Sexless

Many women face: a profound loss of sexual desire and function

The title "Sexless" captures a harsh reality many women face: a profound loss of sexual desire and function that feels like an emotional and physical void—sometimes described as feeling "dead inside." This isn't uncommon in my practice. Patients often present with complaints of decreased libido, difficulty achieving orgasm, fewer sexual thoughts, genital numbness, discomfort, or vaginal dryness. These issues frequently trace back to abnormal menstrual flow, gynecologic conditions, or treatments involving artificial hormones (such as hormonal contraceptives or other progestin-based therapies).

Research consistently shows that hormonal contraceptives and traditional hormone replacement therapy, particularly those containing progestins, can disrupt natural hormone balances. Progestins suppress ovarian function, reduce endogenous estrogen and androgen production (including testosterone, which may play a key role in desire), and alter neurotransmitter activity essential for sexual response. Common reported effects include:

• Decreased libido — from suppressed ovarian androgens and overall hormonal shifts.

• Difficulty achieving orgasm — linked to changes in arousal pathways and sensitivity.

• Reduced sexual thoughts — fewer fantasies or spontaneous interest.

• Genital numbness or discomfort — often tied to vaginal dryness, reduced lubrication, and tissue changes from hypoestrogenism.

These symptoms typically emerge gradually, making them easy to overlook or dismiss by both patients and providers. The slow onset contributes to under-recognition.

Unfortunately, many healthcare providers are too busy, uncomfortable discussing sexual health in depth, or lack the training to address it effectively. Patients often carry shame or hesitation, leading to these concerns going unaddressed. The result? Strained or ruined relationships, emotional distress, and a diminished quality of life.

To change this, providers must prioritize normal sexual response principles and integrate sexual health into routine care. A sexual history should be standard in every annual exam. This builds trust, encourages openness, and creates a confidential, nonjudgmental space. Key questions to ask include:

• Are you currently sexually active? If not, why not?

• Do you have any sexual concerns, difficulties, or pain? Vaginal dryness?

• Are you satisfied with your sexual function and desire? Is your partner?

These open the door to honest dialogue.

Traditional treatments—such as testosterone supplementation, Viagra (to boost blood flow to vaginal and clitoral tissues), or creams/lubricants—often yield disappointing results. They target symptoms superficially without addressing root causes.

Patient should start improving within just a few weeks

A more comprehensive, holistic approach shows better outcomes:

1. Avoid medications and contraception options that rely on artificial hormones and shut down the pituitary-hypothalamus-ovarian axis. These directly impair sexual health by suppressing natural cycles and hormone production.

2. Restore innate natural hormone balance through testing (e.g., hormone level panels) and symptom-guided feedback. Monitor estradiol, progesterone, testosterone, and others to guide adjustments toward physiologic levels.

3. Guide inter-couple communication with practical techniques. Encourage first-person verbal expressions to foster intimacy, such as:

   • "I feel disconnected when we don't touch like we used to—can we try holding each other more?"

   • "I'm noticing my desire is low right now, and it makes me sad; I want us to work on this together."

   • "I love when you initiate gently—it helps me feel desired." Promote awareness of moods, energy levels, and intentional scheduling for connection (e.g., date nights or dedicated time without distractions).

4. Eliminate energy drainers ("energy rubbers") that compound the issue: poor sleep, chronic stress, suboptimal diet, lack of exercise, and insufficient "me time" for self-care and recharge.

With this approach, recuperation often begins within a few weeks. Patients typically report significant improvements: more frequent sexual thoughts, renewed libido and desire, better stamina, increased orgasm frequency and intensity. Beyond the bedroom, many experience a revitalized relationship—deeper emotional intimacy, better communication, and overall vitality.

Conclusion

Sexual health issues deserve attention, empathy, and proactive management. By moving beyond quick-fix traditional treatments to a patient-centered, holistic strategy—one that respects natural hormone dynamics, fosters open communication, and eliminates lifestyle barriers—we can help restore not just sexual function but a fuller, more vibrant quality of life. It's time to normalize discussing sex in clinical settings. Everyone deserves the chance to enjoy a fulfilling sexual life without shame or dismissal. If you're experiencing these challenges, know you're not alone—and effective, compassionate help is available.