Lack of sex drive is a common reason women come into my office.
I appreciate this because sex drive – a.k.a. libido – is not only about sex. Libido reflects motivation, drive, passion in life.
Libido reflects life energy.
I also appreciate when women acknowledge the importance of sexual health and intimacy for the health for their relationships.
[I think most men are much quicker than most women to admit the importance of sex in their lives. What do you think? Comment at the end of this blog.]
Evaluating a woman with a low sex drive starts with questions about her physical health.
- Is she perimenopausal or menopausal?
- Does she have vaginal dryness?
- Does she have pain or discomfort with sex?
If a woman is in menopause or perimenopause (the 10 or more years leading up to menopause), her hormone levels might be rising and falling, affecting her sleep, mood, sex drive, and more.
If she has pain or discomfort with sex, as I often remind women, It’s normal to not want to do something that hurts.
Vaginal dryness can happen anytime there is a lack of estrogen effect on the tissues of the vagina or vulva. This can happen after childbirth, during breastfeeding, or in perimenopause or menopause.
This symptom is actually not a “dry” surface, but it is a lack of elasticity of the tissue underneath. Think of an elastic band losing its stretchiness.
The good news is that, in addition to water-based lubricants, low doses of vaginal estrogen preparations can pretty quickly improve vaginal dryness without any measurable amount of estrogen getting into the bloodstream. For women who are worried about using estrogen, I like to reassure them about this. (My patient Barbara [never real names] was even allowed by her oncologist to use some vaginal estrogen a few years after she was treated for breast cancer.)
In addition to making sex comfortable, treating vaginal dryness (medically called vaginal atrophy) also helps women avoid bladder infections. This is because the base of the bladder is the same type of cell (squamous) as the surfaces of the vagina and the vulva.
Hormonal balance and sex drive
Once a woman is physically able to have sex without discomfort or pain, we can then look at the mental influences on sex drive. This, of course, is where things get more complicated.
There is a stereotype that men have one ”on-off” switch regarding sex, while women have a complicated set of dials and switches related to their own sex drive.
My friend Helana Hope likes to ask: “What is the most important sex organ?”
Did you guess the right answer?
It’s the brain.
(The skin is a close second.)
This is true for both men and women; the brain is where sensations and thoughts can combine and translate into sexual desire.
Here are some important influences on the brain that help sex drive:
- Quality of communication in the relationship
- Good sleep quality and quantity
- Good overall health
- Healthy self-image (affecting self-confidence)
- Enough exercise
- Enough estrogen (in BOTH women and men)
- Good testosterone level
While a complete list of all the mental variables affecting libido is a great topic for another blog post, we can say that both men and women benefit from the effects of good hormone levels.
Reading any of my blog posts, you know I am passionate about women and men knowing about the safety and effectiveness of hormone treatments, especially when the hormones being used are bioidentical. It’s not my job to persuade anyone to use hormone therapies, but I do consider it my job to crusade against the fear of hormones that have been generated in the media since 2002.
Testosterone therapy for men and women
Testosterone therapy can have side effects (read more here) but I do not think there are any medical risks for the vast majority of people with optimizing levels of this (and other) hormones.
As Helana and I discuss in our short video above, sexual health is the same as general health; they reflect each other. If you or your intimate partner suffer from low sex drive, get it checked out.
When it comes to your libido and your life, don’t settle. Go for GREAT.
Don’t forget to leave me your comments below.