Women, it seems, are increasingly losing interest in sex. Around a third of pre-menopausal women and half of older women report sexual problems, with lack of desire a main cause, according to the Sexual Advice Association.
A study recently published in the journal BMJ Open found that more than a third of 5,000 women aged between 16-74 surveyed said they’d lost interest in sex for three months or more in the previous year. And nearly two-thirds of these women said they found their lack of libido distressing.
This is not a problem unique to women — around one in five men experience low libido at some point, but they definitely have the advantage when it comes to treatments.
Around a third of pre-menopausal women and half of older women are reporting sexual problems (FILE photo)
It’s now 20 years since Viagra provided an instant fix for men who struggled to achieve an erection, however scientists have not been able to produce as successful a pill to help women feel more in the mood.
Some experts think the reason this has proved so elusive is that many women are dealing with underlying health conditions, from incontinence to menopausal symptoms and pelvic pain, that affect their interest in sex, and no ‘pink Viagra’ is going to sort this out.
Yet for years a female Viagra has been the Holy Grail. So there has been some excitement about a drug called bremelanotide, which has just undergone successful phase 3 clinical trials in the U.S., the last stage before a drug can be licensed.
It was originally tested as a tanning pill in the Eighties but was found to boost muscle recovery. Body builders of both sexes found unexpected benefits — the men reported spontaneous erections, the women said it put them ‘in the mood’. The drug company, Palatin Technologies, switched their efforts to developing it as a treatment for female sexual dysfunction.
The drug works by binding to chemicals in the brain involved in sexual desire, increasing production of the ‘feel-good’ chemical dopamine which plays a key function in arousal. For best effects, the woman must inject herself around 45 minutes before sex.
Trials found it worked better than a placebo but the development of the treatment suffered a setback in 2007 when the original nasal spray version was found to cause high blood pressure in some, leading the Food and Drug Administration in the U.S. to halt trials.
The manner of administering the drug was changed to an injection. The latest trials have shown that as well as improving a woman’s libido generally, bremalanotide also makes sex more satisfying for premenopausal women. Palatin Technologies now hopes to make billions from worldwide sales.
But before the champagne is opened, experts urge caution. Not least because bremelanotide would not be the first ‘female Viagra’ to be licensed and promise much —only to then fall short. Addyi was also labelled the female Viagra when it was launched in 2015.
Originally developed as an antidepressant, it reduces the effect of the brain chemical serotonin, which in turn leads to an increase in dopamine levels.
In the UK, Addyi is yet to receive approval due to the cost (up to £700 for a month’s supply) as well as concerns about its effectiveness.
Even in the U.S., where it is licensed, take–up has been slow, probably because Addyi doesn’t help all women — only around 10 per cent found any increase in ‘sexually satisyfing events’ compared to those taking a placebo, and around 75 per cent of those who take it experience side-effects such as nausea, headache and dizziness.
It also has to be taken daily, and drinking alcohol can make side-effects worse.
But if a pill isn’t the answer, researchers at the University of Michigan in the U.S. have been trying out a new device which sends electrical signals from a needle inserted in a woman’s ankle to stimulate nerves and blood supply in the genital area.
Although it reportedly creates a pleasant tingling, there are concerns about how practical it is during energetic love-making sessions (as the needle needs to remain in situ).
Study published in the journal BMJ Open found that more than a third of 5,000 women aged between 16-74 had lost interest in sex
The focus on pills — and zappers — misses the bigger problem, say experts. This is not just that there are so many complex factors in female desire, such as stress and breakdown of relationships — though clearly these play a role.
‘A woman seeks intimacy which leads her to be receptive to sexual stimuli and only then feels desire,’ says Dr Catherine Hood, a consultant in psychosexual medicine at St Pancras Hospital, London.
However experts are increasingly admitting that often low libido in women is nothing to do with what’s going on in their head — there are a whole range of physical issues that can kill desire.
It might be that the muscles in their pelvis are so tense it makes it difficult to have sex, or the impact of the menopause makes it painful. Fix the physical problem, they say, and a woman’s normal desire for sex will return.
‘There are many physical reasons why women lose their desire for sex, including illness and pelvic pain,’ says Dr Hood.
‘It may be that drugs could help solve issues that are caused by genuine chemical or hormonal imbalances, but these are just one small part of a bigger picture when it comes to low libido in women.’
Yet these physical factors are often overlooked, says Myra Robson, senior women’s health therapist at the Lewisham and Greenwich NHS Trust.
