By Dr. Kathleen Regan, ND

No discussion of fertility is complete without talking about sex drive, or libido. Little interest in having sex can influence the likelihood of becoming pregnant for obvious reasons. As well, trying to conceive can be stressful which influences libido and your hormones. Yet, this can be a really difficult subject for women to bring up despite the fact that about 40% of women report some type of sexual dysfunction.

Healthy sex consists of 4 important phases: desire, arousal, orgasm, and resolution. Low libido can be caused by problems in any of the first 3 phases.

Hypoactive Sexual Desire Disorder: Women who don’t experience sexual fantasies or desire for sexual activity occurs in about 5-46% of the population (with post-menopausal populations expressing higher rates).

Female Sexual Arousal Disorder: Women who experience insufficient lubrication-swelling response to sexual excitement occurs in about 8-21% of the population.

Female Orgasmic Disorder: Women who have unusual difficulty reaching an orgasm occurs in about 4 – 24% of the population.

Dyspareunia: Women who don’t like having sex due to persistent pain during intercourse (not due to infection or lack of lubrication) occurs in about 3-18% of the population.

If low –to-no sex drive is an issue for you, I am sure you can see yourself in one of the above categories. But before you diagnose yourself remember that each of these ‘conditions’ is caused by multiple and overlapping biological, psychological, and social factors including:

  • Gender Orientation & Identity
  • Body Weight & Image
  • Mood
  • Stress
  • Physical activity
  • Diet & Lifestyle
  • Hormone Balance (particularly of estrogen and testosterone)
  • Medical Conditions Including obesity, diabetes, cardiovascular conditions and neurological conditions

Naturopathic treatment of low libido for women focuses on 4 main areas: lifestyle, nutrition, hormonal balance & emotional balance.

Lifestyle:

  • Exercise: Regular Exercise helps to increase circulation to the pelvic area which is important for arousal and reaching orgasm. In the long-run exercise helps improve mood, reduce stress, promote healthy body weight (which is associated with positive body image and feelings of attractiveness) as well as balance hormones.
  • Weight Loss: The association between obesity and sexual dysfunction has been described in many studies. High Body Mass Index (BMI) is associated with poor circulation and cardiovascular risk factors that decrease circulation and blood flow to the pelvic area but also with body image issues and feelings of unattractiveness.
  • Adequate Sleep. It isn’t a mystery or a surprise that sleep deprivation reduces the desire and ability to have sex. Getting at least 8 hours of uninterrupted sleep with the first two hours before midnight is an excellent way to build your energy back up. Natural sleep remedies like melatonin, 5HTP, or passion flower can be great aids in getting your sleep rhythm back on track.
  • Smoking places a huge toxic burden on the body which seriously compromises blood flow. If there is reduced blood flow going to your lady parts then you will be less aroused, less lubricated and less likely to orgasm. Quitting smoking is a must for increasing sex drive. Acupuncture, biofeedback, and natural herbal remedies can help with smoking cessation.

Naturopathic treatment of libido will focus on basic lifestyle changes including building an exercise plan that is right for you. Not everyone needs to hit the gym for an hour a day. This may include walks or yoga depending on your preference. The important thing is incorporating movement and sweating into your daily routine. Exercise will help to improve circulation, boost mood and improve body image. Exercise at the right time is also a great promoter of deep sleep. 

Nutrition:

  • A high caloric diet, high carb & low protein or high fat diet can lead to an imbalance in blood sugar, excess estrogen and excess androgens that decrease both sex drive and your ability to become pregnant.
  • A low caloric intake can lead to low levels of estrogen and androgens that also cause decreased sex drive and inability to become pregnant.
  • Alcohol consumption in high amounts suppresses the desire to have sex, the ability to become aroused AND the ability to orgasm.

A naturopathic plan for increasing libido focuses on balanced caloric intake, minimal sugar and carbohydrates, adequate protein and fat intake with minimal consumption of alcohol.

Hormonal Balance:

  • Low sex drive can sometimes be an indicator of hormonal imbalance in androgens, testosterone and estrogen. Both of these hormones can alter sex drive if they are too high or too low in women.
  • Post-menopausal women are most susceptible to low libido with dropping levels of estrogen. But pre-menopausal women can also have low levels of estrogen leading to the same issues. In young women this can be caused by low body weight and low body fat percentage, or other physiological issues. Establishing normal levels of estrogen has been shown to increase sex drive.
  • High levels of estrogen put women at risk for many health concerns including sexual dysfunction. Loosing weight, reducing environmental and dietary exposure to xenoestrogens, adequate dietary fibre, reduced coffee intake and liver support can help the body to deal with excess levels of estrogen.
  • Levels of androgens including testosterone have been related to low libido at both high and low levels. Interestingly, it has been found that testosterone can help to improve sex drive in women at higher than normal physiological levels but not just by increasing testosterone to normal levels. Testosterone therapy also seems to work best when used in conjunction with estrogen therapy.
  • The birth control pill has been found in multiple studies to affect libido, mainly because of its influence over estrogen and the metabolism of other sex hormones in the liver.

