Hypoactive Sexual Desire Disorder
Blood Flow Problems | Pharmacological Causes for Low Sexual Desire | What Can You Do? | Medical Causes of HSDD | Overcoming Libido Loss
Hypoactive Sexual Desire Disorder is a lack of sexual desire that causes a woman personal distress. This includes a persistent or recurring deficiency or absence of sexual fantasies or thoughts, or a lack of interest in sex or being sexual. Often women suffering with this complaint will report they feel "flat" sexually or sexually "dead".
Medical factors: e.g. medications.
Emotional factors: e.g. depression, anxiety, stress.
Relationship factors: e.g. conflicts, anger, lack of trust
Menopause: natural or surgical.
Sexual arousal disorder: e.g. sex is frustrating and/or painful.
What Can You Do?
First, consider whether there are indeed emotional or relationship variables contributing to your problem. It helps to be evaluated by a trained sex therapist who can help you sort this out. Rule out medical causes as well. The first step is to rule out hormonal factors, especially low testosterone. This can be accomplished with simple blood tests. From what we presently understand about the role of testosterone in women, Free Testosterone should be a minimum of 1.9 and Total Testosterone should be a minimum of 20. If your testosterone is low, you can talk to your doctor about potentially replacing your testosterone. If you feel like your sexual response is low and that is feeding into your lack of interest due to pain, dryness, or lack of response or arousal, or physical release, you should consider seeking evaluation and treatment of sexual arousal disorder.
Blood Flow Problems
Low blood flow to the pelvic organs can affect arousal, engorgement, and lubrication. We have named this disorder clitoral and vaginal vascular insufficiency syndrome, which has a variety of causes. Each of these problems often interacts with the others. Among the most common are:
Coronary Heart Disease:
This is also known as atherosclerosis, is the buildup of fatty material called plaque along the inside walls of the arteries. The buildup narrows the arteries and ultimately can cut off blood flow to vital organs like the heart or brain, causing heart attack or stroke. This same buildup can restrict blood flow to the arteries leading to the pelvis and genitalia, causing diminished arousal. Human studies show that diminished pelvic blood flow can lead to thickening and fibrosis of both the vaginal wall and smooth muscle tissue of the clitoris. This can lead to vaginal dryness, and loss of the elasticity and moisture in the vagina.
High Blood Pressure:
This reflects an abnormal increased pressure of the blood flowing in the arteries as they feed organs and tissues. High blood pressure can lead to damage of blood vessels, making them more prone to a buildup of fatty deposits and coronary heart disease (see above). High blood pressure is known to cause erectile dysfunction, but its effect on women is just now being studied. It makes sense that high blood pressure in women can be associated with decreased pelvic and genital blood flow, also contributing to decreased sexual arousal, decreased vaginal lubrication, and pain.
This involves the buildup of a waxy, non-soluble substance made up of different types of fat. Bad (LDL) cholesterol allows fat to build up in the walls of the arteries. A woman's cholesterol level is one factor in her risk for heart disease. When a woman has a high level of bad cholesterol, the fat builds up on the walls of the arteries stimulating abnormal growth of cells that scar and inflame the artery lining and lead to the formation of plaque. Large amounts of plaque can cut off the blood flow through the arteries to the vital organs and the pelvic region. Diminished blood flow will likely reduce a woman's sexual sensation and her ability to become sexually aroused.
This causes blood vessels to constrict, reducing the flow of blood to the heart, lower extremities, and the pelvic area. Toxic substances in the smoke may also damage the artery walls and help cause coronary heart disease. Long term, heavy smoking over a lifetime may well play a significant role in reducing blood flow to the pelvic region and cause a woman to have a diminished sexual response.
Particularly prolonged riding on a standard bicycle seat may crush the bundles of nerves and arteries leading to the clitoris causing sexual dysfunction. In one study, of 282 female bike riders, more than 40 percent reported clitoral numbness.
What Can You Do?
Certainly ceasing any health risk behaviors that are negatively impacting on your genital blood flow is important (e.g. smoking, high cholesterol, etc.). Beyond that, it is important to seek evaluation and treatment from a health care professional who is trained in treating female sexual function complaints. There are ways to evaluate blood flow to the genital area, as well as genital sensation and lubrication (both connected to blood flow) by using ultrasound and sensory perception devices. This way the problem can actually be diagnosed. In terms of treatment, there are several blood flow enhancing agents such as Viagra and the EROS- CTD and devices, as well as numerous other treatments presently under trial that you may be a candidate for so that some degree of blood flow can be restored in order to enhance your sexual response and function.
Pharmacological Causes for Low Sexual Desire
There are several drugs and medications that may contribute to low sexual desire. Many medications, even the most common, can adversely affect sexual response. Some of the most common are:
Tamoxifen, prescribed to delay the recurrence of breast cancer can cause vaginal bleeding, vaginal discharge, menstrual irregularities, genital itching and depression.
Anti-seizure drugs including phenobarbital (Luminal) as well as Dilantin, Mysloine, and Tegretol can cause sexual dysfunction.
