One of the most common topics that women want to discuss during their annual exams is sex. Low libido is by far the most common sexual complaint I hear from my patients.

Diminished sex drive occurs in patients of all ages. When women complain of a low libido, I begin by asking them a few basic questions. I ask them if this a relatively new issue, or if they’ve felt this way for a prolonged period of time. I also ask them how long they’ve been with their current partner and how the low libido is affecting their partner and their relationship.

For women with a new onset of diminished desire, there is often a major life change that has also occurred. The birth of baby, job and financial stress, and illness or death of a parent can all be common etiologies for low libido.

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Sometimes simply pointing out that it is completely normal and acceptable to experience sexual issues during stressful times makes a female patient feel better. This is a great time to emphasize the importance of self-care. Often when women feel they have time to care for themselves, they are more interested in sex.

According to Rosemary Basson, a leader in sexual medicine, a woman’s sexual response cycle is complex and can change after the woman has been in a relationship for a while. Basson believes that women in long-term relationships rarely feel spontaneous sexual desire, but are driven more by a desire for intimacy or love. Once sexual contact begins, then arousal and desire is sparked.

Often, women believe that there is something wrong with them because their sexual desire does not match their partner’s libido. The misconception that there is a “normal” level of sexual desire leads to guilt particularly if a woman’s partner complains or is critical.

Educating patients on the complexities of the female sexual response cycle is crucial in helping alleviate some of the guilt associated with diminished sexual desire. Often the reassurance that what they are feeling is not only common but quite normal is all the patient is looking for. However, for patients who are looking for ways to increase their libido, I will give them homework.

I encourage women to take some time for themselves, whether that means a long bath, a run, a massage, or even a weekend away. I recommend thinking about sexual fantasies, reading erotic books, shopping for lingerie or sex toys as simple ways to exercise the libido.

Most importantly, I encourage patients to talk openly with their partner if possible. I always offer to schedule another appointment when the patient can bring her partner so we can further discuss sexual response. If there are deeper problems in the relationship affecting intimacy, I encourage both individual and couples counseling.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.