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The therapist will take a history and examine you to discover possible causes of your problem- for example painful intercourse [see: Sexual Pain in Women] which would affect the desire to engage in sex, and would treat accordingly.
Counselling: should enhance emotional intimacy, communication, and mutual guiding to promote more varied, prolonged and effective sexual stimulation, and encourage the use of fantasy to avoid distractions, improve self worth and body image.
Lifestyle changes may be recommended to relieve stress and fatigue, such as diet and exercise, reduce alcohol, stress management, and prioritize work and domestic activities, consider reducing your work load and getting help at home. Ensure safety, privacy, optimal timing of sexual interactions.
Psychotherapy may be indicated for past abusive sexual experiences.
Medical: there is no approved medical treatment for the management of low libido. The use of Tibalone for post menopausal women, and of buproprion [Wellbrutin] is promising, but needs further study [2].
If depression is diagnosed, it should be treated as this is a major cause of loss of libido.
The use of androgens [testosterone] to treat low sexual desire is still controversial, but may be advised by your doctor, in particular after premature menopause, chemotherapy for cancer, or following surgical removal of both ovaries with hysterectomy. The safety of long term use of testosterone in women is still unclear, and there are side effects [facial hair and deepening voice] and it cannot therefore be recommended, and lasting effects of short term treatment is unproven. The testosterone patch may become available and may reduce adverse effects, but this remains to be tested.
It is unlikely that treatment with estrogen improves sexual desire, but it can restore well being after the menopause, improve sleep quality, and restore sexual hypersensitivity of the skin and reduce vaginal dryness, all of which may improve desire and arousability.
Discuss the use of hormone replacement treatment with your doctor.
Relationship therapy: is indicated especially where sex has been used as a weapon- ‘if he’s nice I’ll let him’, both partners must recognise that this is the sort of battle which when they win, they lose! Once sex becomes unsatisfying it is common for women to avoid sex and this can spread to other areas of the relationship, and as the low libido problem increases she may avoid kissing and hugging in case it would encourage her partner to initiate sex, and this distances them and can cause breakdown of the relationship. Discuss this and let your partner know how important it is for you to sometimes have hugs and kisses when you only want affection- and ask that it does not go further on those occasions.
A relationship needs to be tended [like a garden- which if left untended the weeds [nasty bits] grow, and overtake the good bits!!], but far too many couples make it their last priority. You need to keep courting even when you are in a long term relationship, even though it takes effort.
Try to reduce boredom and increase the quality of time you spend together. Most women who also work outside the home feel that they are stretched out, so do try when you are both at home to spend relaxed time together alone, just talking about how you feel [good and not so good], and caressing and getting close, without feeling you have to perform sexually every time.
Ideally every couple should have a date at least one night a week,--- if you can’t get a baby sitter, make a picnic out on the lawn once the kids are in bed, to start spending private time together. There should be no discussion about kids or work or daily problems, but try to connect with one another emotionally and physically – just caressing one another, whether it goes on to sex or not. Focus on sensuality using light massage, touching, and kissing and let go of being intercourse – focused.
Allow yourself the luxury of a slow warm bath with aroma oils before your date, and have a fragrant body lotion for your partner to apply, try using fantasy or reading something erotic that may arouse you. You may enjoy the romanticism of soft music and candles, and wear attractive lingerie to help set the mood. Use a lubricant to counteract dryness in case you don’t respond immediately.
After being together for some time many couples find lovemaking monotonous, so it may help to introduce some other romantic ideas, like dinner for two, dancing, watching erotic movies together, trying different positions. But importantly: set aside time to relax and have fun together, and then enjoy sensuous massage and caressing - enjoy the journey while sometimes not going on to intercourse. If you are both comfortable with it you may stimulate your partner to climax, thus reducing the demand on you to 'be sexual' when being sensual is what you want at that time.
Sex Therapy: places less emphasis on orgasm and more on physical and emotional intimacy. Women with low libido often find that their mind wanders during sex, so it helps to conjure up images that keep your mind on sexual pleasure, using fantasy about anything that turns you on. Many people use fantasies as a turn on, and it is not weird to do this.
Sensate focus or pleasuring exercises help both partners to accept sensations, express them and enhance them by guiding one another while focussing on feelings, and this too reduces distractions. Focussing on sensations enables you both to give and receive clear messages about sexual desire and arousal, and reduces feelings of vulnerability. Sex can be much more fun without the pressure to perform.
It is very difficult to go directly from your daily chores to feeling sexy- it is usually the last thing on your mind. So accept the fact that most women need a transition phase to let go of the all the stress in their lives before they can relax and turn their attention to their own sexuality. Many women use fantasy to help them through the 'transition phase' going from daily chores to being sexually receptive.
There are different approaches to sexual stimulation, and positions, and there are many good books on the subject, and it may help to share these with your partner to get new ideas, so visit your bookshop together to see what is available.
You need to see sex as an important part of your life- not that 'you are doing this for your partner'.
Desire can be triggered by sexual stimulation – often all that is needed is a change of attitude to be willing to be receptive, and the resultant sexual satisfaction will feed the desire for more sexual contacts.
If these suggestions don’t help, you may both want to see a sex therapist or psychologist or social worker who deals with sexual problems.
