Women With Low Libido. Is There A Role For Testosterone?

Loss of or Low Libido — Women.

Hypoactive Sexual Desire Disorder in Women.

Definition: It would be as well to remind ourselves again, so as to avoid any confusion that female sexual response may be thought of as arriving in four separate and distinct phases. First described by Masters and Johnson in 1966 those four phases of sexual response were: Excitement, Plateau, Orgasm and Resolution. Of course we now accept that these responses are not as cut and dried as once thought. They are rather a continuum that blend and fuse and that require emotion and feelings for them to work in the first place. Also, other things have changed since 1966. While most people might still agree in principle about the usefulness in phasing sexual response for the purposes of therapy, the phases themselves have been changed and reduced to three. Today these are:

(1) LIBIDO: This is interest or desire or sex drive or lust or sexual urge. You can even call this first phase appetite, craving or sexual hunger. It is NOT however arousal or horniness or the hots, because those are completely separate and later phases of the human sexual response.

(2) AROUSAL: This is what starts to happen as a result of sexual stimulation in a woman who has normal libido. If she has not got normal libido then she is not going to get to the arousal phase of sexual response.

(3) ORGASM: When stimulation is sufficient to bring about a high enough degree of sexual excitement the orgasm should take place.

Again, these three phases of sexual response are mentioned here only for the purposes of clarity when it comes to targeting therapy. They are not being put forwards as in any way necessarily, stereotypical, ideal or always achievable. Furthermore, it is acknowledged that for libido, arousal or orgasm to occur at all, emotions, feelings and attraction are also essential requisites.

If I seem to be labouring this point it is only because, almost on a daily bases, I see people confuse libido with arousal, response and orgasm, such that it is impossible to focus in on their particular dysfunction with any clarity. Even if reached somewhat artificially, clarity in this area is, in my view, essential for progress. Otherwise there is just endless confusion and no progress.

To return to definition then: Lack or loss of libido in a woman, may be defined as the persistent or recurring absence or near absence in her of any interest ,sexual desire or urge to engage in sexual activity with another person for whom she might feel otherwise attracted.

What are the causes of Hypoactive Sexual Desire in Women?

Causes of Hypoactive Sexual Desire Disorder in women (low libido) can be divided into Physical and Psychological:

Physical Causes.

(1) Menopausal collapse of one or other of the sex hormones estrogens, progesterone and testosterone.
(2) Pregnancy, childbirth and breast feeding.
(3) Medications like the birth control pill, SSRI’s or any antidepressant, sedative, anti-psychotics, anti hypertensives and chemotherapy.
(4) Excess alcohol or illicit drugs.
(5) Chronic illness, stress, emotional upheaval, diabetes, arthritis, chronic renal disease, chronic heart failure, raised blood pressure, chronic neurological disease like MS, spinal cord injury, Parkinson’s , chronic fatigue syndrome, motor neuron disease etc.
(6) History pain during intercourse – dyspareunia. Fear of pregnancy. History child or adult sex abuse.
(7) Obesity or anorexia.

Psychological Causes.

(1) Depression, stress, anxiety, hostility, anger.
(2) Poor body image.
(3) Relationship issues.

Treatment of Low Libido in women.

In the first instance every effort needs to be made to identify the underlying cause or causes of failing libido. All the above possible causes and much more need to be considered and ticked off in a mental list. You will need to treat the underlying cause or remove it where possible. There is simply no point in hoping that HRT, for example, is going to rekindle a flagging libido when the underlying cause remains unaddressed.

If there is no treatable underlying cause, and often there may not be, then the woman’s general physical and emotional health need to be look at. If overweight she should be encouraged to take regular exercise and to make life-style adjustments designed to increase her overall levels of fitness and wellness.

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