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The 5 Keys to the Magic of Sexual Desire for Women

Published in Women's Services, Gender Medicine, Sexual Medicine, For the Health of It Author: Joni Steffens,APRN,CSC Author: Joni Steffens, APRN, CSC, CentraCare – Specialty Care Center

Ah, the enchanting pixy dust known as sexual desire. Natural. Effortless. Transcendent. Spontaneous.

We have all fallen for it …. hook, line and sinker.

But what happens when fairy tale and reality collide? Low sexual desire is a common challenge among women. We don’t have a good handle on the actual numbers because low desire is defined in many different ways. Frankly, I don’t spend a lot of energy trying to determine how many women experience difficulties with desire because I work with … individuals. If a woman is sitting in my office because her sexual desire is less than she thinks or wishes it was, the numbers are irrelevant. This is about her and her unique experience.

Women and health care providers alike crave a simple explanation for low desire. And it would be awesome if desire could be wrapped up in a pretty, tidy little box of solutions. Sexual desire is fascinating, rich, complex and messy. This is why I love what I do.

While you won’t find a silver bullet here, I am going to offer five keys I believe all of us should consider when our sexual desire is getting in the way of the sexual experiences we long for.

1. I am normal

Why do I believe my desire is abnormal? Is it because we’ve been told that desire is spontaneous? Is our level of desire different from our partners or our friends? Is the latest magazine cover telling us that we have a desire problem?

A little fact checking goes a long way. There are different kinds of desire — spontaneous and responsive. Both are normal. Being overcome by sexy thoughts while scrubbing the kitchen floor or walking by an attractive person is spontaneous desire. It happens for about 15 percent of women. Responsive desire is desire that shows up to the party after sexy things are already happening — “hey, this is fun, I’d like more of this” kind-of-thing. This happens for 30 percent of women. If you experience responsive desire to pleasurable situations, you are normal. You do not have a desire problem.

It is normal to have different levels of desire, at different times, than a partner. This is a discrepancy of desire. While not abnormal, desire discrepancies between partners may have a negative impact on relationships and may require some navigation skills.

Lacking desire for dissatisfying sex is normal. Does sex bring you pleasure? Are your needs being met? Most of us will be interested in repeating experiences we enjoy and finding pleasure in. It’s not about forcing ourselves to like something, but it’s about creating the sex we want to desire.

2. Life gets in the way

One of the first questions I ask when working with people who want more from their sexual experiences is: Are you willing to put skin in the game? How does sex fit into your life, what priority does it have? None of us are going to find two more hours in our days. Making something a priority means other things are going to have to give.

Chronic stress is a major showstopper when it comes to sexual desire. As a society, we are consumed by busyness and distraction. Stress reduction techniques have been shown to improve sexual desire and include mindfulness and yoga.

3. Taking care of you

What leads to health and wellbeing is also good for sexual wellbeing. Healthy lifestyles = healthy sex.

If you have a chronic health condition like cancer, heart disease, diabetes, chronic pain, depression or anxiety — managing the effects of these can enhance your sexual response, including sexual desire. Sometimes, better sex is the “carrot” needed to motivate us to care better for ourselves.

Many medications negatively impact sexual desire. For example, many people take antidepressants, and while moods may improve, antidepressants often do not improve sexual desire, arousal or orgasms. Adjustments to medications might be an option but sometimes we need strategies that work around our necessary medications.

Nutrition, physical activity, sleep and substance use may be factors in lower levels of sexual desire. Those who consume a Mediterranean diet have fewer sexual challenges. Exercise has been found to be helpful in enhancing sexual desire. Tobacco and other substance use get in the way. So many women describe fatigue as a factor for their low desire, and we are a society that is chronically deprived of restful sleep. While it may seem completely unsexy to eat well, move often, rest, stop smoking, and moderate our substance use — these are all modifiable factors we can influence and leverage to craft desirable sexual experiences.

4. Medications of desire

I’m sure some of you were looking for the little pink pill to be at the top of my list. Make this easy, Joni!

Before you think I’m a pessimist when it comes to medicating desire, keep reading.

There are now two FDA-approved medications for low desire in women. While we don’t completely understand why they work in some women, we know they work with our brain chemistry. We have brain chemicals that can enhance or inhibit sexual desire — think dopamine, norepinephrine and melanocortin as exciters and serotonin as an inhibitor.

Flibanserin (Addyi) is a daily oral pill. Bremelanotide (Vyleesi) is a self-injection prior to anticipated sexual activity. Both seem to provide some improvement in desire for a subset of women. They are not without side effects and may not be appropriate for all women. And long-term safety data is still lacking. However, for low desire that is not attributed to an identifiable cause, these medications might an effective addition to our treatment plans.

Testosterone has long been used in women for low desire. Its use is “off-label” — meaning FDA has not approved it for the use of low sexual desire. However, there is both clinical evidence and antidotal clinical experience that testosterone can be effective for some women. In 2019, a number of professional medical organizations came out with a consensus statement supporting the use of testosterone in postmenopausal women with hypoactive sexual desire.

5. Cultivating the magic

Instead of waiting for sexual desire to fall upon us like pixy dust, we can cultivate the magic of desire in ourselves. Yes, it takes planning and effort — but what great things in our lives don’t?

What is it that you want to desire? I suspect it may be more than the physical experience of sex — of desiring an orgasm. In fact, I encourage that! Knowing what we want to want is a pretty good start to getting where we want to be. Think big. Be bold. Do you want to yearn for physical touch, positive emotions, intimate connection, sexual self-esteem, empowerment, and/or the absence of shame? Let’s tackle what you truly desire.

Cultivating sexual desire is a lot like learning something new, developing a new skill, discovering a new interest. It takes a certain amount of immersion — maybe in the form of reading books, watching YouTube videos, practicing, or spending time with and learning from others with a shared interest. When we sprinkle something new throughout our life and take time to develop a passion, we find we think about it more. We might “spontaneously” find desire.

When sexual desire has become our computer screen that has “gone to sleep” — we need to move the mouse. It may not be magic. But that doesn’t mean it we can’t unearth a desire for pleasure, connection, intimacy and self-worth.