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More Than Just an Excuse: No Thanks, I�m Not In The �Mood�

Posted Sep 13 2008 4:07am
According to a recent study, 53 percent of American women are not �in the mood�. 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. 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. If this sounds like you, counseling and therapy with your partner is probably your No. 1 treatment option to overcome 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! Sometimes, however, a medical condition is the underlying cause of low libido, and I�ll discuss them in turn below.

Medication Use: 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.

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Menopause: 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 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.

Depression: 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. A woman with dysthymia may feel isolated and overwhelmed and withdraw from sex and social activities.

If you're suffering from loss of libido and think there is a medical basis for your problem, here are some solutions to consider:

Talk to your doctor 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. Through my practice I have found testosterone central to a woman's sexual function, that no lover and no amount of sexual stimulation can make up for its absence. Testosterone to treat FSD has not been approved by the FDA, 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.

Switch to medications 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. In my practice I generally switch to one that has less of a sexual side effect, like Celexa, Wellbutrin, BuSpar, Serzone or Effexor.

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. 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 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.

Additional resources on female sexuality are available from MayoClinic.com:

http://www.mayoclinic.com/health/kegel-exercises/WO00119
http://www.mayoclinic.com/health/sexual-health/HA00035
http://www.mayoclinic.com/health/womens-health/WO00110
http://www.mayoclinic.com/health/sexual-health/HQ01363
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