What to do for low Libido?

What to Do About Loss of Libido

A few years back I was chatting with a patient after her exam, and she started to ask me, “What’s the most common question you get from patients over 40—?” She never finished her sentence. I replied, “What happened to my sex drive?!” Every day, year in and year out, at least one of my peri- or postmenopausal patients asks me that question. Usually she thinks she's the only one experiencing this condition.

Unfortunately, it’s a very common complaint: Between one-half and three-quarters of women age 45 to 58 report a significant drop in sex drive.

And that’s just the ones who are brave enough to talk about it. While it’s no picnic for anyone, libido loss can be particularly distressing for women in long-term relationships who have enjoyed a good sex life and have now lost interest, much to their — and their partner’s — chagrin and surprise.

There are two main causes for libido flameout (after you’ve ruled out psychological ones, such as depression, stress or a change in relationship status): One has to do with estrogen, and the other, testosterone.

Loss of estrogen can affect your mood, but this in itself will not necessarily depress your libido, though the physiological side effects can make vaginal sex so painful as to render it virtually impossible or at least undesirable. When estrogen loses its decades-long influence after menopause, the vagina narrows, and the skin in the genital area gets thinner and less moist and loses its elasticity, leading to the No. 1 complaint of women in this age range: Sex hurts.

Along with the loss of estrogen, women stop secreting testosterone from their ovaries, thus diminishing their ability to become aroused and sometimes affecting their ability to reach orgasm. While some women barely notice these changes, for others they’re life-altering.

A 53-year-old patient who had her last period 18 months ago still wants to have vaginal sex with her longtime partner, but it’s too painful. On exam, I found the skin in the vaginal region was very thin and pale and showed a lack of elasticity. As I often will in this situation, I prescribed a local estrogen, the most effective remedy.

(MORE: Sex and the Midlife Woman)

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