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Video: Have you two lost your sex drive?

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updated 9/13/2007 11:32:55 AM ET 2007-09-13T15:32:55

'Not tonight, I have a headache.'

Low libido is a common and troubling problem for many women. In a recent survey, 43% of women reported suffering from some form of sexual dissatisfaction, and 33% of these women complained specifically of low sexual desire.

Low libido is generally a multifaceted issue and is caused by a combination of physical, emotional, and relationship issues. The best treatment usually includes addressing all the contributing factors at the same time

Medical causes for low libido:
The most common medical culprits might be found in your own medicine cabinet. For instance, low libido and difficulty with sexual response are common side effects of SSRI's like Prozac and Zoloft, most commonly used to treat depression. If you are experiencing this, talk to your prescribing physician about ways you may adjust or switch the medications you are taking.

In addition, many women don't realize that their birth control may be wreaking havoc on their libidos. Hormonal contraceptives like birth control pills or patches can cause low libido because they increase a protein in the blood called sex hormone binding globulin (SHBG), which results in a decrease of free circulating testosterone in your body. Testosterone is the hormone of desire for men and women, so anything that affects your levels may affect your sex life. If you fit into this category, you might consider a hormonal option called NuvaRing, as that is locally delivered to your reproductive organs and is believed to have fewer sexual side effects because the hormones are minimally absorbed into the bloodstream.

Testosterone also declines during perimenopause and menopause and some women experience a drop in their levels after multiple children or after periods of chronic stress. If you suspect you are suffering from a hormonal imbalance, it is important to get a full hormone workup done. This includes a blood test to assess your estrogen, progesterone, and testosterone levels. Depending on what your test reveals, you have several options for dealing with hormonal imbalance. Some options include: pills (oral), creams, gels that are applied to the skin or genitals, patches and sublingual lozenges. Topical options are generally the best bet because they can be compounded to meet your specific needs and they work on the spot, which means the hormones do not circulate through your body to the degree that they would if taken orally.

There are also other methods of hormone treatment, including Hormone Replacement Therapy (HRT) and bio-identical hormone therapy. However, HRT has fallen out of favor in recent years due to a Women's Health Initiative study which linked HRT with an increased risk of stroke, heart disease and breast cancer.

Thankfully, other options are coming down the pipeline as well. For instance, Eugene Lipov, M.D., director of research at Alexian Brothers Hospital Network Pain Program, has pioneered a new approach to improving libido that is hormone-free and has few side effects. This treatment involves a nerve block that results in a kind of re-booting of the insular cortex of the brain, and preliminary studies show promising improvements in libido and sexual response. More studies are under way to expand on clinical applications of this treatment.

Of course, you should discuss all of these options with your doctor before treatment, in order to decide which is best for you.

Emotional/relationship causes
Low libido can also be the result of emotional factors such as stress, anxiety, or relationship struggles. In these cases, counseling or therapy is crucial. Often medication is needed as well, but studies have shown that the most effective treatment combines medication and talk therapy.

Relationship conflicts, communication issues and lack of trust or connection can be the cause of low libido and often outgrowths of the sexual disconnect between you. Even if you are in a loving, happy marriage, low libido can put added stress on your relationship. It is important not to ignore this issue of sexual dissatisfaction, as this issue can certainly take on a life of its own if it goes unaddressed. Don't wait until your marriage is almost irreparable before you seek therapy. More and more couples are seeking therapy much sooner, when they first start to notice problem and still actually like each other, which makes the speed and effectiveness of therapy much quicker. When the couple has a good foundation it often only takes an intensive couples retreat week or a couple of months of weekly therapy to get the relationship and the sex life back on track.

Whichever treatment you choose to help heal your low libido, just be sure that you don't allow anything to prevent you from a having a happy and healthy sex life. Women who are sexually satisfied are also more likely to be satisfied with the rest of their lives as well — so continue pursuing your dream sex life! It is truly worth it.

Laura Berman, LCSW, Ph.D., is the director of the Berman Center, a specialized health care facility in Chicago that's dedicated to helping women repair their sex lives and find relief from menopausal symptoms. Dr. Berman is also an assistant clinical professor of psychiatry and obstetrics/gynecology at the Feinberg School of Medicine at Northwestern University.

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