Dr Arun

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June 28, 2017 News

Low sex drive in women – What is killing the sex drive?

A woman’s sexual desire naturally fluctuates over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some antidepressants and anti-seizure medications also can cause low sex drive in women.
If you have a persistent or recurrent lack of interest in sex that causes your personal distress, you may have Hypoactive Sexual Desire Disorder (HSDD)— also referred to as female sexual interest/arousal disorder.
But you don’t have to meet this medical definition to seek help. If you are bothered by a low sex drive or decreased sexual desire, there are lifestyle changes and sex techniques that may put you in the mood more often. Some medications may offer promise as well.
If you want to have sex less often than your partner does, neither one of you is necessarily outside the norm for people at your stage in life — although your differences, also known as desire discrepancy, may cause distress.
Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line: There is no magic number to define low sex drive. It varies from woman to woman.
Some signs and symptoms that may indicate a low sex drive include a woman who:
Has no interest in any type of sexual activity, including self-stimulation Doesn’t have sexual fantasies or thoughts, or only seldom has them Is bothered by her lack of sexual activity or fantasies
A Silent Growing epidemic
The American Medical Association has estimated that several million US women suffer from what doctors often call Hypoactive Sexual Desire Disorder (HSDD).
However, currently there seems to be an HSDD bandwagon in North America, driven by doctors who think that nearly half the female population (43 per cent) lack sex drive. In order to be diagnosed with HSDD, women need to have low libido for at least six months and feel distressed about it.
But lack of sex drive alone isn’t a problem. While some women simply don’t want sex that often, low libido is often a temporary side effect of an external stressor, like a new baby or financial troubles.
And we’re not talking about postmenopausal women. These are women in their 20s, 30s, and 40s, who are otherwise healthy, happy, and in control of every area of their lives—except, suddenly, the bedroom.
When to see a doctor
If you’re bothered by your low desire for sex, talk to your doctor. The solution could be as simple as changing the type of antidepressant you take.
A woman’s desire for sex is based on a complex interaction of many components affecting intimacy, including physical well-being, emotional well-being, experiences, beliefs, lifestyle and current relationship. If you’re experiencing a problem in any of these areas, it can affect your sexual desire.
Physical causes
A wide range of illnesses, physical changes and medications can cause a low sex drive, including:
Sexual problems: If you experience pain during sex or an inability to orgasm, it can hamper your desire for sex.

Medical diseases: Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.

Medications: Many prescription medications — including some antidepressants and anti- seizure medications — are notorious libido killers.

Lifestyle habits: A glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive; the same is true of street drugs. And smoking decreases blood flow, which may dampen arousal.

Surgery: Any surgery, especially one related to your breasts or your genital tract, can affect your body image, sexual function and desire for sex.
Fatigue: Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a low sex drive.

Hormone changes

Changes in your hormone levels may alter your desire for sex. This can occur during:

Menopause: Oestrogen levels drop during the transition to menopause. This can cause decreased interest in sex and dryer vaginal tissues, resulting in painful or uncomfortable sex. Although many women continue to have satisfying sex during menopause and beyond, some women experience a lagging libido during this hormonal change.

Pregnancy and breast-feeding.:Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sexual desire. Of course, hormones aren’t the only factor affecting intimacy during these times. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby can all contribute to changes in your sexual desire.

Psychological causes

Your problems don’t have to be physical or biological to be real. There are many psychological causes of low sex drive, including:

Mental health problems, such as anxiety or depression Stress, such as financial stress or work stress
Poor body image
Low self-esteem

History of physical or sexual abuse Previous negative sexual experiences

Relationship issues

For many women, emotional closeness is an essential prelude to sexual intimacy. So, problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of ongoing issues, such as:

Lack of connection with your partner
Unresolved conflicts or fights
Poor communication of sexual needs and preferences Infidelity or breach of trust

Primary care doctors and gynaecologists often ask about sex and intimacy as part of a routine medical visit. Take this opportunity to be candid about your sexual concerns.

If your doctor doesn’t broach the subject, bring it up. You may feel embarrassed to talk about sex with your doctor, but this topic is perfectly appropriate. In fact, your sexual satisfaction is a vital part of your overall health and well-being.

What you can do

To prepare for this discussion with your doctor:

Take note of any sexual problems you’re experiencing, including when and how often you usually experience them.

Make a list of your key medical information, including any conditions for which you’re being treated, and the names of all medications, vitamins or supplements you’re taking.

Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.

