Female sexual health can be influenced by foundational lifestyle factors such as stress management, exercise, sleep and mental health. However, there are several notable factors unique to women that can influence sex drive and overall sexual function. 

Urologist and pelvic medicine expert Dr. Rena Malik, M.D., highlighted the phases of female sexual response: excitement, plateau and orgasm. Each phase involves physiological changes, like increased heart rate, heightened physical sensations and pelvic floor muscle contractions. Prolactin is the hormone responsible for setting the refractory period after sexual activity, which calms the nervous system and promotes relaxation.

Psychological and emotional factors play a significant role in women’s sexual health and libido. Medications such as some antidepressants are known to have side effects like low libido — however, depression, anxiety or chronic stress themselves are correlated with lower energy levels, self-esteem, sexual desire and sexual satisfaction. It’s important to note that libido does not have a standard measurement, as it fluctuates based on age, life circumstances and personal preferences.

Female fertility largely revolves around the menstrual cycle and corresponding levels of estrogen and progesterone, which prepare the ovary for ovulation and the uterine lining for possible implantation. There are a number of risk factors for infertility including age, weight, chromosomal abnormalities, lifestyle choices (including alcohol and cannabis use) and underlying health issues. The impact of age on fertility is more critical for women due to the age-related decline in egg quality and increased risk of chromosomal issues and miscarriage. Conditions like endometriosis, fibroids, polycystic ovary syndrome (PCOS) and premature menopause can also make it difficult to become or stay pregnant. 

Infertility treatment options can include taking prescribed hormones such as follicle-stimulating hormone and luteinizing hormone, in vitro fertilization (IVF) and freezing eggs at a younger age (ideally early 30s) for future use. It’s important to consider fertility not just when trying to conceive, but also as an indicator of reproductive, hormone and metabolic health — to better understand your body and overall health.

Female hormone health is intricately connected to sexual health, primarily through the roles of estrogen, progesterone and testosterone. Estrogen fluctuates across the menstrual cycle to prepare the body for potential conception by increasing libido and aiding in the release of eggs. Progesterone is crucial for preparing and maintaining the uterine lining for implantation and triggering the shedding of the uterine lining (menstruation) if pregnancy does not occur. Both estrogen and progesterone influence mood and cognitive function by influencing other neurotransmitters like dopamine and serotonin. Additionally, testosterone is crucial for sexual arousal in both men and women, and women actually have higher levels of testosterone than estrogen. 

Hormonal contraception, including oral contraceptives (birth control pills), can offer benefits for managing medical conditions like PCOS and endometriosis but can also negatively impact mood and emotions. The physiological response to contraceptives is highly individual, and some women may tolerate them well while others may not. On the podcast, board-certified OB/GYN Dr. Mary Claire Haver, M.D., discussed the broader aspects of women’s hormone health, particularly the underfunding of research and health care for menopause and other female-specific health conditions.