The Lowdown on Libido

Once upon a time, you may have felt sexual desire hit with the force of a tsunami—no mistaking the intensity of that jump-your-bones drive. These days, it passes like a gentle drizzle. If it comes at all.

Meanwhile, back at the doctor’s office, one of the most frequent questions this gynecologist hears (and I would agree) is: What happened to my sex drive?

Loss of libido is common. The numbers are all over the map, and I’m not sure that they’re particularly helpful anyway, but many women—and men, too—experience a loss of sexual desire. And this state of affairs can stir up a lot of consternation and unhappiness in the bedroom and beyond.

Lack of sexual desire has a couple of dry, scientific names: hyposexual desire disorder (HSDD) or hypoactive sexual interest and arousal disorder (this one, HSIAD, is relatively new, coined in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM]; can you imagine the discussion at the recent FDA forum?). Despite studies exploring its frequency, causes, and symptoms, no pharmaceutical silver bullet has been found to fix it—yet. And, believe me, having tasted the commercial success of erectile dysfunction drugs like Viagra, pharmaceutical companies are extremely keen on finding a similar blockbuster drug for women.

Loss of libido all by itself isn’t the problem—exactly. If you are content to let your sexual self recede with your youth, and this isn’t disturbing to you or anyone else, then by definition you don’t have HSDD/HSIAD.

If, however, loss of libido is distressing to you or to your partner; if you want to continue enjoying sex with your partner and you mourn the loss of your old sexy self, then you have a problem. According to medical diagnostic manuals, in order to meet the criteria for HSDD/HSIAD, you not only have to lack desire for any form of sexual activity, but this also must cause you or your partner “personal distress and/or interpersonal difficulties.”

Loss of sexual desire is a tough nut to crack. There’s no “on” switch for libido; there’s no one-size-fits-all therapy; there’s no FDA-approved drug. So rather than searching for a quick fix for a waning libido, you may have to take a patient, holistic, experimental, long-distance view of the situation. You (and your partner) may have to adjust your expectations: sex can still be close and satisfying, but it may be different.

Additionally, you may have to take a clear-eyed assessment of your overall health and lifestyle because, like so many things, sexual response doesn’t happen in a vacuum. It’s intimately connected with other parts of your physical and psychological health.

With this in mind, loss of libido can be affected by:

• Loss of hormones—the loss of both estrogen associated with menopause and testosterone associated with aging. Low libido is a frequent complaint of post-menopausal women and those with surgically induced menopause due to removal of ovaries.
• Some medications, for cancer and depression, for example, are known to depress libido, as are some recreational drugs.
• Some illnesses, such as diabetes and kidney disease, can disrupt hormone levels and damage nerves in the genital area.
• Relationship problems. If you have a rocky relationship with your sexual partner, disinterest in sex is a likely side-effect. Stir in some menopausal changes and you have a discouraging environment for sex.
• Stress and anxiety. Financial worries, career challenges, family problems. It’s hard to feel open to sex with major life issues on the brain.
• Abuse, whether physical, sexual, or emotional, especially if the abuse is still ongoing.
• Obesity, which for the women I meet in my practice has most effect on self-image.

We’ve mentioned before that good sex is good for your health. So, how does losing your libido impact health and well-being? A 2009 study conducted by a team of researchers at University of North Carolina at Chapel Hill sought to answer those questions.

In a survey of almost 2000 women, the researchers found that women with HSDD/HSIAD were more likely to be depressed and dissatisfied with their home lives and their partners, and that they were more likely to have other health issues, like heart disease and thyroid problems. In fact, the effect of HSDD/HSIAD on quality of life measures was comparable to that of other chronic health conditions, such as back pain or arthritis.

Ouch.

So what’s to be done with a case of lost libido? How do you begin to tackle this very real and very frustrating condition?

Fortunately, there’s a lot you can do, from lifestyle changes, like exercising and losing weight, to pharmaceutical regimens, which, while limited, might include estrogen replacement or using testosterone off-label. And while you may have to experiment, in the end, you can be every bit as intimate, sexy, and feminine as ever.

I’ll dig into those details in a future post. In the meantime, your recommended reading is my new book, Yes You Can: Dr. Barb’s Recipe for Lifelong Intimacy. Because that’s what we’re all about here—believing that we can.