, the mind and the relationship together. Common contributors include:
The ISSWSH process of care describes a stepwise approach that a clinician can follow:
The ISSWSH document lists behavior therapy, cognitive behavioral therapy and mindfulness as forms of sex therapy. It also emphasizes that patient and partner preferences and goals guide the choice of treatment.
Blood tests have a limited role. The 2019 global consensus statement on testosterone therapy for women states that a blood testosterone level should not be used to diagnose HSDD.
Two medications are FDA-approved for acquired, generalized HSDD that is not due to a coexisting medical or psychiatric condition, relationship problems, or a medication or drug effect. Neither is indicated to enhance sexual performance.
| Flibanserin (Addyi) | Bremelanotide (Vyleesi) | |
|---|---|---|
| Approved for | Women under 65 with acquired, generalized HSDD | Premenopausal women with acquired, generalized HSDD |
| Form | Oral tablet taken at bedtime | Injection under the skin, used as needed |
| Key label warnings | Low blood pressure and fainting, especially with alcohol close in time, certain interacting drugs or liver impairment; drowsiness | Temporary rise in blood pressure; nausea; skin darkening |
| If no improvement | Label advises stopping after 8 weeks | Label advises stopping after 8 weeks |
The flibanserin label's indication was updated in December 2025 and now applies to women under 65 with acquired, generalized HSDD. The bremelanotide label states that it is not indicated for postmenopausal women. Bremelanotide is contraindicated in uncontrolled high blood pressure and known cardiovascular disease. Dosing for either medication is set by the prescriber. Our PT-141 explainer covers bremelanotide in depth, including how the approved product differs from compounded PT-141, which is not FDA-approved.
The 2019 global consensus statement concluded that the only evidence-based use of testosterone in women is for postmenopausal women diagnosed with HSDD after a full biopsychosocial assessment. In that group, therapy at levels close to the normal premenopausal range improved sexual function, including an average increase of one satisfying sexual event per month over placebo. The panel found insufficient data to recommend testosterone for premenopausal women, did not recommend pellets, injections or compounded "bioidentical" testosterone, and advised stopping if there is no benefit by 6 months. The ISSWSH document notes that testosterone for postmenopausal HSDD is off-label in the US.
Estrogen is not a treatment for HSDD itself. However, when low desire is tied to vaginal dryness or pain that began around menopause, treating those symptoms can be an important step. Our article on menopause, vaginal dryness and intimacy explains the options.
Changes in desire over a lifetime are normal, and low desire without distress is not a disorder. In the 2008 US survey, distressing sexual problems actually peaked in midlife and were less common in women 65 and older. If a change bothers you, it is worth discussing, whatever your age.
A licensed provider decides which tests are useful based on your history. The 2019 global consensus statement advises against using a testosterone level to diagnose HSDD, although testing can be relevant for other reasons, such as monitoring treatment.
Often, yes. The ISSWSH process of care treats desire as biopsychosocial and lists sex therapy, including cognitive behavioral therapy and mindfulness, alongside medication.
It contains the same active molecule, bremelanotide, but compounded PT-141 is not FDA-approved and has not been reviewed by the FDA for safety, effectiveness or quality. Its use outside the approved indication is off-label.
Low desire is a common, legitimate health concern, and you do not need to wait for it to become severe before asking about it. A licensed provider can review your health, medications and life circumstances and help you decide which approach fits your goals. You can learn more on our sexual health page. This article is educational and does not determine eligibility for any treatment.
Written by the NewDay Wellness editorial team from the sources above and checked against them before publication, and medically reviewed by Dr. Sean Arora and Dr. Shannon Arora of Arora Health & Aesthetics; see our editorial standards. This article is educational and does not diagnose conditions, establish eligibility for any medication, or replace care from a licensed provider. Compounded medications are not FDA-approved.
Vaginal dryness and painful sex after menopause are usually part of the genitourinary syndrome of menopause. Lubricants and moisturizers help mild symptoms; low-dose vaginal estrogen and other prescription options treat moderate to severe symptoms.
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