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Libido
Libido is a person’s overall sexual drive or desire for sexual activity. As such it plays
a very important role in the physical, mental and social well being of an individual.
Sex drive is determined by a multitude of factors, the most important of which are
psychological and physiological.
PYCOLOGICAL FACTORS THAT CAN LOWER THE LIBIDO:
Sigmund Freud determined that the libido is the instinctive
energy or force contained in what he called the id. From a
psychological point of view the id represents a basic drive
present in every person. Freud maintained that the id
really cares little for how it is expressed just as long as it is
expressed. And so a basic drive within us wishes to express
its sexuality. Society on the other hand does care very
much how a person expresses their sexuality in the world.
Society creates rules or norms by which it is acceptable to
express sexuality. For Freud these norms form what he
called the superego. And he also introduced another
concept he named the ego which plays the role in each
person to act as the mediator between the id and the superego. To Freud, most all
psychological problems derived from conflicts between what the id wants and what
society or the superego demands. If the ego is overly stressed in trying to resolve
these conflicts, the result is neurosis or emotional distress. This distress can easily
lead to a repression of one’s libido and desire to have a fulfilling sexual life. But
internal conflict is not the only psychological factor that results in lowered libido.
Other psychological factors can reduce the desire for sex. These factors can include
lack of privacy or intimacy, stress or fatigue, distraction or depression.
Environmental stress, such as prolonged exposure to elevated sound levels or
bright light, can also affect libido. Other causes include having experienced sexual
abuse, assault, trauma, neglect, body image issues and anxiety about engaging in
sexual activity.
PHYSIOLOGICAL FACTORS THAT CAN LOWER THE LIBIDO:
As mentioned at the beginning of this article, physical or biological factors also play
a large role in diminished libido. Physical factors that can affect libido include:
endocrine issues such as hypothyroidism, levels of available testosterone in the
bloodstream of both women and men, the effect of certain prescription medications,
various lifestyle factors and the attractiveness and biological fitness of one's
partner. Being very underweight or malnourished can cause a low libido due to
disruptions from normal hormonal levels. Smoking, alcohol abuse and drug abuse
may also cause disruptions in the hormonal balances and therefore lead to a
decreased libido. Reduced libido is also often caused by medical intervention
(iatrogenic). It can be caused by many medications, such as hormonal
contraception, some of the antidepressants, antipsychotics, opioids and heart
medicines such as beta blockers. In some cases medically caused impotence or
decreased libido can be permanent.
HORMONE LEVELS AND MENSTRUAL CYCLES
A woman's desire for sex can be correlated to her
menstrual cycle, with many women experiencing a
heightened sexual desire in the several days immediately
before ovulation, which is her peak fertility period, which
normally occurs two days before until two days after the
Testosterone Model
ovulation. This cycle has been associated with changes in
a woman's testosterone levels during the menstrual cycle. According to Gabrielle
Lichterman, testosterone levels have a direct impact on a woman's interest in sex.
According to her, testosterone levels rise gradually from about the 24th day of a
woman's menstrual cycle until ovulation on about the 14th day of the next cycle,
and during this period the woman's desire for sex increases consistently. The 13th
day is generally the day with the highest testosterone levels. In the week following
ovulation, the testosterone level is the lowest and as a result women will
experience less interest in sex.
Although the last days of the menstrual cycle are marked by a constant
testosterone level, women's libido may boost as a result of the thickening of the
uterine lining which stimulates nerve endings and may result in a woman being
more easily aroused. Also, during these days, estrogen levels decline, resulting in a
decrease of natural lubrication.
Although some specialists disagree with this theory, aging and menopause are still
considered, by the majority of specialists, to be the one of the leading causes of
decreased sex desire in women. The levels of testosterone typically begin to fall at
about 35-40 years of age and continue the decline as a woman ages. Estrogen also
decreases at menopause and this usually causes a lower interest in sex and vaginal
dryness which makes intercourse painful.
The Endocrine Society updated their Clinical Practice Guidelines in October 2014.
The guidelines had not been updated since 2006. For women, they suggest only
prescribing testosterone for women with Hypoactive Sexual Desire Disorder, aka:
“low libido”. Low libido is one of the most common complaints that I hear voiced on
a daily basis.
There is also new information from the North American Menopause Society that
seemingly links low testosterone in women to hair thinning. Once I have had time
to more thoroughly research the information, I will share it with you.
Currently, there are 5 or 6 FDA approved testosterone formulations for men.
It is approved to treat hypogonadism.
Hypogonadism affects approximately 4 to 5 million American men.
Symptoms of hypogonadism include:
•
Impotence
•
Decreased sexual desire
•
Fatigue and loss of energy
•
Mood depression
•
Regression of secondary sexual characteristics (growth and maturation of
prostate, seminal vesicles, penis, and scrotum; the development of male
hair distribution, including facial, pubic, chest, auxiliary hair; laryngeal
enlargement; vocal cord thickening; alterations in body musculature; fat
distribution)
•
Osteoporosis
So testosterone is FDA approved to treat each of the bulleted symptoms
listed above in Men.
We could have a very extensive discussion regarding how many women have
decreased sexual desire and fatigue with energy loss. Or how many women
have hypogonadism {defined as reduction or absence of hormone secretion or
other physiological activity of the gonads (testes or ovaries)} as a result of
having their ovaries removed or living long enough to have ovarian failure
occur (menopause). And we could even compare the rates of osteoporosis in
women (1 out of every 2 American women, usually Caucasian or Asian women
and 1 out of every 8 men) will suffer from an osteoporotic fracture.
Testosterone is ‘the other’ female hormone. Thankfully, research is
beginning to be funded. Someday, it may actually be FDA approved. Until
then, more and more medical providers are using it “off-label” for their
female patients who suffer from ‘hypoactive sexual disorder’ and
‘hypogonadism’ who have low or very low levels of testosterone.