Sexual health concerns (low libido, dyspareunia)
Your provider will take a detailed sexual, medical and psychosocial history. Using frameworks such as PLISSIT or ALLOW, they ask about lack of desire, difficulty becoming aroused, problems with orgasm, pain or dryness during intercourse, mental health, stress, relationship satisfaction and medicines that might be contributinghttps://www.aafp.org/pubs/afp/issues/2008/0301/p635.html#:~:text=female%20sexual%20function%20continues%20to,indicated%20in%20women%20with%20abnormal. A focused pelvic exam evaluates the vulva, vagina and pelvic floor. Vulvoscopy and a ‘Q‑tip’ test may be used to identify tenderness or thinning tissueshttps://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/#:~:text=A%20complete%20medical%20history%20should,such%20as. Vaginal pH and KOH microscopy can detect infections or atrophic vaginitis, and pelvic muscles are assessed for tightness. Laboratory tests are ordered only when physical findings or symptoms suggest a hormonal or medical cause; these may include thyroid function, prolactin, estrogen and testosterone levelshttps://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/#:~:text=Laboratory%20investigations%20can%20help%20identify,a%20low%20cFT%20that%20can. Your provider may order a pelvic ultrasound or other imaging if there is concern for structural problems, such as fibroids or endometriosishttps://my.clevelandclinic.org/health/diseases/15216-low-libido-low-sex-drive#:~:text=To%20find%20out%20what%E2%80%99s%20causing,provider%20will%20ask%20about%20your.
Treatment focuses on the underlying cause. First‑line measures include non‑prescription lubricants and moisturizers and pelvic floor therapy. Local vaginal estrogen (cream, tablet or ring) is highly effective for vulvovaginal atrophy and pain with intercoursehttps://www.aafp.org/pubs/afp/issues/2015/0815/p281.html#:~:text=depends%20on%20the%20etiology,been%20shown%20to%20improve%20the. Ospemifene is a selective estrogen receptor modulator that can improve painful intercourse. Vaginal dehydroepiandrosterone (prasterone) can help relieve dryness and painhttps://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556#:~:text=,to%20treat%20low%20sexual%20desire. Testosterone therapy, usually as a transdermal patch or cream, is sometimes used off‑label to improve desire in postmenopausal women, but data on long‑term safety are limitedhttps://www.aafp.org/pubs/afp/issues/2015/0815/p281.html#:~:text=depends%20on%20the%20etiology,been%20shown%20to%20improve%20the. FDA‑approved drugs for hypoactive sexual desire disorder in premenopausal women include flibanserin, a daily pill, and bremelanotide, a self‑injection taken before sexual activityhttps://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556#:~:text=,to%20treat%20low%20sexual%20desire. Some women benefit from bupropion or adjustment of antidepressant regimens when depression contributes to low libidohttps://www.aafp.org/pubs/afp/issues/2015/0815/p281.html#:~:text=depends%20on%20the%20etiology,been%20shown%20to%20improve%20the. Non‑pharmacologic therapies—open communication, stress management, counseling and sex therapy—remain the cornerstone of treatmenthttps://www.aafp.org/pubs/afp/issues/2008/0301/p635.html#:~:text=female%20sexual%20function%20continues%20to,of%20women%20with%20sexual%20dysfunction.
• Thyroid‑stimulating hormone (TSH) and free T4 – to rule out hypothyroidism or hyperthyroidismhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/#:~:text=Laboratory%20investigations%20can%20help%20identify,a%20low%20cFT%20that%20can.
• Prolactin level – elevated prolactin can suppress libido and should be checked if menstruation is irregular or milk leakage occurshttps://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/#:~:text=Laboratory%20investigations%20can%20help%20identify,a%20low%20cFT%20that%20can.
• Sex hormone profile – estradiol, sex hormone–binding globulin and total and free testosterone to evaluate hormonal causes of low desire or vaginal atrophyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/#:~:text=Laboratory%20investigations%20can%20help%20identify,a%20low%20cFT%20that%20can.
• Other tests as indicated – follicle‑stimulating hormone (FSH), luteinizing hormone (LH), fasting glucose, hemoglobin A1C, complete blood count and comprehensive metabolic panel to detect anemia or metabolic conditions; pregnancy test if appropriate.
• Vaginal pH and wet mount/KOH microscopy – detects bacterial vaginosis, yeast infection or atrophic changes when symptoms warrant evaluationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/#:~:text=A%20complete%20medical%20history%20should,such%20as.
Not usually required. A transvaginal ultrasound or pelvic MRI may be ordered if structural problems like uterine fibroids, endometriosis or ovarian cysts are suspected based on history or exam findingshttps://my.clevelandclinic.org/health/diseases/15216-low-libido-low-sex-drive#:~:text=To%20find%20out%20what%E2%80%99s%20causing,provider%20will%20ask%20about%20your.
Seek medical care if you experience persistent pain or burning during intercourse, bleeding after intercourse, new sores or lumps on the vulva or vagina, foul‑smelling discharge, sudden loss of libido that causes distress, or symptoms of infection such as fever or chills. Talk to your provider if low desire or pain is affecting your well‑being or relationshiphttps://my.clevelandclinic.org/health/diseases/15216-low-libido-low-sex-drive#:~:text=When%20should%20I%20see%20my,healthcare%20provider%20about%20low%20libido.
Follow‑up is tailored to the underlying cause. After starting hormones or medications, visits every 3–6 months are common to adjust dosages and monitor side effects; more frequent visits may be needed when beginning therapy. Ongoing counseling or pelvic floor therapy may be scheduled weekly or monthly. Once stable, annual check‑ups are usually sufficient.
Maintain open communication with your partner and discuss your needs. Limit alcohol use, avoid smoking, exercise regularly and manage stress; these habits improve sexual well‑beinghttps://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556#:~:text=To%20treat%20sexual%20dysfunction%2C%20your,professional%20might%20suggest%20the%20following. Use lubricants or moisturizers to prevent pain from dryness and avoid harsh soaps or douching. Stay sexually active if comfortable, because regular sexual activity helps maintain blood flow and tissue healthhttps://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/diagnosis-treatment/drc-20372556#:~:text=To%20treat%20sexual%20dysfunction%2C%20your,professional%20might%20suggest%20the%20following. Practice safe sex, and seek prompt treatment for infections or conditions that may affect sexual function.
Because sexual dysfunction often has biological, psychological and relationship components, a multidisciplinary team is beneficial. Primary care doctors work with gynecologists or urogynecologists for examination and hormone therapy, pelvic floor physical therapists for muscle dysfunction, and mental health professionals or certified sex therapists for counseling and relationship supporthttps://www.aafp.org/pubs/afp/issues/2015/0815/p281.html. Endocrinologists may manage hormonal disorders; psychologists or psychiatrists treat depression and anxiety; dermatologists manage skin conditions affecting the vulva; and couples therapists help improve communication. Collaborative care ensures that medical, emotional and relational factors are addressedhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5994984/#:~:text=Treatment%20is%20patient,14.