By Evelyn Minaya, MD, OB/GYN Vice President of Women Caring for Women
Every day, I encounter questions about sexual libido in my clinical practice. As with most things, there are no easy solutions to such complex problem. I believe that libido has to be addressed from two angles: the physical and the mental.
First, I address any physical problems. The most common complaint that I get from my patients is painful sex. This presents a vicious circle in that the more pain the woman experiences, the less of a desire she has to have intercourse. No one wants to be uncomfortable, especially with something that supposed to feel good. The three most common causes of painful sex are vaginal dryness (not unique to post-menopausal women), vaginal atrophy as a consequence of vaginal dryness, and lack of lubrication that has “staying power.” Your doctor should be able to address these issues.
A thorough examination should be done, including blood work to rule out any metabolic causes. Thyroid disease, especially, can lead to vaginal dryness. You should specifically address where you experience pain with intercourse. Different locations of pain can be caused by different reasons. You should also be tested for any sexually transmitted infections because they can cause painful sex. Your physician can prescribe hormonal (estrogen cream) or non-hormonal remedies (olive oil). You should always use lubrication during intercourse, even if you feel moist.
Secondly, I address any medication the patient might be taking. Certain medications like birth control pills, anti-depressants, anti-anxiety, and thyroid medications can affect sexual libido. Men can also experience a decrease in libido with anti-hypertensive medication. You can check with your physician to see if you could change the prescription or maybe the strength.
There are no FDA-approved drugs for increasing libido today. Hormonal replacement therapy (HRT) is only approved for hot flashes – not to increase libido. However, while women who undergo HRT feel better, it does not necessarily increase their desire to have sex. There are some compounding pharmacies that make testosterone (male hormones) as a cream to improve sexual libido. Studies have shown that testosterone can work for about three months but can loose its efficacy after this period. Long-term use of the drug can increase your cholesterol, increase male-pattern hair growth, and increase clitoral size. For more on hormone replacement therapy, click here.
Lastly, I address the relationship. Couples in long-term relationships tend to fall into a routine. Sex takes a back seat to jobs, children, illnesses, parents and stress. As I tell my patients, 95% of libido is in your head, the other five is “down there.”
If you are not happy, stressed, or having financial difficulties – your libido will suffer. My solution? Communicate and express how you feel. Your partner is not a mind reader and open dialogue is good. Changing your lifestyle and making the time is important. I know it is easier said than done but putting your mind to it could possibly save your relationship. Sex is not only an integral part of any relationship but it also is healthy for you. Studies have shown that it decreases heart disease, stress, and burns off calories. Most importantly, it makes you feel satisfied, sexy and happy. Make it happen!