What Your Libido Says About Your Health
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.
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 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 or chronic medical conditions
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, can lead to low desire.
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) — including antidepressants such as citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft) — have been shown to reduce libido. But a 2015 study suggested that bupropion (Wellbutrin) 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. Flibanserin (Addyi) is the first FDA-approved product that works on premenopausal women. “I have had good response to Addyi in my patients,” says Becky K. Lynn, MD, adjunct assistant professor of obstetrics and gynecology at Saint Louis University in Missouri. “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 post-menopausal women, and it seems to work.”
Men with erectile dysfunction may benefit from sildenafil citrate (Viagra).
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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. 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 or testosterone enanthate, 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. An oral form of testosterone, Jatenzo, is also now approved for use in the United States.
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.
Relationship Problems: Causes and Solutions
“Many times, the problem is simply that the couple is bored. There is no novelty, which is the kiss of death to human sexuality,” says Lou Paget, a sex educator certified with the American Association of Sexuality Educators, Counselors, and Therapists and author of The Great Lover Playbook.
Other problems include lack of communication, trust, and intimacy, pent-up resentment, and body insecurity.
Most of these problems can be dealt with through honest face-to-face conversation when you’re vertical — not horizontal. Why? Because when you’re horizontal you often have heat of the moment involved. These conversations may include comments like “This is what I’d like to try, this is how I feel”; or they may be part of counseling with a trained sex therapist, in which you will explore emotional issues that may contribute to sexual dysfunction through cognitive behavioral therapy or mindfulness therapy.
Lifestyle and General Health Factors Behind Sex Drive
These are what Parish calls “modifiable risk factors.” If you aren’t getting enough sleep or exercise, if you never have privacy, or if you aren’t making your relationship a priority, your sex drive is going to take a hit. Also, do you drink or smoke too much? If you can’t work these issues out with your partner, a licensed therapist can help.
A Complementary and Alternative Medicine (CAM) Approach to Sex Drive
Some people find success by taking a complementary approach using herbal supplements. Just be sure you don’t add any supplements, vitamins, or herbs without talking to your physician first, since some can interact with your medication.
