“Anything else?” I asked as I was about to leave the room.
We had just finished up my patient’s annual exam. She and I had caught up on life and families. I’d seen the latest pics of her adorable kids whom I had the pleasure of delivering, gotten the necessary business of her Pap smear out of the way, and made sure she had contraception in place. I was about to exit the room, but I sensed a hesitation from her.
“My husband wants me to talk to you about my sex drive.”
The Mechanics of Low Libido
This conversation is brought up in my office several times a week. The range of stories is wide, from “we’re only having sex a few times a week” to “I can’t remember the last time we had sex.” Regardless of the specifics, a low sex drive, or low libido, can be a significant concern for women and men alike. The task in conversations about libido is to differentiate between someone who has gotten out of the habit of sex but still enjoys it once she engages in intimacy, versus someone who has hypoactive sexual desire disorder (HSDD). Female HSDD is fairly common. It could be diagnosed in almost one-third of adult women in the country. The defining characteristic of HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or relational strife.
Libido is not an on/off or black/white situation; it’s full of shades of grey. Libido can also be influenced by current and recent life experiences (childbirth, surgery, menopause) and can fluctuate on a daily basis depending on the menstrual cycle. For women specifically, libido has multi-factorial influence. As a generality, men want to have sex to feel good. And women want to feel good to have sex. We women are much more likely to be “in the mood” if our children are behaving, the to-do list is done, and that amazing partner of ours is being helpful and kind. If we are preoccupied with one thing or another, we are far less likely to be want to devote time and energy to intimacy.
Low libido and HSDD both are tied to physical and emotional dissatisfaction and unhappiness. When women don’t feel good about their bodies, they are less likely to want to show it to someone, have someone touch it, or express themselves or gain pleasure from it. Self confidence, self worth, and a good libido go hand in hand. Feeling good in your own skin is a hard skill to learn. This skill is one that we must hone as we move through life as women, and our bodies endure what life (and bringing life into this world) does to them. Learning to love our bodies and ourselves is not historically something that popular culture has been helpful with. There are campaigns that are trying to shift the norms and promote body positivity across the spectrum, but these are not the predominant influence in our current culture.
The big truth however, and one we don’t grasp well as women, is that our partners frequently DO NOT CARE what our body looks like. If the scale reads five or 10 or 20 pounds more than we would like, they usually don’t see that. If you happen to let them see you naked . . . all they see is a naked lady, and that’s just fine with them. Saggy boobs from nursing your babies? They honestly don’t care as long as you give them the occasional access. The take home here is that our hang ups are our own. As soon as we start to give ourselves some grace, we can start to appreciate our bodies for the wonders that they are, not all that they are not. With that acceptance can come an increased willingness to share those bodies with our partners.
Other emotional factors that can contribute to sexual dysfunction can include depression and anxiety. Untreated anxiety and depression can make sex a very low priority for most people. When just making it through the day is taxing in and of itself, “extras” like intimacy with our partners becomes “extra” taxing. The unfortunate thing is that many medications that treat anxiety and depression may also adversely affect sexual function, even when anxiety and depression is fully treated.
Get that Sex Drive Functioning!
All told, sexual dysfunction is a complex issue, and one to discuss with your doctor. It may be as simple as lifestyle changes, or as complex as medication changes, additions, or subtractions. The good news is that some lifestyle changes are easy to implement and try on your own. Here are some suggestions I give to my patients.
- Bibliotherapy: Get yourself a good romance novel. Yes, reading about sex and thinking about sex make you more likely to want to have sex!
- Date nights: If you can not remember the last time you and your partner spent a few uninterrupted hours together with no kids, it’s time to reconnect. Emotional connection through conversation can lead to physical connection. Take some time to remember why you love this person, and then show him.
- Exercise: Yes, exercise makes it all better. It will improve how you feel in your skin, and HELLO ENDORPHINS. All those feel-good hormones your body releases during exercise are the SAME hormones your body releases during sex. Exercise and sex are both similar in that the more you do them, the more you want to do them. Get in a good habit of doing both.
- Schedule it: This may not sound sexy, but when life is busy, sometimes you just need to put it on your calendar. Pick a night, and make it the night that YOU engage sex with your partner. Again, making a habit of having sex will make you have more sex.
These suggestions are not going to help in certain situations. If you have pain during sex, please talk to your doctor. There are many things we can do to help with the different causes of pain during sex.
If you think you qualify for HSDD, make time to come and discuss it with your OB/GYN. There are some medications that can be used, and some modifications to your current medication regimen that may also improve things, but this should not be done without your doctor’s direction.
The final thing to leave you with is that there is no “normal” amount of sex to have. The right amount of sex for any one couple to have is one that they both want to have. And that amount will fluctuate throughout your life, and that is normal.
Remember to keep the dialogue open between yourself and your partner. Express your needs and allow him to express his, then come to a place where you can meet each other’s needs both in and out of the bedroom.
Originally published at Taking Back Libido :: An OBGYN’s Guide to Sexual Dysfunction: