The Decreased Libido: WhY Your Sex Drive is Low

Decreased libido. It's a common complaint.

The first thing I always ask my patients who complain of low sex drive is if they have sexual dreams or fantasies. If they do, then they may be experiencing a relationship problem and family therapy may be the answer.

However, if they say they have decreased or absent sexual dreams and fantasies, then a low testosterone level may be the problem, a common issue in women 40 and above. There's an easy way to find out if you fit into this category. Simply get a blood test from your doc who can test your level of testosterone. And, if it's on the low side, ask about testosterone supplementation.

Why Does the Libido Wane?
Your sex drive depends on estrogen and testosterone. At menopause, the ovaries slow in their production of the three major sex hormones: estrogen, progesterone and testosterone and after menopause, the lower levels of hormones produced by the ovaries may not be enough to support the sex life you and your hubby have been used to.

In addition, depression is more common at midlife. One of the hallmark symptoms of depression is loss of interest in sex. Other tell tale signs are sleeping too much or not enough and a loss of appetite. If that sounds familiar, you may be making it through a midlife depression.

Many drugs can also cause decreased libido. Antidepressants and painkillers are two of the worst offenders. If you're suffering from a mild depression, ask your doctor to try St. John's Wart, an herb that has antidepressant properties, rather than having a prescription filled. One study found the herb ginko decreased the sexual side effects caused by antidepressant drugs.

Is Viagra for Women the Answer?
Viagra has FDA approval for the treatment of sexual impotence in men only and ever since hitting the market in 1998, the little blue pill has seen unprecedented success. Even at $10 a tablet, men are lining up at their doctors' offices for prescriptions. But what about the millions of perimenopausal women with sexual dysfunction? Dr. Steven of Columbia University published the first study of Viagra in women. The women took 50 mg of Viagra one hour before intercourse. Only seven women (21 percent) noticed an improvement with Viagra. Therefore, it seems Viagra is only for men -- at least for now. However, there's another larger trial going on in Europe that may come to a different conclusion.

Solutions That Work
Hormone replacement therapy (HRT) is the most potent libido enhancer available. Estrogen with or without testosterone is available to peri- and postmenopausal women, yet only 30 percent of women who are prescribed HRT ever fill the prescription, and of those only 25 percent take it as prescribed for the full year until the next visit.

Another solution: fantasize. Many women have never developed adequate sexual fantasies (unlike men who usually develop enough). This may be the result of shyness, cultural expectations or even ignorance. For these women, I often recommend some respectable reading material such as "The French Lieutenant's Women" by John Fowles or "Lady Chatterley's Lover" by D.H. Lawrence.

There's also cream that enhances sex drive. It's called testosterone and is available by prescription only. This treatment will only work if you have a low sex drive -- it won't increase a normal sex drive -- so your physician may want to check the testosterone level in your blood first. If you're menopausal, testosterone is available in a pill form combined with estrogen.

Dealing With Dryness
The vaginal ring is an excellent source of estrogen for postmenopausal vaginal dryness and I haven't received any reports of chemical tastes, so there shouldn't be a problem with oral sex.

What's Up, Doc?
Make sure to bring up your intimacy concerns at the beginning of your doctor visit. It never fails that just when I turn to leave the exam room I hear, "Oh, doctor, there's just one thing. I just don't...you know...feel like doing it anymore..."

Of course, when I hear this at the end of an exam, my mind is on the next patient. So please, if your doctor doesn't ask early in the visit, make it your business to bring up the subject of sexual function. It's a complicated but important aspect of your genealogical health.

Sexual dysfunction is a hot topic in medical circles today. Driven by women's special interest groups, physicians are paying more attention to female sexual health. There are many national conferences held annually and respectable scientific journals are beginning to publish on this once-taboo subject. In addition, here are three Web sites that can help you locate a qualified sex therapist in your area.

• American Association of Sex Educators, Counselors and Therapists
• Society for the Scientific Study of Sexuality
• The Society for Sex Therapy and Research