Let's talk low libido

As a family medicine physician, I understand how low libido and sexual issues can be an uncomfortable topic for patients to discuss. These are common problems that affect adults everywhere, yet many of the patients I see have never been asked about their sexual health. In some cases, discussing topics of this nature can be just as uncomfortable for the health care provider and, thus, are many times overlooked. However, many primary care, psychology and OB-GYN providers specialize in the care and treatment for issues centered on a medical diagnosis for hypoactive sexual desire disorder, or HSDD.

While there's no magic pill or cure for your low libido, hopefully a better understanding of some the issues, causes, myths and initial treatments may help move you in the right direction.

Low libido in men

Some of the most common causes of low libido in men include:

• Physical issues
  Increased weight, diabetes, hypertension and high cholesterol all can effect the male erection. However, they can also lead to low energy and low self-image that can cause significant loss of libido. In many cases, this can be corrected through diet, exercise and medical management.
• Pornography
  This is a big one, folks. Pornography permeates many committed relationships and, unfortunately, affects young and old as a pseudo-low libido. What this means is that a person may still be interested in sex, yet not in the correct way. The way they view sexuality deviates, resulting in unrealistic expectations of body image, what an intimate encounter is and, in some cases, can lead to negative sexual behavior. The internet has been an extremely large contributor to this. Often, people who are committed to changing their behavior are referred to sexual addiction counseling to manage this effectively.
• Loss of intimacy
  I'm always amazed at how dedicated and committed people are to their job, career, sports team or extracurricular activities but treat their relationship like a given, self-maintaining entity. This simply isn't correct. Relationships, intimacy and sexual health all take work and require effort.
• Medications
  Many antidepressant medications used for anxiety and depression, such as Prozac, Zoloft and Lexapro, are known to lower libido in men and can, in some cases, delay orgasm. While some men have no side effects, others may encounter significant issues and need to follow up with their medication prescriber. Don't simply stop taking the medication.

These are merely some preliminary points to ponder. There is much more your primary care provider or another health care professional can offer you in the form of evaluation and treatment. Remember, the answer to your low libido is much more than turning to Cialis or Viagra. Acknowledging there's an issue and seeking professional help can be the start of getting back something great.

Low libido in women

The issue of low libido in women is even more complex, ranging from past negative and abusive experiences with sex to motherhood, working full time and, eventually, menopause scenarios.

Top issues related to low libido in women include:

• Life stressors
  After growing their family, many women not only are weeks behind on quality sleep, but also haven't exercised in months and eat only when they can find a spare second. It's no wonder they tell me they feel dead inside sexually. Often, they confide they don't feel like they could, even after a prolonged time, have a sexual or intimate encounter.
• Medications
  As with men, many medications, especially antidepressant medications, are related to lower libido in women. Yes, depression and anxiety lead to lowered libido. Yet, the medication you're on could be making it worse or causing it. This isn't a reason to stop taking an important medication, but it's definitely a topic to discuss with a sexual health specialist.
• Weight gain
  Weight gain can lead to low energy, negative self-image and the vicious cycle of loss of intimacy with your significant other.
• Birth control and menopause
  Many oral contraceptive pills can cause lowered libido. While this is not a common result, I always consider the possibility with an initial evaluation. In some cases, oral contraceptives can cause chronic irritation in female genitals that can lead to decreased willingness to initiate a sexual experience. Menopause poses many other issues, but the fluctuation/decrease in hormones at this life stage also can greatly affect libido.
• Sexual pain or dyspareunia
  If it hurts, why would you do it? The good news is that often this is something that can be treated. Initially, you'll need an evaluation by your sexual health specialist who can make recommendations for treatment. This is followed by close evaluation and, if needed, referral to a psychology specialist and pelvic floor physical therapist.

How to get help for low libido

First, contact a provider who specializes and has been trained in treating sexual health. We're few and far between, but we're out there and can assist in a potential diagnosis.

Initially, you can expect to work with your provider on a comprehensive history and evaluation, which includes filling out a questionnaire. This is followed by the creation of an initial plan put in place with a follow-up appointment for more discussion and a physical exam focused on sexual health. Finally, a treatment plan and, if needed, referrals will be made at that time.

Tips to combat low libido

Here are a few tips to combat low libido:

• Start an exercise program.
  Regular aerobic exercise and strength training can increase your stamina, improve your body image, lift your mood and boost your libido.
• Plan a trip — but leave the kids at home.
  Spend a good, dedicated vacation for just yourself or with your significant other. Don't go with other couples. This can be a distraction as you look to reconnect.
• Communicate.
  Yes, something as simple as sitting across from each other at a restaurant as you start to communicate again can do wonders. Make sure you keep topics light and have no expectation of an encounter later. Let the moment simply be about spending time with each other.

Graham King, M.D., is a Family Medicine physician in Mankato, Minnesota.