While a change in your interest and desire for sex may signal a medical problem or side effect, it’s not considered a red flag. If you consider your libido levels too low, or too high, treatments are available.
While a change in your interest and desire for sex may signal a medical problem or side effect, it’s not considered a red flag. If you consider your libido levels too low, or too high, treatments are available.
How do you define or describe your sex drive? Also known as libido, sex drive is a nonclinical term that means enthusiasm or interest in sexual activity, either with a partner or by yourself. The presence of it (or lack thereof) can indicate the state of your mental and physical functioning.
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To get a sense of the factors involved, as well as an idea of where you may fall on the continuum, check out the Decreased Sexual Desire Screener. Keep in mind that sexual desire ebbs and flows naturally. What is going on today may not be going on tomorrow.
Factors That Can Contribute to Sexual Desire, or the Lack of Sexual Desire
What controls the sex drive is actually a very complex intertwining of biological, psychological, and social-cultural influences. “All of that comes together to create the sex drive. Some of it is not well understood, but we do know that certain ducks have to be in a row,” says Sharon J. Parish, MD, professor of medicine in clinical psychiatry and clinical medicine at Weill Cornell Medical College in New York City. Libido levels can be affected by:
- Abuse of alcohol and drugs
- Anxiety, stress, and depression
- Disease
- Fatigue level
- History of sexual abuse
- Life circumstances
- Medication
- Menopause
- Quality and novelty of relationship
- Religious mandates
- Sensory stimuli
What Is Normal Sex Drive? And Is There a 'Normal' Level?
There are diagnostic conditions of hypoactive (low) libido and hyperactive (high) libido. But in general, libido levels (high or low) are only a problem if they are a problem for you or your partner. “If a couple agrees on once or twice a month or once or twice a week, and that works for them, that’s fine. Even if there is a discrepancy where interests are different, it’s not necessarily pathological. I would only be concerned as a doctor if there has been a sudden change from their own normal,” says Dr. Parish.
What to Do When Your Mojo Goes Missing: Treating Low Sex Drive
- Go to your internist or primary care doctor for a medical workup. Many diseases, including diabetes, thyroid problems, cancer, and cardiac problems, as well as disease treatments, such as radiation for cancer, can lead to low desire. Depending on what is found, your doctor may refer you to a specialist.
- To rule out drug side effects, discuss with your physician any medication, supplements, or herbs you're currently taking. Some can have a depressing effect on sex drive; but perhaps your doctor can find an alternative. For example, selective serotonin reuptake inhibitors (SSRIs), antidepressants such as Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), and Zoloft (sertraline), have been shown to reduce libido. But a study published in February 2015 in the journal Obstectrics & Gynecology suggested that a different type of antidepressant, named Wellbutrin (bupropion), can treat depression without negatively affecting sexual desire (1). Other drugs that can put a cramp in your sexual style are beta-blockers and antihistamines, and for women only, birth control pills.
- Ask about libido-enhancing medication. Addyi (flibanserin) is the first FDA-approved product that works on premenopausal women. “I have had good response to Addyi in my patients. It won’t give you a sex drive of a 15-year-old boy, but it will make you more receptive. I tend to use it in premenopausal women but I do use it off label with postmenopausal, and it seems to work," says Becky K. Lynn, MD, assistant professor of obstetrics and gynecology at Saint Louis University in Missouri.
- Men with erectile dysfunction may benefit from Viagra (sildenafil citrate).
Hormone Therapies That May Help You Find Your Sex Drive
Testosterone Replacement Therapy
When the levels of the steroid hormone testosterone go down in either gender, so can libido. It’s a normal part of the aging process, but decline in testosterone can be related to surgical menopause and removal of the ovaries, as well as other medical conditions. You doctor can determine through a blood test if this has happened to you. Unlike menopause, where the clinical consequences of estrogen deficiency is known, the clinical consequences of testosterone level decline is not well established.
Treatment options may include:
For Men
A topical testosterone gel or cream (AndroGel, Testim) may be used, or a testosterone transdermal system patch ( Androderm ) can be applied once a day to mimic the daily secretion of testosterone. Another option is an injection of testosterone cypionate, which patients can learn to give themselves at home.
The newest product available is a testosterone pellet, Testopel, that’s placed by a physician underneath the skin of the buttock under local anesthesia. It offers a time-released dosage of testosterone over three to six months. Oral forms of testosterone aren’t yet available in the United States, but some are under development.
For Women
The Food and Drug Administration (FDA) hasn’t approved testosterone supplements as a treatment for women with low libido, but there is substantial research supporting its efficacy in women, including a study published in the New England Journal of Medicine. “Clinicians sometimes prescribe the gel or patch to women as an off-label use. As in men, the adverse effects of testosterone therapy can be minimized with proper dosing and following blood levels,” says Parish.
Tuesday, October 13, 2020