Decreased Libido (sexual desire)

Sexual desire is a normal and natural feeling for women and men. However, sexual desire can change over time, and can increase or decrease depending on the situation. Although we see couples on the TV and in movies who seem to have "perfect" love lives, this is rarely the case. Sexuality, like all aspects of a relationship, takes effort to perfect. One of the things complicating discussions about sexual issues is that some people become worried about what is "normal" or "abnormal." A quick look at the magazine section of your store proves this, as most magazines have articles about sexual topics. To understand changes in sex drive, which is called libido in medical terminology, one must understand that every person, and every couple, has a different level of desire. Sexual desire often changes in response to outside forces, like stress. Plus, libido can decrease with certain medical conditions and by many medications. As with all relationship issues, working through issues about sexual desire takes close communication. In other words, good sex first begins outside the bedroom.

There are many ways to express sexual desire. Many women enjoy cuddling, hand holding, back rubs, and kissing, for example. These signs of affection can be very pleasurable. Other women want different kinds of sexual stimulation, which can include masturbation, oral sex, or intercourse. When both partners agree on the types of sexual activity that is desirable there is usually little conflict. However, when one person wants sexual activity that differs from their partner's wishes, relationship problems may develop. Sometimes one partner desires sexual activity more often than the other partner, and this also puts stress on the relationship.

We know that men and women can have differing sex drives. Men and women, for instance, both have a hormone called testosterone, but this is present in much higher amounts in men. Women have high amounts of hormones called estrogen and progesterone. Testosterone is known to cause facial and body hair and larger muscles, but it can also cause certain emotions, like aggression and increased sex drive. Young men, for example, have strong sex drives, most likely due to the increase in testosterone that occurs at puberty. Perhaps these hormones lead to many of the differences found between men and women, but it is probably uncommon that "hormone problems" are the cause of sexual problems. (More often, it is relationship issues that decrease sex drive). Men are often stimulated by things like pictures, watching sexual movies, or looking at women they find attractive. Women, on the other hand, may become more aroused by words, intimate emotions, or signs of affection like kissing or close touching. By talking about these differences each partner can discuss, in a non-threatening manner, what she or he needs. Often just letting the other partner know what you would like or what makes you stimulated is an important first step in working out sexual problems.

Many women remark that movies and TV do not show "normal" sexual behavior. Since men are often aroused by sex scenes in movies or in magazines, women may feel that they have to live up to the behavior found in the media. Real life is almost never as glamorous or "sensual" as the movies. Sexual encounters in movies are often more fantasy than fact. Many women can reduce their discomfort about these issues by discussing them with their partner. A disturbing situation occurs when one partner tells the other "I wish you were more like that movie star." This is hurtful and demeaning, and can damage self-esteem. A better solution is to sit down with your partner and talk about which things you each can do to improve your sex life. It's better to say "there are some things I would like to try when we make love. It would be great if we could do ____________." This conversation is best held outside the bedroom. It's important not to threaten or make fun of your partner, who may be shy about discussing sexual issues. As discussed below, there are a number of books that may be helpful.

There are a number of situations that can lead to a decrease in sexual desire. A common saying is that "the brain is the most important sexual organ," meaning that our emotions play a tremendous role in our sexual lives. Many couples have learned the hard way that stress can decrease libido. Stress from one's job, money trouble, sick family members, marriage problems, and other issues can cause one's sex drive to decrease dramatically. It is hard to feel desirable and loving when you are constantly worried about how the bills will be paid. Men and women respond to stress differently. Women usually notice decreased sex drive when their lives are stressful, but some men actually use sexual activity as a way to reduce stress. Understanding each other's needs is critically important to resolving relationship issues. When a couple struggles to overcome sexual and other relationship issues, seeing a counselor may be very helpful.

Other things can cause diminished libido. For example, childbirth and breastfeeding may lead to vaginal discomfort and a decrease in estrogen levels. This may lead to vaginal dryness, making sexual intercourse painful. Furthermore, women may find themselves in a new role as a busy mother. Even though the duties of being a new mother can be overwhelming, your children will someday grow up and leave the home, but your husband will hopefully be with you forever. It's important to nurture your relationship with your spouse. Part of this is keeping your sex life healthy. Asking your husband to share child-care and other duties with you is one method of reducing stress. Heart disease can lead to fear of exertion. Depression can make all activity, especially sex, difficult. Medications, like some antidepressants and many blood pressure pills, can lead to lower sex drives. As with all medical conditions, your doctor can help you determine if your medical history or medications are causing problems with your sex life. When women go through "the change," called menopause, they may lose interest in sex. Sometimes this is due to vaginal dryness or decreasing levels of estrogen and progesterone. Many women have a good response to small doses of hormones, called hormone replacement therapy. In addition, some women note increased libido when small amounts of testosterone are added. However, testosterone is not a "cure all" for decreased sex drive, and it can have side effects, such as unwanted hair growth. As with all medications, it's best to talk with your health care provider about this. Doctors and other health care professionals are used to talking about private issues like sex, so there is no need to feel embarrassed or ashamed.

As mentioned before, men and women have different sexual needs and responses. Women do not automatically experience orgasm, and it usually takes more effort for women to experience orgasm. There are many myths about female orgasm, but the truth is that most women cannot have an orgasm by intercourse alone- they need manual or oral stimulation of the clitoris. The clitoris is the small, round "bump" on the very top of the genital organs that is super sensitive to touch. As a society we do not do a good job of teaching children and young adults about sexuality, so some men (and women) may not understand the female sexual response. You may have to teach your partner how to please you sexually. It is important to remember that we are each responsible for our own sexual pleasure. It may be hard at first to show your partner what you like, but it is very likely that he will appreciate this and find it arousing. Women may become discouraged or frustrated if they are not achieving arousal or orgasm with their partner. If this happens, talking with your partner about the things you like "in bed" will help a lot. Again, it is likely that your partner will be happy you talked about this issue.

Sexual relations should be a time to share, care and enjoy each other, at a time and place agreeable to both partners. Partners must talk with each other, and plan to enjoy the time together. Then, sexual desire should not be a problem for the couple. A long and happy relationship takes commitment from both partners to keep it exciting and interesting. Once person cannot do it all. If talking does not help as much as you thought it would, consider reading one of the books listed below, or talking with your health care provider, a counselor, psychologist, or psychiatrist, who can help you work through sexual issues.

Books:

• Barbach, Lonnie: For each other.

• Zilbergeld, Bernice: The new male sexuality.

• Love, Patricia: Hot monogamy.

• Moglia, Robert F.: All About Sex : A Family Resource on Sex and Sexuality

• Barbach, Lonnie: For Yourself : The Fulfillment of Female Sexuality

• David and Bernhardt: The Good Sex Guide : The Illustrated Guide to Enhance Your Love-Making

References:

Jean Christensen, ARNP

Marlene Woodard, ARNP

D. Ashley Hill, M.D.

Associate Director

Department of Obstetrics and Gynecology

Florida Hospital Family Practice Residency

Orlando, Florida

http://home.mpinet.net/dahmd