What can help women increase their libido?

Transdermal testosterone (applied through the skin, so not as a pill) has the strongest evidence base. A meta-analysis of 36 randomised trials involving more than 8,000 postmenopausal women with low sexual desire showed that the treatment leads to significantly more satisfying sexual experiences, increases desire and arousal, and reduces sexual distress. An important detail: only the through-the-skin variant. A testosterone pill has unfavourable effects on cholesterol (more LDL, less HDL), whereas the patch or gel does not. Too little is still known about the long-term safety of testosterone in women, and acne and excess hair growth occur more frequently.

For women who have not yet reached menopause, there is flibanserin, a well-documented medication that improves sexual desire. It is approved in the United States for premenopausal women with low desire, but is not on the market in most other countries (including the Netherlands). Bremelanotide is another approved treatment, used as a self-administered option before sex, that improves both desire and arousal. Neither medication is routinely available at Dutch pharmacies.

Mindfulness-based cognitive behavioural therapy is the psychological approach with the most evidence behind it. Multiple studies show improvements in desire, arousal, and orgasm. Brain research suggests why it may help: women with low sexual desire appear to have greater activity in areas of the brain involved in self-criticism and self-evaluation. Therapy focused on mindfulness may break through that inhibition, although this is mechanistic research and not yet proof that the therapy specifically derives its effect from that pathway.

Herbal remedies and so-called natural aphrodisiacs, such as yohimbine or ginseng, have not demonstrated convincing efficacy in women. The available data are sparse and not compelling enough to base a recommendation on.