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A Candid Conversation about Low Sexual Desire

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I sat down with Dr. Lisa Chism to answer your most private questions about female sexual health and low sexual desire. – GIGI ENGLE


Low sexual desire is one of the most common sexual concerns I hear about from women. There is no end to the emails I receive on a daily basis from women who have lost their libidos. They’re super stressed and don’t know what they can do to light that fire again. If this sounds like you, you may want to speak to your healthcare provider. Because while there are holistic ways to get your libido up and running, it could be a medical condition called Hypoactive Sexual Desire Disorder (HSDD).

Hypoactive Sexual Desire Disorder (HSDD) is defined as ongoing low sexual desire that women find frustrating, and it affects about 1 in 10 US women. That is not some measly little number! With so many women affected by this issue, we need to be talking about it. 

It makes no sense that we give so much attention to men when they have issues in the bedroom. Getting a prescription for Viagra is, like, easier than ordering a beer. OK. Maybe not that easy, but you get it. And that’s because there isn’t a social stigma around needing the “little blue pill.” Yet, if you’re a woman frustrated by your low sexual desire, it’s thought to just be a “normal” thing. This backward, wrong, and damaging line of thinking is not OK. 

YOU DESERVE A FULL, GLORIOUS SEX LIFE, GIRL! Since low sexual desire is not something we’re comfortable talking about, I had a candid conversation with Nurse Practitioner and sexuality counselor, Dr. Lisa Chism to answer your most private questions. Because you deserve helpful information that leads to solutions.


My tip would be that women need to be more proactive and need to be more educated about the fact that this is something they should be able to talk to their healthcare provider about.

— Dr. Lisa Chism 


GE: When people have a medical concern, they usually go and seek help. So, why don’t more women who have frustrating low sexual desire talk to their healthcare provider about it? 

LC: Clinicians have not historically done a very good job of asking their patients about their sexual health. And that kind of sets the tone: where patients don’t necessarily feel comfortable bringing it up, we did not have good tools to deal with sexual health concerns. Luckily, the landscape is changing and we have a lot more at our disposal. But when providers don’t feel that they can help or fix something for patients, sometimes they tend to shy away. Patients may sense that their provider isn’t comfortable as well, or there really isn’t something that can be done. We know there are treatments for men for sexual health concerns and issues, but it has not been advertised to consumers and our patients know that there are now things that can be done [for women].

GE: Ultimately, while taking control is important as a patient, clinicians share the weight of responsibility. Everyone needs to get straight on the facts so that patients can ask questions and doctors can send them to someone who might have more expertise than they do. What is the biggest tip you would give to patients when they’re dealing with this?

LC: My tip would be that women need to be more proactive and need to be more educated about the fact that this is something they should be able to talk to their healthcare provider about and there are treatments and therapies available. And if they don’t get it from their healthcare provider, ask: Where can you direct me? The lack of education and the lack of comfort is on both sides, and that’s the problem. It drives this problem where women don’t get assessed for low desire because they don’t get asked—and it’s this vicious cycle. 

GE: What if your lifestyle choices have changed, you’ve changed your diet, tried new sexual adventures; you’ve done all the things you’re supposed to do to help get your libido back up and yet … nothing is working? What’s the next step?

LC: Well, the very first thing I talk to patients about is asking them if they are in a relationship. If they are in a partnered relationship, I ask: How is the relationship? Especially if one of their complaints is decreased libido or desire. Because we know that relationship satisfaction can be the very beginning of where sexual response lies for women. So, if relationship satisfaction is not intact for women, then desire is not going to follow. 

GE: Yeah, so interesting and so true. HSDD is such a common concern, but a lot of women who have it feel like they don’t know anyone who also has it. Like we said, women talk to each other, but when it comes to this, there is this huge “embarrassment hurdle”. Why are people so uncomfortable talking about it? 

By the way, if women aren’t interested and their partner is OK with it and there’s no distress, then it’s not a problem.

