Libido: Opioid Induced Female Sexual Dysfunction

Reviewed By: Pramod Kerkar, MD, FFARCSI

What Is Libido Or Female Sexual Dysfunction?

Libido or Female Sexual Dysfunction Means-

  • Low Sexual Desire
  • Lack of Sexual Drive
  • Difficulties To Achieve Orgasm
  • Menstrual Disorder

What Is Libido?

Libido is a medical term used to describe sexual drive or desire. Libido or sexual drive is influenced by biological, psychological and emotional changes.

What Causes Libido or Female Sexual Dysfunction?

What Causes Libido or Female Sexual Dysfunction?

Diseases or Biological Causes of Libido or Female Sexual Dysfunction Are:

  • Opioid Induced Hypogonadism
  • Anemia
  • Diabetes
  • Chronic pelvic pain during intercourse
  • Chronic generalized pain

Which Psychological and Emotional Disturbances Cause Libido or Female Sexual Dysfunction?

Psychological Causes of Libido or Female Sexual Dysfunction Are:

  • Depression
  • Anxiety

Emotional Causes of Libido or Female Sexual Dysfunction Are-

  • Stress
  • Fatigue
  • Distraction

What is Hypogonadism?

Hypogonadism is a term used to describe low (hypo) gonadal hormone. Testes in men and ovaries in women secrete gonadal hormones such as testosterone. In hypogonadism, testosterone secretion is low because of lower blood level of Luteinizing hormone (LH). Luteinizing hormone stimulates the ovaries and testes to secrete testosterone.

What is Opioid Induced Hypogonadism Causing Libido or Female Sexual Dysfunction?

Opioid induced libido or female sexual dysfunction is secondary to low testosterone level in blood. Opioid inhibits secretion of Luteinizing hormone (LH) by pituitary gland. Decreased secretion of LH results in low testosterone secretion by ovaries. LH stimulates ovaries and testicles to secrete testosterone. Opioid induced lower testosterone is one of the major causes of libido and female sexual dysfunction.

What is a Luteinizing Hormone?

Luteinizing Hormone is a hormone produced by anterior pituitary gland.2

Is Libido or Female Sexual Dysfunction Common Among Patients Taking Opioid?

Yes, opioid causes hypogonadism and results in low libido and low sexual desire. Female patient suffering with chronic pain and taking opioids for chronic pain suffer with sexual dysfunction. Symptoms of libido or female sexual dysfunction are more often seen with long-acting opioid medications. Number of patients receiving opioids for chronic pain has increased since chronic pain is being aggressively treated since 1990.1

Which Pelvic Diseases Causing Pain Results in Libido or Female Sexual Dysfunction?

Following is the list of pelvic diseases that can cause libido or female sexual dysfunction:

  • Inflammatory Pelvic Disease-Endometriosis, Vaginitis, and Urethritis.
  • Cancer Disease - Cancer of Uterus, Ovaries and Vagina.
  • Chronic Sympathetic Pelvic Pain Syndrome.
  • Radiation Treatment of Vaginal or Uterine Cancer.
  • Pelvic Surgery.

What Kind Of Biological Changes Influences Libido?

  • Hypogonadism - Low testosterone level is a biological change, which may decrease sexual desire.
  • Pain - Pelvic Pain.
  • Generalized Pain - Secondary to surgery, trauma, fracture and arthritis.

What are the Associated Symptoms of Libido or Female Sexual Dysfunction?

  • Weight Gain
  • Fatigue
  • Depression
  • Menstrual Cycle Disturbances

Does Treating Physician Screen Opioid Inducing Libido Routinely?

Not really, most of the patients taking opioids may not disclose the sexual behavior to physician prescribing pain medications.

Is There a Screening or Diagnostic Test for Libido or Female Sexual Dysfunction?

Screening of libido or sexual disorder involves detailed history of sexual function and lab studies. Routine screening of gonadal function is essential once patients start consuming morphine or other opioids of equivalent dose over 100 mg of morphine.3 Laboratory study includes checking specific age range serum testosterone level. If testosterone level is low then screening for serum prolactin and Luteinizing hormone (LH) level to rule out pituitary disease is necessary. Normal prolactin and low Luteinizing hormone (LH) level suggest diagnosis of hypogonadism.

How Is Libido Or Female Sexual Dysfunction Treated?

Treatment For Libido or Female Sexual Dysfunction Caused By Depression - If libido is secondary to depression then depression should be treated with antidepressants.

Libido or Female Sexual Dysfunction Caused by Antidepressant - If antidepressants such as paroxetine (Paxil, Pexeva) and fluoxetine (Prozac, Sarafem) causes libido and lower sexual drive, then these are discontinued and replaced with bupropion (Aplenzin, Wellbutrin).

Treatment For Libido or Female Sexual Dysfunction Caused by Emotional Disturbances:

Counseling - Sex education by sex therapist or counselor can help with libido caused by stress, fatigue distraction and anxiety.

Estrogen Therapy - Estrogen has positive effects on brain function and mood factors that affect sexual response.

Treatment Options For For Libido or Female Sexual Dysfunction Caused by Hypogonadism:

Estrogen Therapy - Libido is often treated with estrogen in hypogonadism.

Side Effects of estrogen can cause heart disease and breast cancer.

Prescription - Estrogen is prescribed as pills, patch or gel. Estrogen and Progesterone

Combination - Some physicians may prescribe combination of estrogen and progesterone to prevent estrogen side effects.

Testosterone - Testosterone is prescribed only when estrogen is not effective. Testosterone is produced at much lower amount in females than male. Testosterone is rarely prescribed in female for libido. FDA does not approve medical use of testosterone in female.

Side effects - Testosterone in female can cause acne, excess body hair, and mood changes.


  1. Olsen Y, Daumit GL, Ford DE. Opioid prescriptions by US primary care physicians from 1992 to 2001. J Pain. 2006;7:225-235.

  2. Mendelson JH, Ellingboe J, Kuehnie JC, et al. Heroin and naltrexone effects on pituitary gonadal hormones in man: interaction of steroid feedback effects, tolerance, and supersensitivity. J Pharmacol Exp Ther. 1980;214(3):503-506.

  3. Daniell HW. Hypogonadism in men consuming sustained-action oral opioids. J Pain. 2002 ;3:377-384.

Pramod Kerkar

Written, Edited or Reviewed By:


Pain Assist Inc.

Last Modified On: June 6, 2018

This article does not provide medical advice. See disclaimer

Sign Up for Our Newsletter

We'll help you live each day to the healthiest