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No Sex in the City

  • Paul E. Evans MD

Lack of sexual desire is a common problem in many relationships.

Forty three percent of women report problems with sexual dysfunction, decreased desire being the most common complaint. Decreased libido is reported in more than half of postmenopausal women and in one-quarter of premenopausal women.
What are the factors that cause decreased sexual desire?

  • Psychological/social factors include things that many encounter from time to time in our present society. These include chronic stress, fatigue, depression, lack of privacy/intimacy, neglect, history of sexual abuse, body image, performance anxiety, and anxiety about the risk of unintended pregnancy.
  • Physical factors include medical conditions such as hypothyroid, low testosterone, side effects of medications, fitness (underweight or overweight), smoking, anemia, alcohol abuse, drug abuse, menopause, painful intercourse (dyspareunia), vaginal dryness, and sleep deprivation, to name a few.

What can one do to overcome a lack of sexual desire?

  • Revitalize ones relationship
    Reenergize your relationship by devoting time and energy back into activities that enhance intimacy. This can be done by bringing the best out in your partner or seeking counseling to resolve deep-seated conflicts; Re-establish spontaneity and communication in your time together; help fill your partners needs; do things that you both like to do together.
  • Becoming more fit
    Being physically active (20-30min of yoga or aerobic exercise etc.) can reduce fatigue, stress, depression, improve body image, increase endorphins, relax ones mind and body, and yes increase libido. Dietary changes can improve hormone balance, feelings of wellbeing and increase libido.
  • Individualizing hormone therapy
      1. Does testosterone improve sex drive? 
        Debate persists over the effect of testosterone and libido, however in post-menopausal women testosterone has been shown to have a modest improvement on sex drive. However, There are limitations in available products for women. Compounded creams may be used but are not FDA approved because of concerns about cardiovascular health.
      2. Does estrogen increase sex drive?
      3. Estrogen is not directly linked to sex drive but deficiency can lead to vaginal atrophy and dryness and painful coitus. Estrogen replacement and vaginal cream can resolve these issues.
    1. Do Oral Contraceptives (OCPs) have an effect on sex drive?
      There has been a long debate over the effect of oral contraceptives on libido. Theoretically OCPs can decrease available testosterone and in turn decrease libido, yet studies have not consistently supported this effect. Some women have increased libido on OCPs because they are worried less about unintended pregnancy.
    2. Melatonin may have effect yet it primarily improves sleep with a possible affect on circadian rhythm and hormone balance.

Everyone desires a great sex life that promotes healthy relationships and wellbeing.

Decrease sex drive has a plethora of causes requiring an individualized approach. Call us today to set up a consultation with a doctor to help find the best approach for you!