Female Sexual Wellness-(FSW)

I am a woman, why would I need testosterone??

Testosterone is a female hormone just as much as it is a male hormone.  Women produce testosterone at a smaller amount than men in the ovaries, adrenal glands and in the peripheral tissues.  Testosterone is responsible for libido (sexual desire), bone and muscle health. A lowering of testosterone is an age related issue and not specifically related to menopause.

I am not that old, why do I have no desire?

Low desire in young women can be due to a number of causes. Testosterone is a sex hormone that is responsible for sex drive. Testosterone will usually peak in a women’s 20’s- 30’s and start a slow decline from there. Testosterone will likely already be low when menopause starts and may further decline as progesterone declines during menopause. However, testosterone will continue to be produced in the adrenal glands and peripheral tissues after menopause but a smaller percentage.

Low desire can also be attributed to a variety of other medical problems and/or medications. Oral birth control pills are one of the most common medications associated with low libido due to its role in Sex Hormone Binding Globulin.

My partner and I have always had a great sex life but now I find myself avoiding him so we don’t have to have sex.  Is there something wrong with me?

Hypoactive Sexual Desire Disorder ( HSDD) is an absence of sexual fantasies and desire for sexual activity.  This must cause distress or interpersonal difficulty and cannot be accounted for by another major mental disorder and is not due solely to the effects of a substance or general medical condition.

  • 33% of women are affected by low sexual desire.
  • There are many other medical conditions and medications that can contribute to low libido, decreased arousal and decreased vaginal lubrication.

Can Birth Control Pills really affect me sexually?

Use of oral contraceptives made up of a synthetic ethinyl estradiol can lead to long term sexual side effects. This can include decrease in sexual interest, sexual frequency, and sexual arousal as well as a decrease in vaginal lubrication and an increase in pain with intercourse.

I have gone through menopause. I guess sex is just over for me.

If you want to have sex and you want to enjoy it then you should be able to!!

Low Desire Treatment Options

  • Relationship issues, stress, body image issues – sometimes evaluating these issues and discussing them with your partner or a sex therapist can improve sexual desire.
  • Eliminating certain medications or treating underlying medical problems
  • Hormone replacement therapy – sex hormones like testosterone can increase your libido and it’s not just for men anymore.

Dyspareunia (Pain During Sex)

  • Lubricants, vaginal moisturizers, vaginal dilators
  • Vaginal Estrogen – lack of the sex hormone, estrogen, can decrease the moisture and elasticity of the vagina
  • Oral Medications – non hormonal
  • Hormone Replacement Therapy – the tissues in the vagina are fed by the sex hormones. You can think of your vagina like a sponge. When you are young and making hormones at the appropriate level the vagina is like a wet sponge. When the hormones are lacking then the vagina is like a sponge that has been sitting on the counter for a month without moisture.
  • Pelvic Floor Physical Therapy – vaginismus or painful contraction of the vagina in response to contact or pressure, especially during intercourse. This can happen as a natural response to try and protect your body from pain. Can be related to a traumatic experience or any painful intercourse.

Arousal or Difficulty Achieving Orgasm

  • Topical treatments – warming agents, lubricants, moisturizers
  • Vibrators
  • Medications
  • Sex Therapy

Vaginal Dryness / Lubrication Issues

  • Non Hormonal Topical treatments – lubricants, moisturizers
  • Hormonal Topical Treatments – topical estrogen cream, compounded estrogen/testosterone creams
  • Systemic Hormone Replacement – remember the sponge analogy
  • Elimination of medications that may cause the dryness


It’s About Time!!!!

The FDA has finally approved a medication for women to help with sexual desire!! The medication is called ADDYI (flibanserin). Please ask us about it and see if it is for you.


You may be at risk for experiencing symptoms of sexual dysfunction if you have:

Heart disease

Use cardiovascular medications




Ride bicycles for more than 3 hours/week

Male over age 50

Peri or post menopausal

Low testosterone

Have or currently use oral or patch birth control

Take Antidepressants

Have anxiety

Have given birth

Had a hysterectomy


Leading causes of Vaginal Dryness

  • Menopause
  • Hundreds of medications
  • Diabetes
  • Autoimmune Disorders


Common Medications that cause vaginal dryness

  • Antidepressants
  • Antacid
  • Anticholinergic
  • Anticonvulsants
  • Blood pressure medication
  • Anti-inflammatories
  • Antihistamines
  • Anti-anxiety
  • Decongestants
  • Diuretics
  • Muscle Relaxants
  • Narcotic Analgesic
  • Many more. . .