Help Doctor, I Have No Sex Drive: Part 1

“Everything looks and feels normal. You should get your pap results within the week. Any other concerns?”  I ask as I finish the annual check up of one of my long term patients, a busy mom.

“No, all is good.” she replies with a smile, attempting to look relaxed in her paper exam gown.

But as I place my hand on the door to exit I hear,” Oh, I guess there is one more tiny thing.”

Sitting back down, I resume my listening stance on my rolly stool.

“I think I might need my hormones checked, because I have no sex drive.” she says rather sheepishly.

That conversation didn’t actually happen to me once today. It happened 3 times.

Based on the magazine headlines at the checkout, not to mention shows like Sex and the City (I’m referring to the TBS edited PG version, of course) women are supposed to be swinging from the chandeliers. Much like many other facets of our culture, the media paints an unrealistic picture of a woman’s sex life.

What is normal? The average married couple under the age of 30 has sex twice a week, whereas the average couple over 30 has sex once a week. Depending on which study you look at, 50-75% of women cannot climax through intercourse alone and up to 10% of women cannot climax at all. Obviously, each couple needs to figure out what works best for their needs. I don’t give you these numbers as something to aim for, but as an indicator that most housewives aren’t as desperate as the ones on ABC.

For a lot of women it’s helpful to know that having sex once a week and going through phases of life where you are not overly excited about it, is really pretty common.

At least 75% of couples will have difficulties with sexual relations at some point during their marriage. A staggering 40% of women over 40 report decreased libido, with 13% complaining of no sex drive at all. Decreased libido can be attributed to hormonal changes, medical conditions, relationship issues or medications.

Painful Sex

If sex hurts, it’s no wonder you don’t want to do it. A small amount of achy pain that resolves within a day is fairly normal, especially if it occurs near mid-cycle (ovulation). Any pain beyond that should prompt a visit to your doctor.

Painful intercourse is especially common among postmenopausal women or women who have had their ovaries removed. Hormonal changes of menopause can cause vaginal thinning and dryness. This can be easily treated by medications.

In the young woman, persistent pain with thrust is often a sign of endometriosis. Other symptoms of endometriosis including severe menstrual cramps and infertility.

Pain with insertion that is not relieved with lubrication can be caused by spasms of the vaginal muscles (vaginismus) or inflammation of the tissue at the vaginal opening (vestibulitis). These conditions can also be treated by your gynecologist.

Medications

Some medication can effect sex drive; the two most common are anti-depressants and birth control pills. The reasons birth control pills help reduce acne is that they bind the excess testosterone in your system, which is great for your skin, but not so much for your libido.

Other common medications that have been linked to decreased libido:

• Ativan
• Tegretol
• Tagament
• Benedryl
• Atarax
• Depoprovera
• Alleve
• Dilantin
• Zantac

 Too Much Sex

As I’m evaluating a patient for decreased libido, the next question I ask is “How often are you having sex?” Occasionally the answer will be daily or multiple times a day.

My reply is often an unfiltered “Really, everyday?” (These are usually women without children.)

Desire means ‘to look forward to.’ If you are doing it twice a day, that doesn’t give you much of a break to long for the next encounter.

On the other extreme, some women will report only having sex every 6 months to a year. “I just don’t ever feel like it ” they often say. My reply to that is, “If you only do it every 6 months, how can you even remember if you like it?” It is equally dangerous to find yourself out of the habit of having regular sexual relations.

Medical Conditions

Certain chronic medical conditions like diabetes, thyroid disease and hypertension can effect sex drive and sexual function. It is important to inform your doctor of these symptoms so that she can evaluate physical causes of your symptoms.

Depression

Depression is a common cause for lack of interest in sex. Other symptoms of depression include fatigue, feeling like you are numb, crying spells, sadness, wanting to run away and being easily distracted. Depression is very treatable with therapy and/or medication.

Life

Stress. Work. Kids. Laundry. Sex. To some women, sex becomes another box to check off on their long list of chores. 

They don’t want it to be that way, but the realities of their busy life make it so. A busy life with sex at the bottom of the checklist is the most common cause of decreased libido.

So what’s the answer? See you doctor to make sure everything is physically, medically and hormonally healthy. If all is good, then life stress is likely playing a role in your waning desire. Stay tuned for part two of this post, where I  will offer suggestions for helping the busy mom get her groove back.

Dare I ask a question at the bottom of a sex post….

What do you find to be the most challenging for you in your intimate relationship with your husband?

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