My libido (sex drive) is low. Is there any treatment?

My libido (sex drive) is low. Is there any treatment?

Libido (sex drive) is a complex and particularly personal issue. Emotion plays a relatively major role in female sex drive and self-esteem plays a critical part in a woman's sexual feelings. Your relationship with your partner could be encouraging or inhibiting your self-esteem. It is all too easy to get into a spiral if your libido is low it will affect your partner and his self-esteem: he may show less interest in you thus perpetuating the underlying problem. Anti-psychotic drugs (e.g. For depression or anxiety) may be associated with reduced libido although it is difficult to quantify how much is due to the medication rather than to the underlying psychological problems.

Love-making should be one of the greatest pleasures in life. It is nature's way of ensuring continuation of the species. Both partners need to be relaxed - it is difficult to enjoy anything in life when you are under stress. All too frequently, poor libido can be related to social circumstances that need to be changed. Medical treatment is only likely to be required or beneficial on occasion.

A couple need time together by themselves. Both partners need to contribute fully to the relationship to be able to reap the benefits. There is a danger that as a relationship matures, the early feelings of adventure and experimentation will give way to repetitiveness and familiarity. When it comes to life in general, and sexual relationship in particular, there is frequently need for personal review. It is all too easy to fall into a rut. Before seeking investigation of your hormone status and perhaps embarking on hormone therapy, check to see whether refining or adjustment of your own lifestyle or perhaps that of your partner is required.

Hormones undoubtedly have an important role in libido with both oestrogen and androgens (Q 2.9) being involved. Oestrogen replacement therapy may sometimes provide benefit. Vaginal discomfort or pain due to oestrogen deficiency would clearly be off-putting and this is relatively simple to treat either by HRT or topical oestrogen creams or pessaries (Q 28.2). Oestrogen replacement may improve libido by its actions on the higher centres within the brain. Tibolone (Livial) has oestrogenic, progestogenic and androgenic effects. It may improve mood, libido and somatic symptoms in surgically menopausal women to a greater extent than estrogen therapy alone.⁰⁷⁰¹

If oestrogen replacement does not resolve this problem, testosterone supplementation^0201,0702 with tablets (Restandol), injections (Sustenon) or implants may improve the sex drive.(Q 28.17) These agents are not licensed for use in women but the British National Formulary (a major reference book published for doctors and listing all available medications) confirms the acceptance of the testosterone implants for women. Testosterone implants can also improve general energy-loss problems. Side-effects, such as increased body hair, are uncommon and they generally disappear when treatment is stopped. It seems appropriate to monitor testosterone levels for patients receiving testosterone.

There is a new generation of drugs on the horizon. Viagra appears to benefit male impotence and there are reports that it may improve female libido in some instances. If problems with libido persist, the advice of a specialist counsellor should be considered. 

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