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November 20, 2001

'For some reason I'm not as interested in sex as I think I should be. I could go for weeks without sex. Why?'. Questions about low libido are all too familiar on any magazine 'problem page'. It can happen to any adult at any age. Peta Newbold reports.

Libido is one of the fundamental sources of energy within each of us that's vital for the survival of the species. In neuro-chemical terms it's a highly complex mix of hormones and brain signals but to you and me it's the drive to be sexual.

Surprisingly for something so intrinsic, decreased libido is all too common. Studies done in the early 1980s found that in the general population (those who were not on any medications and did not have a medical diagnosis or a psychiatric diagnosis), 13 per cent of men and 27 per cent of women had inhibited sexual desire. Seven to 12 per cent experienced erectile dysfunction and ten percent of men and 25 per cent of women had inhibited orgasm.

Causes of low libido

It is often difficult to sort out psychological from organic sources of sexual problems and it may well be influenced by several factors: biological drive, adequate self-esteem, previous good experiences with sex, the availability of an appropriate partner, and a good relationship in non-sexual areas with one's partner. Stress and fatigue can turn love making from a joy to a chore and it can also depend on how healthy you are.

A diagnosis of cancer can mean that sex becomes the furthest thing from your mind for a time, and other conditions like diabetes, atherosclerosis, high blood pressure (hypertension) hypothyroidism or multiple sclerosis can also affect libido. Even minor illnesses can diminish sexual interest and although many people are happy exceptions to the trend, sex drive generally decreases with age.


It's estimated that 43 per cent of people taking anti depressant medication experience sexual dysfunction and they are a major cause of low libido. They can lift sexual desire for someone who is depressed but on the other hand they can interfere with sexual response and being able to experience orgasm.

That can lead to 'performance anxiety' and more than 60 per cent of people suffering from a major depressive disorder have prominent anxiety symptoms too. Anxiety causes activation of the autonomic nervous system that inhibits sexual excitement and it can become a viscous circle.

Many other medications can also decrease sexual interest, including diuretics, blood pressure medications, steroids and some drugs for treating ulcers. Non-prescription medications, including alcohol, can also depress libido and the causes can also relate to what gender you are.

  • Low libido can be caused by a low level of testosterone due to problems with the testes or the pituitary gland in the brain,
  • Physical problems that can lead to getting and keeping an erection,
  • Ejaculation problems,
  • Inability to reach orgasm.

  • Libido in women can be deceased by the contraceptive pill,
  • Breast-feeding,
  • Menopause,
  • Mood-elevating drugs,
  • Problems with sexual arousal or orgasm,
  • Poor vaginal lubrication or pelvic diseases that cause pain with intercourse.

Getting help.

Many people find it difficult talking about sexual matters but the first port of call is your GP who will consider your medical history and most likely give you a physical examination. If libido and erectile problems occur together, your doctor may recommend you see a urologist.

If psychological issues play the prominent role, he or she may recommend you see a professional with expertise in that area. Desire problems rather than functional ones are more likely to be treated successfully by a sex therapist.

If the cause is antidepressant treatment there are a number of options such as decreasing the medication to the minimally effective dose or adding an "antidote" antidepressant or other medication that has positive sexual effects to counterbalance the sexual dysfunction. Another possibility is switching to a different class of antidepressants.

The importance of testosterone

As testosterone levels decline with age, testosterone replacement therapy can be effective in increasing sexual desire in some men, however its role in the well-being of women is only just beginning to be understood. It is known to influence the development and maintenance of bone mineralisation and it also seems well established that testosterone is an important factor in determining female sexuality.

Around menopause testosterone levels can become diminished, causing fatigue, a feeling of being unwell and of course, diminished libido. However Australian research has found that these symptoms will mostly be relieved by a testosterone 'top-up'. According to a report in the Journal of American Medical Association, (Vol. 283 No. 20, May 24/31, 2000) Dr Susan Davis of the Jean Hailes Foundation in Clayton, Victoria said that women who receive testosterone therapy claim the biggest boost is to their energy level. "They have more energy to do things, and I think that is what ultimately affects libido," she said.

The study also found that while side effects such as masculinization and fluid retention are possible, they are unusual when therapeutic hormone levels are maintained within normal physiological levels.

The search for an aphrodisiac.

If only there was a drug that increased sexual desire.an aphrodisiac in fact! Over the centuries many claims have been made but nothing has really proved successful. However a US company may be getting close.

Palatin Technologies drug PT-141 was originally intended as a tanning product but its developers were surprised to discover there was a more immediate effect on erectile function.

It is the mechanism by which PT-141 appears to work that makes it particularly interesting, and very different to that of the sexual dysfunction drug-of-the-moment, Viagra. Palatin's Director of Biological Research Dr Annette M. Shadiack said, "Viagra increases the blood flow to the genital organs, a purely physiological response. PT-141 on the other hand affects centres in the brain responsible for sexual function. PT-141 has the potential to be a unique treatment for sexual dysfunction in both men and women."

"They might be on to something there," Consulting Clinical Psychologist Norman Rees said. He was involved in trialling Viagra at the Australian Centre for Sexual Health in Sydney. He said, " The indications are that the drug is acting on 'desire' rather than 'arousal' and that's the Holy Grail of work on sexual dysfunction." He said that it is important to differentiate the two. "Arousal is the physical mechanism whereas desire is the motivational drive to be sexual and it's the imbalance of desire between men and women that is currently the biggest problem we see."

It is likely to be some years before such a product makes it to the market but in the meantime Norman Rees says there is much that can be done to help libido problems. "Counsellors are encouraging couples to talk more openly about each others sexual needs and having a variety of strategies within the relationship for balancing the sexual need equation," he said.

References: Journal of the American Medical Association at http://jama.ama-assn.org/issues/v283n20/ffull/jmn0524-3.html CBS Healthwatch on http://cbshealthwatch.medscape.com

By Peta Newbold

Reprinted with permission from Editforce

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