This is one of those topics no one wants to talk about.
In a committed relationship, kissing and sex is an incredibly healthy activity.
Sex is good for the immune system, can help lower blood pressure, has been shown to lessen pain, improves sleep, lowers stress levels, strengthens the relationship, improves mood and, specifically in men, reduces prostate cancer risk.
As good as all of that sounds, and as great as sex often feels, to many adults, the thought of sex sounds like a chore.
Amateur's Guide to Libido – Part One
The desire for sex is driven by emotional, mental and physical states. And while a couple’s relationship needs to be in a good spot, there are a lot of other factors that affect the desire for sex.
Unfortunately, many people assume that the relationship is the problem, when in reality, there may be some physiological reasons why things just aren’t happening.
With that idea in mind, if your relationship isn't in a good spot, tweaking hormones, using supplements or eating oysters isn't likely to get you or your partner in the mood.
What is Libido?
In short, libido is sex drive. It's a conscious awareness of a desire for intimacy with another person.
Though we can clearly envision when it's high or when it's low, giving it a greater definition is difficult. It's like describing “air.” We know that it surrounds us. We are aware when we can't get enough of it, but we can't really describe or define it.
Men are known for having a greater desire than women, but the rates of low libido are increasing in both genders.
What is “Low” Libido?
Average sex drive across a population may not be normal for an individual. However, a very low libido should not be considered normal for an individual. Nor should an insatiable appetite for sex.
The clinical condition of low libido is called hypoactive sexual desire disorder (HSDD). HSDD can be caused by:
- Neurotransmitter imbalances
- Insufficient or imbalanced sex hormones like estrogen, testosterone, cortisol, DHEA and progesterone
- Environmental toxins
- Lifestyle issues such as insufficient sleep, relational or financial stress or work stress
- Other health problems such as obesity or heart disease
- Mental health issues such as body image and trust issues
Recent research shows 43% of women and 31% of men have a low level of sexual desire.
Frequency of Sex
Obviously, when libido is low, many people won’t engage in sex. According to WebMD, married couples have sex an average of
- 112 times per year in the 18-29 year old age group
- 86 times per year in the 30-49 year old age group
- 69 times per year in the 50-49 year old age group
About 80% of men and women, married or couples, aged 25-50 have sex at least a few times per month. About 25% have sex two to three times per week.
After age 50, the frequency tapers down to about 50% having sex at least a few times per month.
A Georgia State University study found 15% of married couples have not had sex with their spouse in the past 6-12 months.
There seems to be a trend toward less interest in sex. Our overbooked lifestyles could be a factor, but as you’ll see, some physiological factors are at play as well.
Low Libido in Men
Men are expected to desire sex. They think of it multiple times per day. Except when they don't.
And when they don't, they know something isn't right, but often ignore it, bottle it up or just refuse to admit it.
As a result, it may appear that low libido is more of a female issue, but this may not be true. It's just that guys aren't sharing the issue as often as it actually occurs.
Men, Libido and Self-Confidence
If a guy loses self-confidence, due to frustrations at work, or job insecurity, he becomes more likely to lose interest in sex.
Interestingly, if men aren't having enough sex with their significant other, it kills their self-confidence. Eventually, with the lower self-confidence, they may also lose interest in sex.
It's a catch-22.
Frustration at work or a loss of self-confidence in other areas may sabotage his libido, and an understanding partner might have to help him through this.
Men, Libido and Erectile Dysfunction
Tom and I watch about four hours of television per week, but we've been shocked by the number of erectile dysfunction commercials lately. These ads seem to proclaim that the key to great sex is just swallowing a pill.
What these commercials fail to mention is that erectile dysfunction is often related to cardiovascular problems or low testosterone.
Of course, if a guy can't “get it up,” it might be a total blow to his self-esteem, and low self-esteem can further sabotage his libido. Do you see the pattern here?
If erectile dysfunction is an issue, please get some comprehensive lab testing done. Difficulty in maintaining an erection may be a sign of something worse than no erection (yes guys, there's something that could be worse).
Men, Libido and Hormones
Low testosterone levels are consistently associated with low libido. And, depression is common in men with low testosterone.
In Europe, when men complain of low libido or erectile dysfunction, they usually have their hormones tested by their doctor. In the United States, they're more likely to just get an antidepressant medication.
Low testosterone is also associated with, loss of muscle, increased visceral fat, reduced bone density, reduced libido, Alzheimer’s disease and heart disease.
Each of the conditions associated with low testosterone could be causes of low testosterone, or low testosterone could contribute to their development. Testosterone tends to drop with age as well, but this may be more a result of lifestyle and nutrition habits than aging itself.
Low Libido in Women
Libido in women is often tied to emotions. Disappointment, anger, frustration, sadness, loneliness, and other emotions can cause a swift loss of libido.
Short-term stress and negative emotions, as well as chronic stress can undermine libido in women, whereas men tend to be more affected by long-term than acute stress.
But often overlooked is the fact that over time, emotions can affect hormones, and hormones can affect libido.