‘We see women who are trying to maintain good sex lives while dealing with issues such as endometriosis, [where womb lining-like tissue develops elsewhere, causing scarring and irritation] which can cause deep pelvic pain; fibroids, which affect the lining of the womb, and stress incontinence, which affects one in three women after childbirth,’ she says. ‘These things need to be sorted out first before we go for the candles and the chocolates, and long before we even think about female Viagra.’
Dyspareunia, or painful sex, is a common cause of low sex drive in women. Around 30 per cent of women experience this according to an article in the Journal of Sexual Medicine in 2015. Large numbers of women do not tell their partner when sex hurts. They might want to have sex, but go off it as it is so painful for them.
‘It’s a common and distressing complaint and it has been a neglected female health problem and can affect young women, women after having children and women who are already through the menopause,’ says Mike Bowen, a consultant gynaecologist based in London and Oxford. ‘It can be felt as deep pain within the pelvis or superficial pain in the vulva during intercourse.’
It is associated with issues such as vaginal dryness and anxiety about sex as well as a range of physical problems, from painful skin conditions to urinary tract infections and endometriosis. Women who have perineal scars after childbirth are also more likely to find sex painful until the scar tissue has stretched and softened, which can take years.
‘Fortunately, there are many ways to treat dyspareunia, by treating the underlying causes, whether they be physical, emotional or a combination of both,’ says Mr Bowen.
Any form of incontinence can put women off sex: Stress incontinence, the most common form that leads to small leaks of urine when someone coughs, sneezes or laughs, affects around one in three women in the UK.
‘Women may feel dirty and unclean and they may not want to have sex at all,’ says Dr Hood.
According to the Sexual Advice Association, the main cause is a lack of desire
Stress incontinence occurs because weakness around the pelvic floor (the band of muscles that stretch from the pubic bone to the front to the spine) means the neck of the bladder is not well-supported, so urine can leak out when the bladder is put under pressure. This commonly happens after childbirth, as the ligaments that support the pelvic floor become stretched during pregnancy or labour.
Pelvic floor exercises can help — although ideally these should be done under the guidance of a specialist physiotherapist, who are in short supply.
Apps such as Squeezy and gadgets such as Innovo, which emits electrical impulses to contract the pelvic floor muscles, can help.
‘There is a place for these devices but women can also try simple techniques like going to the loo before sex and abstaining from coffee and tea, which are mild diuretics,’ says Dr Hood.
A lesser-known issue is pelvic tension, when muscles in the pelvic floor are knotted and tight, which can make sex virtually impossible. Yet it is surprisingly common: up to 15 per cent of women aged between 18 and 50 are affected, according to a study published in the March 1996 issue of Obstetrics and Gynaecology.
It can be caused by stress and anxiety, slouched posture, chronic constipation and even over-exercise. It is a recognised medical condition which can be treated by internal massage, widely available on the NHS.
Amanda Savage, a specialist pelvic floor physiotherapist at the private South Cambridge Physiotherapy clinic in Hauxton, Cambridge, treats many women who suffer from pelvic tension.
‘We often find that women have such overly tense muscles in their pelvic region, their muscles are unable to let go and relax. This can cause long-term pain.’
It’s generally assumed that desire will naturally drop with age, especially following the menopause, but there is no evidence that this should happen to women.
Indeed when Tim Spector, professor of epidemiology at King’s College, London, looked at the effect of the menopause on women’s libido he found that sexual dysfunction problems didn’t increase but stayed constant, affecting around 22 per cent of women. Some women actually saw improvements in sexual function after the menopause.
The results of the four-year study, published in the Journal of Sexual Medicine in 2015, were ‘a little surprising’, Professor Spector admits. ‘They suggest that menopause has been exaggerated as an excuse for everything.
‘By modifying your life and attitudes towards desire, you can change things sometimes surprisingly for the better, although you are older,’ he says.
Any reduced libido is usually associated with hot flushes or vaginal dryness (which can make sex painful). ‘As oestrogen levels drop, there can be problems like vaginal dryness,’ says Kathy Abernethy, specialist menopause nurse and Chair of the British Menopause Society, adding that if these are treated, for example with hormone replacement therapy (HRT), oestrogen creams and lubricants, a woman can find her desire returns.
Dr Hood says that women who maintain active sex lives are more likely to keep thinning and dryness at bay: ‘There’s a maxim, use it or lose it, which definitely applies to women having a great sex life past the menopause. Sexual intercourse helps to keep the walls of the vagina thicker and more elastic.’
Some doctors believe that a lack of sexual desire in women is linked to low levels of the male sex hormone, testosterone, which in women is produced in small amounts in the ovaries and drives sexual arousal.
