Low libido

What is low libido?

Libido refers to sexual desire, or the drive to have sexual activity. It is also commonly called 'sex drive'. A low libido means that you have a low interest in sex and this can affect both men and women. Everybody's interest level in sex is different and there is no 'normal' level.

Causes

Libido can be affected by numerous factors. Some reasons for a reduced libido can include:

• Anxiety about previous performance;
• Psychological issues including stress, depression, anxiety or low self-esteem;
• Familiarity with sexual partner;
• Physical turn-offs caused by changes in appearance or weight gain;
• Pain during sex;
• Tiredness or fatigue;
• Previous traumatic experience including rape or sexual abuse;
• Hormone changes during menopause or pregnancy;
• Medication (such as antidepressant medication), alcohol or drugs;
• Illnesses (e.g. diabetes and thyroid disorders, heart disease, cancer), and;
• A deficiency in male hormones, known as androgens (e.g. testosterone).

Methods for diagnosis

Low libido is defined as having limited sexual desire that, most importantly, is causing distress. A key to diagnosing low libido is determining how you and your partner feel about sexual desires. Some couples are not bothered by a lessened sex drive, while others are not happy if they believe they are not having a healthy sexual relationship. Diagnosis is therefore relative; if it is not causing any relationship problems, it may not be anything to worry about.

To help diagnose low libido, your doctor may give you a series of blood tests to rule out various physical causes of loss of libido including deficiency in certain hormones. The doctor may also explore relationship issues and depression.

Types of treatment

Low libido is treated by identifying and addressing the cause. It is important to note that libido levels can naturally vary while you are in relationships and as you age. Partner dissatisfaction is the most common reason for people seeking treatment for low libido.

General advice

• Seek medical advice from a supportive doctor;
• Manage general health issues that may cause fatigue, such as iron deficiency anemia, abnormal thyroid function (hyperthyroidism or hypothyroidism) and sleep apnea;
• Consider relationship counselling to address any relationship difficulties;
• Where depression and/or anxiety is the cause of low sexual interest, treatment of these conditions may be beneficial;
• Stress management strategies may be helpful if low libido is related to stress, and;
• A medication review can identify certain medicines, such as antidepressants, which can impair sexual responsiveness.

Specific advice

For men:

• Medication for erectile dysfunction is unlikely to treat low libido, and;
• Androgen deficiency (low testosterone), as confirmed by a blood test, can be treated with testosterone replacement therapy. Testosterone can be administered by several methods such as tablets, skin patches, injections and implants. Regular monitoring is generally required by a specialist and, given that this is a relatively new area in medicine, the opinion on when to start treatment is variable.

For women:

• Hormone replacement therapy (HRT) or tibolone (a medication with certain female sex hormone function) can be useful in postmenopausal women with low libido;
• Occasionally, some forms of oral estrogen, such as the oral contraceptive pill or HRT tablets, can lower testosterone levels and lead to low libido. A trial of these medications or a change to alternatives may be beneficial, and;
• A trial of low-dose testosterone therapy may be appropriate in some postmenopausal women, especially those who do not respond to HRT. Testosterone for women is available as a cream. In general, testosterone products approved for use in men should not be used by women because of the danger of excess testosterone.

Prognosis

Although low libido may be frustrating for you or your sexual partner, it is something that can normally be overcome. It is important to talk about the condition with each other and overcome it together. Everybody's libido is different and fluctuations in libido levels are common as relationship dynamics change, or as you age.

Prevention

To help prevent low libido, it is important to avoid any potential causes. This can include avoiding fatigue from working too much or not getting enough sleep. It can also help to deal with any psychological conditions including anxiety, depression or low self-esteem. Maintaining a healthy relationship with your partner by resolving any conflict and nurturing your relationship can also help prevent low libido.

References

1. Libido. Better Health Channel. Accessed July 22 2014. link here
2. Low Libido: The Psychological Aspect - Australasian Menopause Society. Accessed July 22 2014. link here
3. Low Sex Drive in Women Definition - Diseases and Conditions - Mayo Clinic. Accessed July 22 2014. link here
4. Marcellin Lindsey MD and MPH. Diagnosing Low Libido. EverydayHealth.com. Accessed July 22 2014. link here
5. RACGP - The Male Reproductive System an Overview of Common Problems. Accessed July 22 2014. link here
6. Sexual Problems in Men. Accessed July 22 2014. link here
7. Sexual Problems in Women. Accessed July 22 2014. link here
8. Andrology Australia 2015. Low libido Monash University accessed on 12th May 2015
9. < link here
10. Australian Menopause Society (2012) Low libido and testosterone therapy Australasian Menopause Society accessed on 12th May 2015 < link here

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