Smart Consultation Guide

Low libido in women refers to a reduced interest or desire for sexual activity, which can be temporary or persistent, and may cause distress if it affects well-being or relationships.

Possible causes include:

• Hormonal changes – pregnancy, menopause, menstrual cycle shifts.
• Medications – antidepressants, birth control, mood-affecting drugs.
• Physical health issues – chronic illness, pain during sex, fatigue.
• Psychological factors – stress, depression, anxiety, body image concerns.
• Relationship issues – lack of intimacy, poor communication, conflicts.

Many women improve with better lifestyle (sleep, exercise, diet), less stress, more emotional connection, and open communication with their partner.

Female Sexual Arousal Disorder (FSAD) means difficulty achieving or maintaining arousal even when you have desire. Anorgasmia is difficulty or inability to reach orgasm.

Can be linked to:

• Hormonal changes – menopause, pregnancy, low estrogen or testosterone.
• Reduced blood flow – cardiovascular disease, diabetes.
• Medications – antidepressants, antihistamines, some birth control pills.
• Stress, anxiety, depression, body image concerns.
• Relationship issues – lack of trust, unresolved conflicts, poor communication.
• Lifestyle – smoking, alcohol, poor sleep, fatigue.

Treatment often combines medical support (if hormones or blood flow are affected), counselling or sex therapy, and practical changes like better foreplay, relaxation, and focusing on sensations rather than “performance”.

Painful intercourse (dyspareunia) and vaginal dryness often go together. Dryness can cause pain, and repeated pain can reduce arousal and create fear or avoidance of sex.

Causes of painful intercourse include:

• Low estrogen – menopause, postpartum, breastfeeding.
• Conditions like endometriosis, pelvic inflammatory disease, fibroids, pelvic floor issues.
• Infections – yeast infections, UTIs, STIs.
• Vaginismus (involuntary tightening), scar tissue, or structural problems.
• Anxiety, past trauma, or high stress.
• Medications that reduce lubrication.

Causes of vaginal dryness include:

• Low estrogen from menopause, childbirth, breastfeeding, some contraceptives.
• Antihistamines, antidepressants, cancer therapies.
• Autoimmune conditions like Sjögren’s syndrome.
• Smoking, alcohol, dehydration, chronic stress.
• Lack of arousal or very little foreplay.

Management may involve lubricants, vaginal moisturisers, local estrogen therapy, pelvic floor physiotherapy, treating infections, and counselling when anxiety or trauma is involved.

Low libido means a drop in sexual desire that may be temporary or long-term. It can be due to physical health, mental health, lifestyle or relationship factors.

Often related to:

• Lifestyle – poor diet, lack of exercise, alcohol, smoking, poor sleep.
• Stress, anxiety, performance pressure, depression.
• Relationship conflicts or low emotional connection.
• Obesity, diabetes, heart disease, low testosterone, other illnesses.
• Side-effects of medicines.

Addressing lifestyle, managing stress, working on the relationship and getting a medical check-up if needed can all help improve desire.

ED is difficulty achieving or maintaining an erection. Occasional ED is common, but regular problems can be an early sign of heart and blood vessel disease or other medical issues.

Common physical causes:

• Heart disease, blocked arteries, high blood pressure, high cholesterol.
• Diabetes and nerve damage.
• Obesity, hormonal problems (low testosterone, thyroid issues).
• Neurological problems or injuries.
• Medications and heavy alcohol, smoking, or drugs.

Psychological causes:

• Performance anxiety and fear of failure.
• Stress at work or home.
• Depression or low mood.
• Relationship problems or low self-esteem.

Management can involve treating underlying disease, using ED medicines, changing lifestyle, and getting counselling when anxiety or relationship issues are present.

PE is ejaculation that happens too quickly, causing distress. It may have been present since the first sexual experiences (lifelong) or can develop later (acquired).

Psychological causes:

• Performance anxiety and pressure to “perform well”.
• High stress or depression.
• Relationship issues and poor communication.
• Conditioned behaviour (earlier habit of rushing due to fear of being caught, etc.).

Biological causes:

• Hormonal imbalance.
• Neurotransmitter differences (e.g. low serotonin).
• Genetic factors.
• Prostatitis or inflammation.
• Higher penile sensitivity.

Management may include behavioural methods (stop–start, squeeze technique), counselling or sex therapy, topical desensitising creams, and sometimes prescription medicines (SSRIs, etc.).

ED and PE frequently appear together. For example, fear of losing erection can make a man rush, which then leads to PE.

Shared physical causes:

• Low testosterone or other hormonal issues.
• Diabetes, heart disease, poor circulation.
• Neurological problems, spinal injury.
• Prostatitis or other pelvic conditions.

Shared psychological causes:

• High performance anxiety and fear of failure.
• Stress, depression, low self-esteem.
• Relationship tension and poor communication.

Treatment usually needs a combined medical and psychological approach – managing heart and metabolic health, using ED/PE medicines when needed, plus counselling / sex therapy and lifestyle changes.