Even though a woman may be in a better emotional state, it's possible that her physiology has changed enough that her libido won't come back on its own.
I also want to make mention of the fact that past sexual abuse, in women or in men, can play a role in their libido. This topic is way beyond what we're covering here, and won't be solved with diet, supplements, or even pharmaceuticals alone.
Stress, Testosterone and Low Libido in Women
Stress is a major factor in a female's state of health.
When you have pressing issues on your mind, like young kids, troubled teens, financial woes or job pressure, it’s hard to remove them from your mind and let it relax enough to contemplate sex.
But stress does more than work against the brain. It can actually disrupt hormones; so much so, that you may not regain your libido even after the stress is resolved.
Mental, physical or emotional stress stimulates cortisol production. Cortisol is secreted by the adrenal glands.
In women, 25% of testosterone is produced by the ovaries, 25% by the adrenal glands, and the other 50% of testosterone is produced from hormone precursors like DHEA and androstenedione, which are also produced by the ovaries and adrenal glands.
About half of a woman's testosterone is dependent on healthy adrenal glands.
But if the adrenal glands are overburdened from producing the stress hormone, cortisol, they won't be as effective at producing DHEA or testosterone.
High stress levels zap the body's ability to produce DHEA. When DHEA levels fall, testosterone levels fall and so does libido.
More than 16 million women in North America admit to low libido, and a large percentage of these women have low androgen levels.
Aging, Low Testosterone, and Low Libido in Women
After menopause, the ovaries don't do much. Remember how much testosterone comes from the ovaries? Half of a female's testosterone come from the ovaries, either directly, or indirectly as testosterone precursors.
Imagine what could happen to a post-menopausal women under stress? Neither the ovaries nor the adrenals may do their job in producing the right sex hormones. It's like a double-whammy.
While women cannot prevent menopause from happening, they can take action to keep their progesterone, testosterone and estrogen levels in balance.
The first step is in getting their hormones checked regularly. We'll talk in part 2 about some of the ways to improve hormone levels once they get out of balance.
Other Causes of Low Libido
Other obvious causes of low libido include:
- Chronic disease
- Past surgeries
- Pregnancy and breastfeeding
- A lack of trust in or resentment toward a partner
- Alcohol consumption (a little boosts libido, too much snuffs the fire)
- The use of certain pharmaceuticals, including some antidepressants, birth control pills, Propecia (for male hair loss), anti-anxiety medications, and beta-blockers
Other drugs, such as cholesterol medications may indirectly affect libido, by lowering testosterone production as cholesterol is a building block for sex hormones.
If you are experiencing low libido, one step you can take today, is to talk to your doctor, or order your own comprehensive lab testing.
Share your thoughts. Share this post.
Sign up for our newsletter so you don’t miss future articles, including Part Two on Libido.
American Psychiatric Association. Female Sexual Interest/Arousal Disorder, 302.72 (F52.22). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013. American Psychiatric Publishing. p. 433-437
Fonseca HP, Scapinelli A, Aoki T, Aldrighi JM. Female Androgen Deficiency. Rev Assoc Med Bras. 2010;56(5):579-82
Friedrich N, Völzke H, Rosskopf D, et al. Reference Ranges for Serum Dehydroepiandrosterone Sulfate and Testosterone in Adult Men. J Andro. 2008;29(6):610-617
Ganz PA, Greendale GA. Female Sexual Desire – Beyond Testosterone. J Natl Cancer Inst. 2007;99(9):659-61
Gianfranco D, Angelo T, Alfio M, et al. Impact of job insecurity on sexual desire: an exploratory analysis. Swiss Med Wkly. 2009;139(33-34):486-492
Guay A, Davis SR. Testosterone insufficiency in women: fact or fiction? World J Urol. 2002;20:106-110
Hayes RD, Dennerstein L, Bennett CM, Fairley CK. What is the “true” prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact? J Sex Med. 2008;5(4):777–778
Kara Robinson Mayer. 10 Surprising Health Benefits of Sex. WebMD. Accessed May 9, 2015. http://www.webmd.com/sex-relationships/guide/sex-and-health
Krapf JM, Simon JA. The role of testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. Maturitas. 2009;63(3):213-219
National Survey of Sexual Health and Behavior (NSSHB). Findings from the National Survey of Sexual Helath and Behavior, Centre for Sexual Health Promotion, Indiana University. Journal of Sexual Medicine. Vol. 7 Supplement 5
Safarinejad MR. Female sexual dysfunction in population based study in Iran: prevalence and associated risk factors. Int J Impot Res. 2006;18(4):382–395
Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5)970-8
Sowers MF, Beebe JL, McConnell D, Randolph J, Jannausch M. Testosterone Concentrations in Women Aged 25-50 Years: Associations with Lifestyle, Body Composition, and Ovarian Status. Am J Epidemiol. 2001;153:256-64
Wespes E, Amar E, Hatzichristou D, Hatzimouratidis K, Montorsi F, Pryor J. EAU Guidelines on erectile dysfunction: an update. Eur Urol. 2006;49:806–815