By Darcie Fisher, Tufts Medical Center Correspondent
Waning libido doesn’t discriminate. Both men and women experience fluctuations in sex drive, especially as we age. Hormones and neurotransmitters regulate our libido, which can be negatively affected by biological, psychological and social factors. In addition, libido can be affected by medical conditions, lifestyle, relationship issue and age.
What causes libido problems?
Liyan Zhuang, MD, a Urologist at Tufts Medical Center says while men and women are both affected, he sees more cases of waning libido in men though it’s unclear why. He warns not to confuse libido issues with erectile dysfunction, which is the inability to get and maintain an erection throughout sexual activity.
“Decreased libido doesn’t mean you have decreased testosterone,” said Dr. Zhuang. “Physicians need to assess someone’s overall, total health to determine what might be at the root of this issue.”
The first stop should be your primary care physician for an assessment. Obesity, diabetes, thyroid, cardiovascular health and other health issues can affect libido. Stress and social issues can also be at play. Addressing those problems can make a huge difference for many men, says Dr. Zhuang.
Testosterone troubles – and help
A low level of testosterone is a major culprit and occurs naturally when men age. This along with lower energy levels and decreasing muscle tone can wreak havoc on the libido. When patients are referred to Dr. Zhuang, he typically checks to see if testosterone levels are off. This involves two separate, simple blood tests which must be done in the morning because that’s when a man’s testosterone level is the highest.
Treatment for issues with libido that does not involve erectile dysfunction is often a boost of testosterone, which can be delivered via a gel, by wearing a testosterone patch or injections given weekly or bi-weekly. In some cases, Dr Zhuang recommends a subcutaneous pellet called Testopel which is implanted during an office visit.
Women and libido
Much less is known about women and libido. A new study published by researchers at the University of Pittsburgh found that hormones are not the only reason a woman finds her libido lacking. Postmenopausal issues such as vaginal dryness or pain during sex are often factors as well as issues with her partner.
The study found that as many as 40% of women over 60 have low libido – yet most of those women do consider sex to be an important part of their lives. The study also finds that low libido in women has a variety of causes.
The most common reasons for a lack of desire included:
- Postmenopausal conditions–a lack of estrogen after menopause can make sex not only less pleasurable, but painful. Vaginal dryness and other related issues can interfere with the desire for sex.
- Erectile dysfunction (ED)–Some women in the study said that because their partner was experiencing ED, they, in turn, lost interest in sex.
- Self-image–Just as the case with younger women, many older women report that changes in their body based on aging or weight gain, makes them feel less desirable and inhibited as their body ages.
- Life stress–The kids may have left the nest, but women today say they remain as busy as ever. Caring for aging parents, watching grandchildren and worrying about their grown children were all reasons stated by the participants in this study.
- Fatigue and body pain–Arthritis and the general aches and pains of aging, as well as reduced stamina made women in the study less likely to pursue sex.
Women who may be experiencing a dip in libido are urged to first talk with their primary care physician. Deborah Blazey-Martin, MD, MPH, Chief of Internal Medicine and Primary Care at Tufts Medical Center says depression can decrease libido in both women and men and that most primary care doctors are comfortable making that diagnosis and treating depression.
“Depression is more than just stress, and people generally do very well with the treatment,” stated Dr. Blazey-Martin. “Although some of the medications we use to treat depression may cause sexual side effects, this is not true of all depression medications. Another condition to keep in mind is alcohol use disorder, which can also cause sexual dysfunction in both sexes.”
Both Drs. Zhuang and Blazey-Martin stress the importance of seeking help. A lagging libido is a condition which is treatable and improvement in this area of your life has benefits beyond the bedroom.
Published January 2020
The above content is provided for educational purposes by Tufts Medical Center. It is free for educational use. For information about your own health, contact your physician.