Libido

I'm a 32 year-old mother of two. For the last year, I've had almost no sex drive. I'm very happy in my marriage, but my husband and I are both very frustrated about this. Help!

Though male sexuality is not terribly complex (for the majority of men, functional genitalia mean functional libido!) many factors play a role in female sexuality - including mood disorders (depression), stress, body image, emotional intimacy, hormones, presence of pain with sexual activity, history of sexual abuse, and certain types of medications. Women may be bothered by loss of libido with differing causes at different ages.

Because of this complexity, one has to spend time taking a sexual history in order to figure out why the decrease in libido has occurred. Has this always been the case, or is it something new? Any recent changes in medications (birth control, high blood pressure pills, anti-depressants)? Is there any evidence of depression or increased stressors? I often hear about drops in sex drive following childbirth, usually from a combination of sleep deprivation, body image ("I don't feel sexy!"), and multiple stressors--child/maintaining the household/working outside the home. In older women, hormonal changes may contribute. Estrogen maintains resiliency of the vaginal tissues and helps with lubrication, while testosterone (a male hormone produced by the ovaries in small amounts) stimulates libido. Surgical or natural menopause can thus affect not only sex drive, but sexual function as well.

If high stress or depression is causing the problem, hormones and other related products are usually unsuccessful--stress reduction (if possible) or anti-depressants can help. If a woman is menopausal, trials of systemic or vaginal estrogen therapy and/or testosterone are reasonable. Though not approved by the FDA for use in women, a number of gynecologists are trying Viagra in select patients--I've seen mixed results with this so far. Sensua! (yes, the exclamation point is part of the product name...) is an FDA-approved cream applied to the clitoris. Though marketed as a sexual stimulant for women, it is actually only approved as a lubricant; this may or may not be helpful. Talk to your gynecologist or primary care physician for specific recommendations.

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