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Libido

Libido

What is Libido?

The discussion around the nature and role of libido still continues. Through time various beliefs surrounding libido, including Freud and Jung’s interpretation as psychic energy, have been proposed but it is now accepted as being the strength of desire and response towards a sexual incentive. Yet it is not so simple.

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Desire & Arousal

Firstly, it is important to distinguish between sexual desire and arousal. Desire is the appetite for sex. This varies for everyone and there is currently no defined objective level of normality.

The difference between desire and arousal

Desire arises in various centres in the brain, heavily influenced by the neurotransmitter Dopamine in a positively correlated relationship. However, dopamine is itself influenced positively influenced by hormones such as Testosterone

Arousal

Following on but distinct from desire is arousal. Arousal is the process of the body preparing for sexual activity. It is controlled by the involuntary nervous system, which directs blood flow to swell the genitals and stimulate the heart and smooth muscle. The nervous system is in turn influenced by sensory stimuli of sight, smell and touch.

Men and Women

The exact molecular processes are different between men and women. Unfortunately, the female libido pathway is less well understood and researched although it is more complex as libido varies within menstrual cycles, peaking towards ovulation and then decreases following childbirth and menopause.

To further complicate matters, desire and arousal also mix with personal expectations, previous experiences and social behaviour in turning a person ‘on.’

Low libido

With increased knowledge of libido biology, low libido has entered medical circles as an illness that should be treated. Some debate this inclusion given that libido naturally declines in both sexes with age- from teenage in males and from mid -30’s in females.

However, low libido is not just a product of aging. Given its complex origin under so many influences, it can transiently occur in young and otherwise healthy individuals for many reasons. These can be summarised as being related to the head, heart and hormones.

Influences: Head, Heart and Hormones

Head: Of the many brain related factors that influence and reduce libido, the most common are stress, personality and psychological disorders such as depression.

• Heart: There are also many social causes of low libido. The most common is relationship dynamics spanning a whole range of issues including a lack of arousal. Lifestyle factors that influence libido range from alcohol and drugs use to over/under exercising to religious or family concerns.

• Hormones: While testosterone is the most important libido hormones, others including serotonin, oxytocin and oestrogen are also involved. Anything interfering with these or the neurotransmitters will affect libido. Relevant medical conditions include hypothyroidism, vascular disease and diabetes. Genital issues such as erectile dysfunction in men and painful intercourse (dyspareunia) in women lower libido. Many medications have been recognised to reduce libido such as SSRI antidepressants, antipsychotics, beta blockers and statins*. Surgery to remove ovaries or the womb can affect hormone release and hence libido.

How to increase your libido

Low libido can have serious consequences, particularly for relationships, given its function to maintain intimacy. Relationship difficulties can in turn affect psychological health.

Men

Hence in the medical world, there has been much recent activity on finding a cure to low libido. For men, testosterone replacement is known to effectively restore libido. However, its use is still not entirely established or recommended, due to concerns over its long-term safety**.

Women

Testosterone has lately also been tried in women. However, research outcomes have been disappointing with little to no benefit found. In August 2015, the FDA approved a new drug for women called Flibanserin. Working by increasing the amount of Dopamine in the brain, it is unfortunately associated with side effects of nausea, dizziness and fatigue for only an increase of half a satisfying sexual encounter per month. It is still the subject of much debate and research, but it is not yet recommended or established in the medical community.

Particular foods and supplements are also frequently claimed to improve libido by health magazines but there is no established research evidence for any of them – although this is also because they are rarely studied.

Lifestyle

So unfortunately there is no clear, safe and widely available treatment for boosting libido. For most people, as there is no underlying medical cause for low libido, treatment focuses on lifestyle (controlling any alcohol/drug intake and normal exercise levels) and relationship interventions (like counselling) to maximise internal desire and arousal capabilities.

So do not suffer in silence! Consult your doctor for further advice.

*It is important to note that these medications are used in the treatment of conditions such as heart disease and depression which themselves lower libido, potentially making the problem worse! Other medications used for a variety of reasons known to reduce libido are: opioids, finasteride, spironolactone, metoclopramide and ketoconazole.

** See earlier post on testosterone deficiency.

© Syed Z Arfeen
Medical Advisor
March 2017