The Surrey Park Clinic
FEMALE HEALTH-GYNAECOLOGY-HORMONES01483 454 016
Stirling House, Stirling Road, Guildford, Surrey, GU2 7RF
Absent libido or sex drive is very common in women, and there can be many different reasons for this. Libido in women can be very easily affected by stress and anxiety, as well as general illnesses and hormonally related issues.
The pelvic floor tissues are very sensitive to oestrogen and testosterone, and low libido can be very closely related to times of low hormone production such as after childbirth and in the pre and postmenopause. Not only is there no desire to have sex but any attempt at intercourse can be painful due to lack of inelasticity of the tissues and poor arousal. Orgasm may not occur or is difficult and unfulfilling.
• Oestrogen deficiency
The ovary produces oestrogen in a cyclical pattern from puberty through to the menopause. As the quality of eggs reduces with age and coming up to the menopause the amount of oestrogen also falls. This occurs even if there is a normal cycle with normal periods, the levels of oestrogen achieved just are not as high.
Oestrogen is important to improve the blood flow to the vulva, clitoris and vagina; therefore low-levels of oestrogen result in failure of arousal and absent nerve response.
• Testosterone deficiency
Women produce testosterone from the ovaries, adrenals and other parts of the body, although not in nearly as high levels as men. Once the ovaries start to fail, testosterone levels also fall and many women without realizing it do suffer from this and notice the difference. Replacing testosterone to within the normal female levels (2.0 to 4.0 nmol/L) compared to normal male levels (10.0-50.0 nmol/L) can result in vastly improved levels of energy and sex drive.
Testosterone replacement on its own does not always work if there is inadequate blood supply to the pelvic organs and this is mostly oestrogen related. Therefore, it is as important that the vulva and vagina are “well oestrogenised” before starting testosterone replacement therapy.
• Diabetes
Diabetes can result in reduced blood flow by constricting the arteries. This means that many of the pelvic organs are starved of oxygen and nutrients and do not function correctly and the nerve endings can die away.
Treating diabetes is very important, not only for short-term quality of life symptoms but for long-term risks.
• Prescribed medications
The use of prescribed medications could also have an effect on your libido. It is important to discuss with the doctor at the time of your consultation at The Surrey Park Clinic any medications that you may be taking now or have taken recently. This may indicate as to why you have noticed a change in your sexual desire.
• Painful sexual intercourse
If you experience pain whilst having intercourse, this can have a negative effect on sexual desire and you associate intercourse with discomfort. Finding and treating the cause of the discomfort can soon see the return of sexual desire. Topical oestrogen (creams, pessaries) to 'rejuvinate the area and or dilators or surgical vaginal enlargement, can make all the difference.
• Depression
Psychological factors are very important in suppressing sex drive in women and depressed women often have no interest in sex and find it very difficult to become aroused. It is extremely understandable that if a woman is emotionally not happy, she may lose interest in sex for a period of time.
• Stress
Stress can have a direct effect on the production of hormones in the brain. Whilst in some people a high stressed job can enhance their sex drive and libido, this appears to be more common in men than in women, where stress and anxiety about work has the opposite effect.
Serious relationship difficulties can cause stress and therefore have a negative effect on one’s libido. Lack of libido can also cause relationship difficulties, so it is important to look at all factors surrounding it, as it can turn into a vicious circle if left untreated.
TREATMENTS
Loss of libido can often be put right, but it needs careful diagnosis of the cause. There are no ‘instant’ cures but with the cooperation of your partner a high proportion of women do eventually return to a normal libido.
Correct diagnosis for the reasons to the noticeable change to a woman’s libido are essential to ensure that correct advice and treatment can be given, for both physical and psychological cause.
• Female Symptom Questionnaire. Prior to your consultation you will be asked to complete a simple ‘tick box form’ relating to the symptoms you experience and each time you return to The Surrey Park Clinic you will be asked to re-do this. This form gives the doctor a huge amount of information, especially if a hormonal imbalance is the reason for your loss of desire.
• Blood samples. A simple blood test taken at the clinic will look at your body’s biochemistry and can detect hormonal imbalances.
• Ultra sound scan. Where there is loss of desire accompanied with discomfort on sexual intercourse, we may recommend that a scan of your pelvic region be carried out. This would show any physical cause for the discomfort, especially following a particularly long and traumatic childbirth, vaginal scarring or any other underlying pathology such as fibroids or ovarian cysts.
When all of the investigations have been thoroughly completed and the reasons for the lack of libido found, there are medications, which can be taken to improve your sexual desire and your general well being.
• Oestrogen replacement
This can be absorbed into the circulation (patches, gel, tablets and implants) and this way many other symptoms of hormonal lack such as,
• Flushes
• Sweats
• Mood swings
• Joint Pains
These symptoms can be treated, which will naturally help sexual interest. The application of local oestrogen can boost the health of the vagina and vulva by concentrating an extra amount oestrogen on that area in the form of cream, pessaries or a vaginal ring. The pelvis is the most sensitive area of the body to oestrogen and testosterone and if circulating levels are low, the sexual organs will simply not respond.
• TOPICAL OESTROGEN also carries the advantage of not being absorbed into the circulation, so in women who have risk factors or are concerned and do not want oestrogen in the blood stream, this is a good way of improving the health of the vagina, vulva and sex drive without any possible risks. Pessaries and creams are the most common ways, but many women benefit from an intravaginal ring.
• Testosterone replacement
In many countries, testosterone replacement is a routine form of HRT (hormone replacement therapy), although this is not the case in this country. That is because our main way of treating with testosterone has been in implant form and only recently have patches become available.
There are some gel forms of testosterone available now, predominantly for male use but if the quantity is reduced, then they are suitable for female use and levels can be measured.
DHEA (Andractim) cream, which is a precursor to testosterone, can also be of benefit. These medications are available at The Surrey Park Clinic.
• Natural aphrodisiacs – do they work?
There are a variety of ‘plant’ based products available to purchase without prescription, these claim to increase your sexual desire. Whilst these may in essence help to enhance your sex life we cannot stress enough the importance of finding out the cause of the loss of libido prior to commencing alternative therapies/medication.
We are happy to discuss natural forms of medication with you at your consultation.