Tricyclic antidepressants like clomipramine (Anafranil) and some selective serotonin reuptake inhibitors (SSRI) such as Prozac, and Paxil are known to cause sexual dysfunction.
Traditional medications prescribed for high blood pressure; beta-blockers marketed under the names Inderal, Lopressor, Corgard, Blocadren, and Tenormin.
Cimetidine or Tagament have been shown to cause impotence in men. We do not know the sexual side effect in women as yet.
Birth control pills:
Some women who take progestin-dominant pills complain of a loss of libido and vaginal dryness because of hormonal shifts.
Antipsychotic drugs like Thorazine, Haldol and Zyprexa can cause sexual dysfunction and emotional blunting in some patients.
Medications like Xanax and Valium, prescribed for anxiety, can cause loss of desire and arousal.
What Can You Do?
Talk to your doctor. Not only may there be alternatives to the medications you are taking, but you may be a candidate for another medical treatment that will counteract the negative sexual side effects you are experiencing. For instance, several studies have indicated that Viagra seems to counteract the negative sexual side effects of SSRI's. However, it is crucial to realize that while it is important to know how your medications may be playing a role in your sexual function complaints, it is important NOT to stop any medication without talking to your doctor first.
Hypoactive sexual desire disorder (HSDD) is the most common form of female sexual dissatisfaction (FSD) and occurs when there is a persistent lack of desire or absence of sexual fantasies. In other words, you're rarely in the mood; you neither initiate sex nor seek stimulation.
Lack of desire often occurs as a result of relationship conflicts, say Drs. Jennifer and Laura Berman, two of the nation's top experts on sexual health for women.
"Communications problems, anger, a lack of trust, a lack of connection and a lack of intimacy can all adversely affect a woman's sexual response and interest," they write in their book: For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life.
If this sounds like you, counseling and therapy with your partner is probably your No. 1 treatment option to overcome HSDD, the sisters say.
Medical Causes of HSDD
Obviously, lifestyle factors also influence the desire for sex. A single working mom who is overwhelmed by family needs may feel too exhausted to relax, kick back and fantasize about sex, let alone engage in it! However, sometimes a medical condition is the underlying cause of low libido, including:
Many commonly prescribed drugs, such as antihypertensives, antidepressants and birth control pills, interfere with sex drive, arousal and orgasm by affecting the balance of sexual hormones and the transmission of chemical messengers. For instance, antidepressants known as selective serotonin reuptake inhibitors combat depression by increasing the production of serotonin in the brain. Unfortunately, serotonin dampens sexual desire.
The onset of menopause, either surgical or natural, is characterized by a gradual decline of the hormones estrogen, progesterone and testosterone. Reduced testosterone levels, in particular, say the Bermans, can lead to a "sudden or gradual" decline in libido. Ironically, the conventional hormone replacement regime of estrogen and progesterone given to relieve menopausal symptoms can make matters worse, because estrogen increases a protein (called steroid hormone-binding globulin) in the blood that binds to testosterone, causing it to become less available to the body.
A common symptom of depression is diminished sex drive, which, in turn, can exacerbate depression. Studies indicate that 12 percent of all women will experience clinical depression at some point in their lives. As mentioned, one of the side effects of the popular antidepressants Prozac, Paxil and Zoloft is loss of libido. Dysthymia is a lower-grade form of depression that is not easily diagnosed because you can function with it, note the Bermans. A woman with dysthymia may feel isolated and overwhelmed and withdraw from sex and social activities.
Overcoming Libido Loss
If you're suffering from loss of libido and think there is a medical basis for your problem, here are some solutions to consider:
about testosterone, especially if you have had your ovaries removed, are taking estrogen or under severe stress. Get your testosterone level evaluated and if it is below 20 nanograms per deciliter, consider starting testosterone therapy. "To us, testosterone is so central to a woman's sexual function, that no lover and no amount of sexual stimulation can make up for its absence," write the Bermans, who report enormous success in treating low-libido patients with supplemental testosterone. Testosterone to treat FSD has not been approved by the FDA, notes Dr. Jennifer Berman, so you'll need to find a physician open to prescribing it to treat lack of sexual desire. If you are already on hormone replacement therapy for menopausal symptoms, ask your doctor to add testosterone to your regimen.
known to have less effect on sexual function or lower dosages. The antidepressants Prozac, Zoloft and Paxil, of which women are major consumers, cause loss of libido in as many as 60 percent of patients. "We generally switch to one that has less of a sexual side effect," like Celexa, Wellbutrin, BuSpar, Serzone or Effexor, says Jennifer.
Viagra, the little blue pill
may help jump-start your sex life as long as "you have the desire to engage in sex and have been stimulated enough for it to take effect," say the Bermans. It's especially helpful if your lack of desire is related to hysterectomy or menopause. Physicians aren't exactly sure how Viagra helps rekindle lust, the Bermans are investigating how it works in their clinic, but they know it helps women achieve arousal, which is the phase that comes after desire, by increasing blood flow to the vagina, clitoris and labia.
Content reprinted with permission from Neil Baum, MD, neilbaum.com.
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