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“My husband wants me to discuss my lack of interest in sex”… As Gynecologists, this is a patient concern not unfamiliar to us. Has low sexual desire been a concern for you in your relationship? Would you ever consider the use of a medication for its improvement? Well I’d hope that most of my patients would want to first examine the possible reasons for low libido, even if their answer is ‘yes’ to trying a medication for it.
But herein lies the concern. Defining the sources of low libido in women is not easy. Research tells us that nearly 4 in 10 women experience some degree of female sexual distress at some point in our lives. The definition of Female Hypoactive Sexual Disorder is made by conditions characterized by loss of sexual desire, impaired arousal, difficulty in achieving orgasm, or sexual pain, with low desire and sexual pain being the most common.
The stages of female sexual arousal have been well studied, and fairly well defined, since the 1960’s with research done by Masters and Johnson. However, the components of female sexual desire remain complex. Sexual desire in women is likely a multi-factor phenomenon, involving biologic, psychologic and social factors, which can elude clear delineation.
As a women myself, I can’t underestimate the psycho-social aspects of sexual desire for women. The balance of family-life, work responsibilities, body and self-image, and relationship satisfaction are huge factors for us in setting sexual desire/intimacy as a priority. The overall fatigue of child-rearing, and emotional dissatisfaction in our significant other relationship, seem to be two of the most common psycho-social causes I find in reproductive aged women with low libido concerns. I’ll often asks patients, “If your husband/partner helped out more, would you be more interested in sex?” The answer is often, “Yes”.
From the biologic standpoint, medical factors can play a role as well. Chronic medical conditions can affect our sexual desire. As well, some medications (such as some anti-depressants, anti-hypertensives) can negatively affect our desire and/or sexual response. The fluctuating and diminishing female hormone levels at the peri-menopause/menopause can negatively affect our sexual interest.
Sexual pain most commonly results from decreased lubrication, occurring more commonly during the peri-menopause/menopausal transition, or from lack of foreplay. Pain with sex can obviously be a deterrent to desire for sex. Don’t be timid about adding lubricants…or in asking your partner for what you need.
So the question remains, where a clearly defined reason for low libido does not otherwise exist, would you try a medication to improve your sexual desire?
This year the FDA approved the first medication for low libido in women, Addyi. Though the efficacy of the medication may only be deemed as moderate, the number of satisfying sexual experiences did improve over baseline. In their studies, where the mean number of sexually satisfying experiences was 2-3/month, Addyi improved rates by an addition 1 experience/month. The significant value of 1 additional satisfying experience, is for you to decide!
The medication is not without risks, however. The biggest concern with the medication comes from potential risks when used with alcohol, and these risks were serious, a higher risk of hypotension (low blood pressure) and syncope (feeling faint) when used with alcohol. Alcohol use must be avoided while using this medication. So if a glass of wine or cocktail is part of your ‘warm up’ for date night, this medication is not for you…or you’ll need to find a different aphrodisiac…maybe oysters!
But seriously, don’t be afraid to discuss low libido with your doctor. There’s finally a ‘pill’ that might help us too!
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
Offices located in Roseville, Grosse Pointe, Rochester, Macomb, MI