— Dr. Lisa Chism 

LC: Based on my interactions with patients every day, women start to accept it as normal and just something they have to deal with. It’s the same with pain with intercourse, especially after menopause. They feel like: Well, yeah. Of course I have dryness and it hurts. Well, yes. It’s just what I have to deal with. So, when I talk to women about desire and over, and over, and over again I hear: Yeah, well, I just know, I’m not really interested in sex. By the way, if women aren’t interested and their partner is OK with it and there’s no distress, then it’s not a problem. But if it is causing distress, they seem to just accept it as their new reality and they are not offered or engaged in any kind of therapies or medical interventions that may help them. They are not aware that these things exist so they stop asking and trying to fix it. Because they really aren’t aware that this is a condition, that it is common, and it is treatable. There are various treatments, whether it’s cognitive behavior therapies or medical intervention. 

GE: Ok, paint a little more of a picture for me: You have a patient who comes to you and is like: Oh, I don’t have a libido anymore, but I guess I just don’t have sex drive. What do you say to someone who says that?

LC: I ask them: How does your partner feel about that? While women may be suffering from this, sometimes even men at a younger age than you would expect are having their own form of sexual dysfunction, so I ask them: How does your partner feel about this? If she tells me: Well, we are both OK with it. That’s where we are at in our life. Then, there’s no distress, then it’s not a problem. However, if she tells me: Well, I just don’t really feel like having sex, but it is a problem. I miss that part of my life. Then, that’s when we start to talk more about the relationship again. If the relationship is intact, we talk about whether or not there are mental health issues or physical issues that would be causing it. And, once again, we rule that out: she’s relatively healthy, the relationship is healthy and that’s when we talk a little bit more about some of the behavioral and lifestyle things that they can be doing. But also letting them know if at the end of the day none of these things are working, there are some things we can talk about as far as medical therapies and interventions.

Please care enough about yourself to bring it up to your clinician or your healthcare provider and if you don’t get what you need, continue to search. Because you deserve it.

— Dr. Lisa Chism 

GE: When it comes to HSDD, you’ve mentioned there are two main avenues for treatment: Cognitive Behavioral Therapy and Medical Intervention. When it comes to sexual health concerns, the issues can be both mental and physiological, meaning that treatment may need a multi-pronged approach, right? What treatments are available for HSDD?

LC: We know that low desire or true HSDD has to do with the neurotransmitter imbalance in the brain. While some women might benefit from cognitive behavioral therapy, others might also need medical treatment.

GE: If you had to send out a message to the women of the world who may be struggling with their sexual desire and don’t feel like they can come out and talk about it, what would you say?

LC: Please care enough about yourself to bring it up to your clinician or your healthcare provider and if you don’t get what you need, continue to search. Because you deserve it. You deserve to feel desire, you deserve to have a healthy sexual response, you deserve sexual health. I think women need to be given permission to make this important because it’s multifactorial. My message to women would be to know that you are worth it and that this is a real condition.


Author Disclaimer: I am not a medical professional and cannot prescribe medical intervention to anyone. I am not qualified to offer prescriptions or medical advice. I do, however, take pharmaceuticals every single day for my mental well-being. I am a journalist and sex researcher who seeks to inform the public to the very best of my ability using facts and medical resources. If you think you might be suffering from HSDD, I strongly recommend speaking to your doctor ASAP. 

About the Author
Gigi Engle is a feminist author, certified sex coach, sexologist, and sex educator. Her first book, All The F*cking Mistakes (St. Martin's Press), is on sale now. Gigi is an accredited member of The World Association of Sex Coaches. As a sexpert for Womanizer and brand ambassador with Lifestyle Condoms, Gigi promotes and teaches about pleasure-based sex education, masturbation, and safer sex practices. She was named Journalist of the Year at 2019 The Sexual Freedom Awards.
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  • what is hsdd?

    It’s a treatable medical condition also called hypoactive sexual desire disorder. Women with HSDD have decreased sexual desire that they find frustrating. HSDD can lower your self esteem and strain your relationship. If that’s what you’re feeling, don’t feel alone or embarrassed—unblush.

  • Resources

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    Conversation Starter

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    How to talk about female libido issues
    Talking to Your Partner

    It’s not easy, but it’s so important. These tips can help you have an open, honest conversation.

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