Testosterone patches deliver small amounts of a synthetic form of the hormone while testosterone creams can be used by peri and post-menopausal women on an ‘off-label’ basis (i.e. the drug has not been approved for that use).
Dr Martin Galy, a hormone specialist practising in London, says that at least half of his female patients complaining of loss of sex drive have inadequate levels of testosterone. However, this is a controversial area, and Dr Galy admits that the science for what counts as ‘inadequate’ is ‘inexact’.
‘A woman’s testosterone levels could be very low and her libido is fine,’ he explains. ‘It works for some women, but not everyone.’ There are also a range of potential side-effects such as bone softening, hair loss and acne.
Whatever the cause, the impact a lack of desire can have on women should not be underestimated, explains Denise Knowles, a sex and relationship counsellor for Relate. ‘A healthy sex life is good for your relationship and how you feel,’ she says.
‘Sex stimulates the production of feel-good hormones dopamine and oxytocin, making you feel closer to your partner as well as improving blood flow, which helps keep the circulatory system in good shape and burning calories. There are all sorts of good reasons why you should take steps to foster your desire.’
Dr Hood says people do have to make an effort. She often sees couples where the woman complains she no longer feels spontaneous desire and the man complains his partner won’t initiate sex. ‘But perhaps we put too much emphasis on “spontaneous desire”, which only really happens in new relationships. After two years or so, spontaneity is replaced by a new cycle of desire, which requires him to initiate intimacy to which she can respond sexually.’
There is also very often a difference in libido between a man and woman, suggests Dr Hood. Generally speaking, one person, usually a woman, loses spontaneous desire, she has said previously. ‘They don’t think about sex that much, they don’t initiate it and don’t really feel like having it.
‘But when they do have sex, they often enjoy it — they have what’s known as reactive sex drive. Also, the person with the reactive sex drive needs to be open to having sex, not just short-circuit the whole idea.’
UNDER THE MICROSCOPE: Actress Ruby Wax, 64, answers our health questions
Actress Ruby Wax, 64 pictured, is under the microscope as she answers our health question
CAN YOU RUN UP THE STAIRS?
I can run up and down the stairs faster than my children — and slide down the banisters, too! I need to keep fit to do my shows. I do pilates three times a week (I have a very strong pelvic floor as a result) otherwise I’d look like a mushroom.
GET YOUR FIVE A DAY?
I’m on the Paleo diet, so I eat lots of fresh fruit and vegetables. But I don’t always trust the word ‘organic’. Those foods are too expensive. It’s like eating the Prada of the food world.
EVER DIETED?
Yeah, every diet known to man. I went on a grapefruit diet 20 years ago and ended up in hospital. A few years ago, I just juiced, shovelling pounds of vegetables and fruit into a blender. I felt sick for a week. On the Paleo diet, I eat everything that once had a pulse.
ANY VICES?
I work really hard — but I enjoy it.
ANY FAMILY AILMENTS?
Yes, mental illness. My great grandmother and great aunt suffered from ‘agitation’, as it was called, and ended up in psychiatric hospitals. When I was younger I didn’t realise my parents had mental health issues caused by their experiences in World War II. They fled the Nazis.
WORST ILLNESS?
I’ve suffered depression most of my life. At times I felt so immobilised I thought there was something physically wrong. I manage it with medication and mindfulness. It led me to set up Frazzled cafes, free meetings at M&S cafes for people who feel overwhelmed. You get tea and cookies.
EVER HAVE PLASTIC SURGERY?
Yes, but only for my career. Appearance counts when you’re on TV. Otherwise, I’d think it stupid.
COPE WELL WITH PAIN?
I’m tough, really tough and I don’t have a lot of pain. But, if I did, I’d hit the medication pretty quick. I’m not one for sitting it out.
TRIED ALTERNATIVE MEDICINE?
Yes, it’s fabulous material for my shows. I’ve tried acupuncture, herbs, flower essences and healing. I’ve also done rebirthing: they put me in a bath tub and shouted at me to go through my own birth.
HANGOVER CURE?
I don’t really drink, apart from the occasional Martini. So, I’d just say, get a blood transfusion.
WHAT KEEPS YOU AWAKE?
Not much. I sleep about ten hours. Sleep is the cure to a lot of distress.
ANY PHOBIAS?
My biggest is flying and if there’s bad turbulence you’ll find me on the ceiling. I can cope with other fears, but there’s no mental technique to stop a plane crashing.
LIKE TO LIVE FOR EVER?
Yes, I don’t believe we come back and I want to carry on learning.