For some, having a low libido, or a reduced or absent sex drive is a delicate, embarrassing problem — especially for those in a long-term relationship or actively looking for a new relationship. For others, it’s a non-issue.
Summit Health gynecologist Susan Roth Pitman, MD, encourages patients to talk openly about their sex lives with their provider, whether it be a specialist or primary care physician. These conversations take place in a safe, confidential space without judgment. Since the causes of low libido are varied, an honest conversation can help the practitioner identify the best way to help the patient move forward. Read more about low libido and how to navigate the condition that affects most men and women at some point in their lives.
Learning about low libido
Libido is “the interest and desire to participate in sexual activity,” explains Andrew Siegel, MD, a urologist at Summit Health. “Libido, simply defined, is one’s sex drive.”
What causes low libido?
The causes of low libido range from mechanical to hormonal and psychological. Similar issues affect cisgender and transgender men and women alike, regardless of sexual identity. They include:
- Physical problems with sexual organs, such as erectile dysfunction, vaginismus (an involuntary tensing of the vaginal muscles), vulvodynia (chronic pain around the vulva and/or vagina), interstitial cystitis (a chronic condition that causes bladder pressure and pain), retroverted uterus (a condition in which the uterus is tipped backward), and uterine fibroids (benign growths that develop in the uterus).
- Undiagnosed, underlying health issues
- Medication side effects, especially from antidepressants
- Hormonal changes
- Relationship issues
- Chronic illness
- Body image/dysmorphia
- Upbringing/religious views
Dr. Pitman notes that libido can diminish because of one's hectic schedule. “Conversations with my younger patients who have children and are usually working full-time, as are their spouses, go something like this: ‘Who does the laundry, the cooking, the cleaning, and bathing the children?’ The more ‘I do’s I get, the clearer the picture becomes,” she says. “A tired woman will most often choose sleep over sex.”
As for men, Dr. Siegel says low libido is “sometimes secondary to erection issues. Because of poor performance, one loses interest — it’s analogous to when your favorite sport's team is in last place, and you lose the desire to watch them.”
Low libido treatment
To treat low libido in men, Dr. Siegel says, “It’s important to get to the root cause of the problem, and a medical examination and lab testing — particularly serum testosterone that measures the amount of male hormone in the blood — is imperative.”
Causes and treatments may include:
- If low testosterone is the cause, Dr. Siegel might recommend testosterone replacement therapy.
- For men with erectile dysfunction, he would advise lifestyle changes and erectile dysfunction medications. If these fail, there are also alternative measures to treat erectile dysfunction.
- When marital, relationship, emotional, or psychological issues are the basis for the issue, patients are often referred to a counselor.
- If another health problem reveals itself, such as sleep apnea, Dr. Siegel will also refer the patient to a specialist.
The cause of low libido is generally multifactorial. Since there is no libido-boosting medication for women that is like Viagra or Cialis for men, Dr. Pitman encourages approaches that build or improve relationships. These include recognizing the importance of intimacy and romance without the expectation of intercourse.
“I think affection and non-sexual contact like holding hands is very important in a healthy relationship. Everyone wants to be respected and appreciated,” she says. “Communication can help boost libido. Hugging silently can help boost this aspect and enhance relationships.”
She also encourages patients with low libido to try to remember what it was like when they were interested, to build “a rich fantasy life,” and to share it with a partner if possible. While hormone replacement therapy helps “improve vasomotor symptoms, sleep, and dryness issues,” she doesn’t recommend it as a solution for increasing sexual desire.
“Many with a low libido are matched by a low libido or erectile dysfunction in their partners,” she says. “I think the take-home message is that low libido is a problem if it is perceived as one.”
Summit Health can help
If you are experiencing a loss of sexual desire, have an honest conversation with your physician or schedule an appointment. Our providers are here to help and are always available to talk about your health concerns without judgment in a safe and confidential setting.