DECREASED SEXUAL DESIRE

If a woman mentions to her doctor that she has a decreased desire for sex, she may receive an evasive statement or answer. It is a complex subject with many causes, not always well understood by many physicians. Sexual desire, or libido as it is sometimes called, is influenced by our own health, environmental circumstances and the behavior of our partner and others. Dr. L. Barbach recently wrote a review article that pointed out the many contributors to this problem, Barbach L. Loss of sexual desire. Menopause Management 1998;7(1):10-14.

Physical causes are often responsible. Fatigue, whether due to stress, to physical work or even sleep deficit from childcare or hot flashes, is a common cause of decreased libido. Physical muscle or joint pain, pain with intercourse and urinary incontinence may also interfere with desire for sexual relations. In this case, fear of pain or embarassment works as a supressive force. Decreased estrogen at the time of menopause may cause the vaginal skin to become thin, dry and painful with the friction of intercourse. The opening to the vagina may loose elasticity and be painful with penetration. Estrogen replacement medication can relieve many of the vaginal symptoms and even stop the hot flashes which cause sleep disturbance, but in spite of this, there still is some loss of sexual desire at the time of menopause.

Many medications that women take can have sexual side effects. Antidepressant medicines can decrease sexual desire above and beyond the effect that the depression itself has. Pain drugs such as opiates block testosterone synthesis and decrease sexual response. Antihypertensive medications notoriously affect sexual response in men and are thought to have a lesser but real effect in women also.

A woman's sexual interaction with her partner can affect desire. If the partner loses desire due to physical fatigue, medications or any reasons, a woman may unconsciously suppress her own desire. If she feels unattractive or anxious or even critical of her partner's lovemaking skills, sex is naturally avoided. Any barriers to communication about a couple's sexual relationship can create dissatisfaction. Past sexual abuse or rape trauma may lie dormant for years and only surface when a woman is safely involved in a committed relationship.

In spite of all the possible causes that can affect sexual desire, the most frequent cause of libido decrease among women is her non-sexual relationship with her partner. Problems over power struggles, resentment, feelings of being unimportant or just plain anger about past behavior can occur at any stage in a couple's life and are often the most common causes of decreased sexual desire. Marital problems frequently come to the surface at midlife.

With all of the above complex interactions, its understandable how the statement "I don't seem to care for sex as much as I used to" puts up a red flag to the physician about the amount of time that problem is going to take. A desireable response might be: "Decreased sexual desire is a complex problem that we will need to take time to investigate. Perhaps we could schedule another appointment for a longer time period so I can give this the attention it deserves."

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