Naturopathic approaches to hormonal balance include dietary, herbal and stress reduction techniques. The herbs used to treat hormonal balance are as unique as the individual. Assessment by a trained naturopathic doctor is essential when using herbs to treat libido and fertility.

Emotional Balance

  • Stress is a big libido killer. It is well accepted that stress leads to profound reproductive dysfunction. In times of stress, glucocorticoids alter different hormonal pathways including testosterone which can alter sexual behavior.
  • Stress also has long term impact on dopamine levels in our brain which promote sex drive and reward from positive sexual experiences. In the short term, if stress is high, you simply will not have the desire to have sex because your attention is elsewhere.
  • Interestingly, long-term stress starting in childhood has been shown to decrease estrogen and testosterone secretion. Stress can actually alter the genetic expression of estrogen receptors that govern sexual behavior.
  • Long term stress extending into adulthood has been shown to activate brain pathways which release norepinephrine into the ovary producing irregular ovulation and ovarian cysts or stopping ovulation all together.

Therapies like acupuncture, cranial sacral therapy and mindfulness techniques can be used to help with stress reduction. However, when stress reaches a place where is creating constant anxiety or depression, it is best to seek out the help of a training mental health professional. These deeper emotional issues can have a large impact on fertility and are worth exploring.

Herbal Medicine For Sexual Dysfunction:

There is much folklore and mystique surrounding herbal aphrodisiacs. Various herbs are held in high esteem by traditional cultures for their history of increasing libido. Here are a few herbs that have shown benefits in research and in clinical practice.

Maca: This long-used herb of Peruvian origin where it grows exclusively between 4000 m and 4500 m in the central Andes. Maca is traditionally employed in the Andean region for its supposed aphrodisiac and/or fertility enhancing properties. There has been more research on Maca than on most other aphrodisiac herbs. Interestingly, Maca seems to increase sexual desire without altering sex hormones. So this may increase desire but not necessarily fertility.

Nutmeg: Nutmeg has been mentioned in Unani medicine for the management of male sexual disorders. In one study , it was found that administration of 50% ethanolic extract of a single dose of Nutmeg and Clove, and Penegra resulted in the increase in the mating performance of the mice.

Panax Ginseng: The word Panax, means “all-healing” in Greek and is a reference to its revitalizing properties for the whole human-body. Panax Ginseng is cardiovascular protective due to its antioxidant and nitric oxide mediating properties. It is thought that the nitric oxide stimulation may partly account for the aphrodisiac effect of P. ginseng used in traditional Chinese medicine.

Tribulus Terrestris: According to the Canon of Medicine and Aghili Khorasani’s Makhzan al-Advia (The treasury of Spices) (18th AD), Bindii or Tribulus terrestris ‘influences libido and is able to boost sex drive in human beings’. Modern research seems to support the use of Tribulus in women although it is often thought of for men. One study found that women placed on Tribulus for 4 weeks showed increase desire and arousal

Yohimbe: Pausinystalia yohimbe is an evergreen tree native to West Africa, also present in Asia. It is the only herb listed in the Physician’s index reference for sexual function. Yohimbe has been widely used for more than 75 years as an accepted treatment for male erectile dysfunction. Yohimbe is also believed to act as a stimulant for the pelvic nerve ganglia and adrenaline supply to nerve endings leading to an increase in sexual sensation and stamina. Sorry ladies, the studies on yohimbe are conducted mostly on men although it is probable that yohimbe would also stimulate clitoral blood flow via adrenalin and the pelvic nerve endings in women.

Estrogenic Herbs: As mentioned earlier, falling libido can mirror falling estrogen levels in post-menopausal women or in younger women with low estrogen. Supporting falling estrogen levels to treat libido has not been well studied in herbal medicine – although estrogen creams and hormonal replacement have been found to support libido in conventional pharmacy. Herbs which help to naturally balance estrogen include soy, licorice, red clover, thyme, tumeric, hops, and verbena. Theoretically, these herbs can be used in this specific group of women with the awareness that estrogen should not be stimulated in estrogen dominant conditions.

DHEA: A supplement rather than a herb, DHEA is aimed at improving libido and wellbeing in postmenopausal women. However there is little evidence to support the use of DHEA for this purpose. The studies of DHEA therapy in women with adrenal insufficiency suggest that this group is the most likely to derive health benefits from DHEA supplementation.