Questions your doctor may ask:

Your doctor will ask Screening questions based upon the tool –
Decreased Sexual Desire Screener (DSDS)
1. In the past, was your level of sexual desire or interest good and satisfying to you?
2. Has there been a decrease in your level of sexual desire or interest?
3. Are you bothered by your decreased level of sexual desire or interest?
4. Would you like your level of sexual desire or interest to increase?
5. Please circle all the factors that you feel may be contributing to your current decrease in sexual desire or interest:

A. An operation, depression, injuries, or other medical condition

B. Medications, drugs, or alcohol you are currently taking

C. Pregnancy, recent childbirth, menopausal symptoms

D. Other sexual issues you may be having (pain, decreased arousal or orgasm)

E. Your partner’s sexual problems

F. Dissatisfaction with your relationship or partner

G. Stress or fatigue

By definition, you may be diagnosed with hypoactive sexual desire disorder – if you frequently lack sexual thoughts or desire, and the absence of these feelings causes your personal distress. Whether you fit this medical diagnosis or not, your doctor can look for reasons that your sexual desire isn’t as high as you’d like and find ways to help.

In addition to asking you questions about your medical history, your doctor may also:
Perform a pelvic exam. During a pelvic exam, your doctor can check for signs of physical changes contributing to low sexual desire, such as thinning of your genital tissues, vaginal dryness or pain-triggering spots.

Recommend testing: Your doctor may order blood tests to check hormone levels and look for evidence of thyroid problems, diabetes, high cholesterol and liver disorders.
Refer you to a specialist. A specialist may be able to better evaluate emotional and relationship factors that can cause low sexual desire.

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counselling and sometimes medication.

Counselling

Talking with a sex therapist or counsellor skilled in addressing sexual concerns can help with low sexual desire. Therapy often includes education about sexual response and techniques and recommendations for reading materials or couples’ exercises. Couples counselling that addresses relationship issues may also help increase feelings of intimacy and desire.

Medication review
Your specialist will want to evaluate the medications you’re already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as paroxetine (Paxil, Pexeva) and fluoxetine (Prozac, Sarafem) may lower sex drive. Adding or switching to bupropion (Aplenzin, Wellbutrin) — a different type of antidepressant — usually improves sex drive.

Hormone therapy
Oestrogen delivered throughout your whole body (systemic) by pill, patch, spray or gel can have a positive effect on brain function and mood factors that affect sexual response. But systemic oestrogen therapy may have risks for certain women.

Smaller doses of oestrogen — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire without the risks associated with systemic oestrogen. In some cases, your doctor may prescribe a combination of oestrogen and progesterone.
Testosterone

Hormones are often suggested as a treatment for HSDD, particularly the male sex hormone testosterone.

Doctors have been trying out testosterone on women for more than 40 years, rarely with much benefit. Possible side-effects include hairiness, spots, a deep voice and enlargement of the clitoris. However, there is some clinical evidence to support the use of testosterone as a treatment for low sexual desire.

In 2007 a testosterone skin patch called Intrinsa became available in the UK and a modest number of women used it. But at the end of 2012, it was withdrawn by the manufacturers, apparently for commercial reasons.

However, there are currently several other testosterone preparations available, though it may be difficult to find a doctor who is willing to prescribe them for a woman.

Flibanserin (Addyi)

Originally developed as an antidepressant, Flibanserin (Addyi) is a prescription medication approved by the Food and Drug Administration as a treatment for low sexual desire in premenopausal women. However, this is not currently available in Australia.

A daily pill, Addyi may boost sex drive in women who experience low sexual desire and who find the experience distressing. Potentially serious side effects include low blood pressure, dizziness and fainting, particularly if the drug is mixed with alcohol. Experts recommend that you stop taking the drug if you don’t notice an improvement in your sex drive after eight weeks.

Healthy lifestyle changes can make a big difference in your desire for sex:
Exercise. Regular aerobic exercise and strength training can increase your stamina, improve your body image, elevate your mood and boost your libido.

Stress less. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive.

Communicate with your partner. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex. Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy.

Set aside time for intimacy. Scheduling sex into your calendar may seem contrived and boring. But making intimacy a priority can help put your sex drive back on track.

Add a little spice to your sex life. Try a different sexual position, a different time of day or a different location for sex. Ask your partner to spend more time on foreplay. If you and your partner are open to experimentation, sex toys and fantasy can help rekindle your sexual sizzle.

Ditch bad habits. Smoking, illegal drugs and excess alcohol can all dampen sexual desire. Ditching these bad habits may help rev up your sexual desire as well as improve your overall health.

Low sexual desire can be very difficult for you and your partner. It’s natural to feel frustrated or sad if you aren’t able to be as sexy and romantic as you want — or you used to be.

At the same time, low sexual desire can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex.

It may help to remember that fluctuations in your sexual desire are a normal part of every relationship and every stage of life. Try not to focus all of your attention on sex. Instead, spend some time nurturing yourself and your relationship.

Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favourite restaurant. Feeling good about yourself and your partner can actually be the best foreplay.

For further enquiries, please contact

Dr. A S Arun MD DNB CCST, FRCOG, FRANZCOG

Waikiki Specialist Centre
221 Wilmott Drive
Waikiki 6169
WA
Tel: 08 95500300
Fax: 08 95929830
Email: specialists@waikikiprivatehospital.com
Website: www.doctorarun.com.au

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