A2 Magazine – Dr. S. Nedic discusses the different physiological causes, effects and treatments for low libido in women…
Many women are continuously suffering in silence as they’re hesitant to talk about their sexuality and libido problems with their partners, or their health care professionals. In my anti-ageing clinic, I deal with peri-menopausal and menopausal women (and sometimes even young women with hormonal discrepancies), and the number of these women suffering from a lack of sex drive is significant. I usually provide my patients with a “tick box” form to fill in with more than 100 questions regarding their hormone balance, general health, lifestyle, diet and environmental toxicity – all of which possess “hidden” questions about their sexuality and libido. It’s surprising to find that these questions were answered truthfully. However, if I ask my patients face-to-face about their libido, they are reluctant to talk about it. Therefore South African women often opt for over-the-counter aphrodisiacs instead, which result in no improvement as the primary cause is not addressed. Sadly, they then surrender to that feeling of an absent sex drive. The Journal of Impotence Research (USA) recently published one global study, explaining that up to 43 % of women, beginning as young as 40, express a loss of sex drive. Meanwhile, 70% of women with absent libido report with a negative effect of their body image, self-confidence and interpersonal difficulties – especially with their partners.
According to a recent global study, a substantial 43% of women have expressed a loss of sex drive – making the number of women suffering from a low libido very significant. Dr Sly Nedic discusses the different physiological causes, effects and treatments
Causes of low libido
The cause of low libido in women is complicated and multi-factorial – much like women themselves. There are three main groups of causes that need to be investigated by different health professionals: 1. Psychological, 2. Sociocultural, 3. Physiological. I usually deal with the physiological causes of absent libido as they are the most prevalent, easy to diagnose and are treatable. These include:
- Hormonal causes of low sex drive:
- Low testosterone
- Altered cortisol level (stress)
- Hormone disrupting estrogens in the environment
- Drug abuse
Estrogens and androgens are critical when it comes to creating a strong libido, as they interact with the organs and neurotransmitters involved in sexual desire formation. The ovary produces estrogen in a cyclical pattern from puberty through to menopause. Estrogen is important to improve the blood flow to the vulva, clitoris and vagina, therefore normal levels of estrogen results in an active arousal and normal nerve response. During the reproductive years, women experience a heightened sexual desire several days before ovulation and two days after, which is due to high estrogen levels. The week following ovulation, progesterone increases, estrogen drops and women have difficulties achieving an orgasm. During the last few days of the menstrual cycle, women’s libido is boosted mainly due to the thickening of the uterine lining which stimulates nerve endings. In the premenopausal period, estrogen declines and receptor stimulation fades – and particularly during the menopausal period, the amount of active estradiol is substantially diminished. All of this leads to a loss of libido and absent arousal. Decreased lubrication and loss of elasticity can also lead to painful intercourse, which can affect sexual desire. Symptoms of menopause from low estrogen like insomnia, hot flushes, night sweats, mood swings etc. can further contribute to a lack of sexual desire.
It is so gratifying to see how women’s libido can easily be restored with bio-identical estrogens, where its used as topical or intravaginal pessaries – and even more so with how their relationships, self esteem, body image etc. is repaired.
Testosterone and other androgens like DHEA also play an important role in a woman’s sexuality. Physiologically, the level of a woman’s libido that is associated with testosterone changes during the menstrual cycle; it increases from the 24th day and picks up on the 13th day during ovulation. This is when a woman has the highest level of libido. Low testosterone can be present during the reproductive years in younger women, usually during periods of high stress (adrenal insufficiency) or in women who use the contraceptive pill.
During menopause, there is a relative testosterone increase – yet it only contributes to a normal or increased sexual drive if there is an “Estrogenisation”of the important tissues (such as the vulva, clitoris etc.). Supportive data demonstrates that testosterone decreases in a 40-yearold woman to about half the level of a 20-year-old woman. Therefore bio-identical transdermal testosterone is a necessary treatment needed to restore women’s libido. Supportive literature also shows that Dehidroepiandosteron (DHEA) given orally increases sexual interest and satisfaction in women suffering from adrenal insufficiency. However, it does not affect sexual drive in women with normal adrenal function.
In addition, all other hormones in conjunction with sex hormones will be investigated to attain the reason for decreased sex desire. Hypothyroidism, high prolactin and low cortisol levels should all be adequately treated – as well as environmental toxicity from xenoestrogens. Women who have an insufficient detoxification capacity often have an overload of xenoestrogens, which clutters the estrogen receptors and thereby diminishes sex drive. Sometimes, introducing personalized detoxification can restore sexual desire in women of all ages. Occasionally women have low libido without an apparent cause, or they just want to highlight libido. If this is the case, I would usually use botanical supplements (“aphrodisiacs”) which are backed by good clinical research and supportive data, such as Trigonella forum graceum, Tribulus terrestrum and Mucuna pruines. These supplements have proven to increase sexual desire, sexual arousal and sexual frequency; however they need to be taken under medical supervision