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26732 Crown Valley Parkway, Suite 327
Mission Viejo, CA 92691


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Sexual Health: Decreased Libido/Sex Drive

Decreased libido also known as a low sex drive, can occur at any age and any stage of life. The cause of a decreased libido can vary and can include a number of possible reasons. 

Risk factors for decreased libido or sexual dysfunction:
  • Aging and menopause: reduced testosterone, low vaginal estrogen
  • Chronic medical conditions: diabetes, high blood pressure, depression, heart disease
  • Pelvic surgery and pelvic disorders: pelvic floor muscle spasm
  • Neurological disorders: multiple sclerosis, epilepsy, paralysis
  • Endocrine disorders: Addison’s disease (hyperthyroidism), Hashimoto’s thyroiditis (hypothyroidism)
  • Medications: birth control pills, anti-depressants, anti-anxiety medications, antihypertensives, steroids, statins
  • Infection: sexually transmitted disease, genital warts

The evaluation for low sex drive and/or arousal disorder involves a complete history of medications, surgeries, and sexual experiences, ability to use tampons, musculoskeletal injuries and relationship status and wellbeing. A complete examination is done, observing the health of the vulva, hymen and vagina, performing a vaginal culture, and palpating the vulvar and vaginal muscles, as well as the pelvic organs.

Treatments for sexual dysfunction including decreased libido
  • Education about current modifiable risk factors (perhaps changes in medication)
  • Sexual response and anatomy, foreplay and sexual positions, and use of sexual aides.
  • Lubricants can be helpful for ease of sexual penetration. Zestra oil is wonderful for local stimulation.
  • Medications that address hormonal imbalance and/or arousal through serotonin levels. Hormone replacement with estradiol, testosterone, and/or progesterone will improve sexual thoughts and interest, arousal and response. Vaginal estradiol cream can be applied to the vulva 3x a week to maintain health.
  • Flibanserin (Addyi®) is the newest drug that is FDA approved for premenopausal hypoactive sexual desire.
  • Pelvic floor physical therapy can treat the tight muscles of the pelvic floor and local massage with vibrators/dilators or wands can help improve relaxation and blood flow to the area.
  • ThermiVa® is a non-hormonal and non-surgical treatment that uses radiofrequency to gently heat the tissue to cause improved blood flow and elasticity, improved orgasm and lubrication.
  • Psychological therapy, including couples’ therapy, is important help women address barriers to sexual wellness and for partners to have similar sexual goals.

There are many treatment options available to address decreased libido. Talk with your doctor about which option would work best for you. It’s time to take back your sexual health and wellness and live your best life. 

Pain with Intimacy

Pain with intimacy or intercourse can include pain with penetration—even when inserting a finger or a tampon. It does not just apply to penile penetration.

Pain can include a burning or aching feeling. It can also include a sharp pain or a throbbing pain that lasts for hours after penetration or intercourse. 

Finding the cause of pain with intimacy is important. That way we can work with you on a treatment plan tailored to your unique needs. 

Some causes include vaginal dryness, infection or injury, muscle spasms (vaginismus), or an anatomical abnormality that has been present since birth.

Childbirth can also lead to tears in the perineum that take months to heal and can make penetration painful. 

Emotional and psychological factors can also contribute to pain with intimacy. It is important that you talk to your doctor and together, you work to determine the cause of the pain. That way, your doctor can recommend treatment options that address the root cause of your pain and allow you to resume satisfying and pleasurable intimacy.

Vaginal Dryness

One of the most common causes of vaginal dryness is due to a hormone imbalance—generally due to a drop in estrogen related to perimenopause and menopause. Estrogen is important in maintaining vaginal lubrication, elasticity, and acidity.

Vagina dryness due to low estrogen levels can be easily managed through a personalized hormone replacement plan. There are other causes of vaginal dryness including certain medical conditions/immune disorders, smoking, and/or use of antihistamines and other medicines that dry out your mucus membranes.

It is important to rule out other causes of vaginal dryness before starting hormone replacement therapy. The doctors at Center for Pelvic Health and Wellness have significant experience with diagnosis and treatment of gynecological conditions including vaginal dryness.

Lack of Arousal and Orgasm

Lack of arousal and orgasm, also called, female sexual dysfunction, can be defined as low sexual desire to the inability to become aroused or to have an orgasm. More than 40% of women complain of sexual dysfunction including low sexual desire or drive and/or problems with orgasm and arousal.

Female Arousal Disorder or problems with orgasming and genital sensation is defined by absent or reduced sexual excitement/pleasure during 75-100% of sexual encounters including internal or external sexual erotic cues (written, verbal, visual).

The doctors at Center for Pelvic Health and Wellness have gone through advanced training in sexual health including diagnosing and treating conditions related to lack of arousal and orgasm. Sometimes the cause is physical while other times the cause is hormone related during or after pregnancy; or, during menopause. 

Other causes may include a medical condition or illness, a side effect of a medication such as an antidepressant, or, emotional and psychological stress.

Once we determine the cause, we can provide you with treatment options to once again experience arousal and orgasm. 

Couples Health

When it comes to sexual health and wellness, the wellness of the couple relies on both the wellness of each individual as well as the dynamics within the relationship between the couple. Sexual health and wellness can be complicated if one partner isn’t willing to address health issues that may be impacting the relationship. There are many issues that can get in the way of a healthy relationship including physical, emotional, and psychological issues. 

Men and women go through different biological changes in their lifetimes. It is critical for the couple that each person take control of his/her own health in order to lay the necessary foundation for a sexually healthy and satisfying relationship.

At Center for Pelvic Health and Wellness, we specialize in sexual health. During an appointment with one of our physicians we will work with you to understand the dynamics in your relationship and work to optimize your health and wellness. This may include hormone replacement therapy for women who are perimenopausal or have gone through menopause.    

Sexual and Intimacy and Wellness Resources
Book recommendations:
  • How to Give Her Absolute Pleasure by Lou Paget
  • Mating in Captivity by Esther Perel
  • Orgasms by Lou Paget
  • The Passion Prescription by Laura Berman
  • For Women Only by Jennifer and Laura Berman
Video recommendations:
  • Being Orgasmic by Julia Heiman
  • Celebrating Orgasm by Betty Dodson
Better Sex Video Series Websites:
To locate a certified sexuality therapist near you:
Some fun sex tips:
  • The fantasy sex box: you and your partner put fantasy requests in a box and you pick one fantasy (or more) during your next intimate moment and make it come true
  • Keep lingerie on!
  • Delay orgasm as long as you can
  • Use blindfolds
  • Shop for sex toys together
  • Try Altoids or other mints during oral sex
  • Make eye contact during orgasm
  • Incorporate a small vibrator (such as the Pocket Rocket) into lovemaking
  • Use lubricant during sexual activity, even if you don’t think you have vaginal dryness (it increases sensation)
  • Zestra oil for clitoral stimulation