By J. Ron Eaker, M.D.

 

Has your sex drive driven off? Does a romp in the hay imply a fun time riding in a wagon with a bunch of straw? Are you more likely to win the lottery than have enjoyable sex with your spouse? If you answer affirmatively to any of those questions, you may be like a significant number of women who have a medical condition known as hypoactive sexual desire disorder.  

The medical definition of this common issue is a persistent or recurrent lack of interest in sex that causes you personal distress.

Two Parts—One Diagnosis

There are two very important parts of this description. One, it has to be persistent or recurrent. There are many instances where it is quite normal to not be feeling frisky. For example, if your house recently burned down, thinking about other things rather than a meaningful sexual encounter is quite normal. Often life gets in the way, so on these occasions, a lack of libido is routine. It’s only when this feeling becomes recurrent that an issue may be present.  

Second, the problem has to cause you personal distress. This is both necessary and subjective meaning that if you are not bothered by your lack of desire, it is hard to label it a significant issue. Frankly, many women I encounter are not particularly bothered by their lack of desire, but they are told they should be bothered by their spouse or an episode of “Sex in the City”. This illustrates the relative subjective nature of this problem and why it is so difficult to get an accurate sense of its prevalence.

For those who meet this definition however, decreased libido can be a significant problem. This definition also alludes to the fact that this problem can’t be taken out of the context. In other words, libido doesn’t exist in a vacuum. It is influenced by any number of things such as stress, marital relationships, physical and psychological issues and medications.

A New Treatment Option

The subject of female hypoactive sexual desire disorder has recently become more prominent due to the FDA approval of a new drug to treat this problem. Flibanserin (brand name Addyi) is the first medication approved by the FDA for any female sexual disorder. It has been erroneously labeled the “Female Viagra” by the media as it has no similarities to this erectile dysfunction drug. Viagra works to increase blood supply to the male genitalia to help with erections and has no impact on desire. The manufacturer of Addyi states that flibanserin corrects an imbalance of dopamine and norepinephrine (both responsible for sexual excitement), while decreasing levels of serotonin (responsible for sexual satiety/inhibition). Flibanserin is not a hormonal drug and does not affect blood flow like the class of drugs approved for men with erectile dysfunction.

This drug is not a panacea. Sexual desire is a very complex subject involving physical and emotional components and no one approach works for all people. It is important to remember this drug is treating a very specific medical problem. It is not intended to “give you a boost” or “set the mood”. The FDA website states, “Because of a potentially serious interaction with alcohol, treatment with Addyi will only be available through certified health care professionals and certified pharmacies. Patients and prescribers should fully understand the risks associated with the use of Addyi before considering treatment.”

Additional potential side effects of Addyi include causing severely low blood pressure  and loss of consciousness. These risks are increased and more severe when patients drink alcohol or take Addyi with certain medicines. Clearly this medication should only be used when the benefits outweigh the risks.

The most important information to glean about libido, or lack thereof, is that the top two reasons for declining sex drive are stress and fatigue. Libido, like appetite, is very subjective and what is normal for one may be abnormal for another.
One characteristic of hypoactive sexual desire is that it often represents a change from what was once a baseline desire. Again this must be placed in context of life events. For example, 75 percent of women will complain of a decreased libido for up to a year after childbirth This can be due to a number of factors but it is important to not label this immediately as a medical issue until other causes are entertained.

Along these lines there are some medications that may reduce sex drive. Perhaps the most common are the family of medicines known as the SSRI antidepressants (Prozac, Zoloft, Effexor, etc). Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.

The take-home message is that you should discuss any concerns you have with your doctor and see what options are available.

This article appears in the October 2015 issue of Augusta Family Magazine.
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