Water. Food. Shelter. Sex.

Only a few things in life are considered basic needs, as deeply imbedded in the human psyche as survival itself... after all, they’re essential to the existence of the human race.

For many women and men in 21st century America, however, the ol’ sex drive isn’t what it used to be. They may not be worried about contributing to the survival of the species, but they sure wouldn’t mind feeling that “spark” again.

What happens to libido, and what can be done to rev up a low or non-existent sex drive?

Fortunately, there are solutions. Unfortunately, one of the problems is that sex drive isn’t exactly a level playing field to start with.

“In general, women tend to have a lower sex drive as they age, while with men, their libido tends to stay the same. With women, a lot of this is due to the decrease in testosterone that occurs after menopause,” explains Dr. Sarah St. Louis, MD, FACOG, one of the physicians at UroGyn Specialists of Florida, which has several locations in central Florida, including The Villages.

Hormonal Changes

Hormones have far more influence on your sex drive than you might imagine, but this is something the average person never even thinks about until it happens to them or their partner.

Both women and men can su er libido trouble due to hormonal changes. Testosterone levels naturally drop as we age, which can be problematic because this hormone is vital for your sex drive.

Blood tests can detect low testosterone levels and reveal whether you need hormone therapy to supplement your natural testosterone.

Men seem to have more options when it comes to treatment, though, including:

› Topical testosterone cream or gel

› Transdermal testosterone patch

› Testosterone injections

› Testosterone pellets implanted under the skin to slowly release the hormone over a period of months

There are also a variety of nutritional supplements advertised to increase the body’s natural testosterone levels, but typically, these products are not approved by the Federal Drug Administration (FDA). What works for one man may not bring about any noticeable change for another.

For women, testosterone, although vital for libido, is prescribed in much smaller doses, if at all, because of potential risks. It is sometimes added to vaginal hormone replacement creams.

Where To Start?

If nookie is the last thing on your mind, you may suspect hormones are to blame, but how can you be sure? And what if it’s more than that?

This is the million-dollar question, as talking to a doctor about sex doesn’t rank high on most people’s lists. And, even if you are brave enough to mention it, many health professionals aren’t sure what to recommend, so loss of libido is frequently overlooked or not addressed.

Your primary care doctor is a logical starting point, but a visit to a specialist is usually needed. For many people, this depends on their particular insurance coverage, as a referral may be required.

For men experiencing issues with erectile dysfunction (ED), a trip to the urologist may be the solution. As many as 30 million men in the United States are a ected by ED, but there are multiple treatment options to compensate for decreased testosterone, blood flow and nerve conduction issues. Medication has revolutionized ED treatment, which you’re undoubtedly aware of if you’ve seen any television commercials over the past decade.

For women, a urogynecologist is often the recommended specialist. Physicians in this field focus on the bladder and urinary tract, so this is who you want to see for issues with low sex drive, bladder leakage, recurrent urinary tract infections (UTIs) and overall pelvic floor concerns. This specialty has been around for decades but has only recently been recognized with boardcertification programs.

“Women don’t typically go to the doctor with complaints about sex drive, but at our practice, we really want to talk about it because it’s an important medical concern,” says St. Louis.

“Sometimes a patient is right on the mark about what their problem is, but other times they don’t know what’s wrong,” she notes, adding that the starting point is a physical exam and detailed history. Although the e ects of low hormones are apparent in a physical exam, blood work to check hormone levels is commonly part of the process.

If a woman has had past pregnancies, her obstetric history is also important. Di cult deliveries or surgery involving the pelvic floor can definitely cause problems with libido if they result in painful sex.

It’s not unusual for the culprit to be multiple issues, often both physical and psychological. For example, pain with intercourse is like dumping a bucket of cold water on a woman’s sex drive. You may love and desire your partner, but intimacy is no fun when it hurts.

Vaginal dryness due to lack of estrogen is the most common

ThermiVa has been shown to help reduce vaginal dryness and atrophy, reduce urinary leakage and improve symptoms of orgasmic dysfunction. Most women require three treatments.

Multiple Issues

We humans are a complex species, and this is certainly apparent when it comes to libido problems.

In addition to hormone levels and vaginal dryness, there are numerous common physical conditions that can directly impact sex drive. These include:

› High blood pressure

› Heart disease

› Type 2 diabetes

› Peripheral nerve disease

› Fibromyalgia

› Chronic pain

› Autoimmune disorders

› Uterine prolapse

› Pelvic floor muscle spasms

› Bladder leakage

› Cancer treatments

Additional issues that can wreak havoc with interest in sex are lack of sleep, alcohol consumption and recreational drugs.

“Sometimes low libido is a result of something women are uncomfortable with physically, such as uterine prolapse or leaking urine during intercourse,” says St. Louis. “Because of how their bodies are functioning, they’re no longer interested in sex, even if they have a loving and willing partner. For example, prolapse, which can become more prominent after menopause, can be profoundly ‘unsexy’ and stressful for women. We have to help them with the primary cause of painful intercourse, leading to decreased interest in sex, according to St. Louis. For many women, lack of estrogen can lead to recurrent UTIs, which, over time, may increase resistance to antibiotics. Vaginal estrogen replacement therapy is the No. 1 way to treat recurrent UTIs.

Such hormone therapy is routinely used to treat vaginal dryness, but it’s not the only option.

“Hormones have to continually be replaced to resolve the symptoms. A more permanent treatment, which has the same e ect as using vaginal estrogen therapy, is ThermiVa, which uses radiofrequency technology to gently heat the vaginal tissues,” says St. Louis. “This increases blood flow and rejuvenates the collagen in that area; it basically reconfigures the wall of the vagina and increases lubrication.” issue so they feel better about sex.”

St. Louis emphasizes the fact that although symptoms may be common, each woman is unique, which means there is no one-size-fits-all treatment.

“I prefer treatment options that are least invasive and come with less risk, but I discuss each option. Together with the patient, we assess whether any risks outweigh the benefits or vice versa and then come to a decision as to what will best help them,” she notes.

Once physical issues have been addressed, if low sex drive is still an issue, it may be time to talk—with a therapist or couples counselor, that is. Problems and stress in a relationship can be a huge libido buster, even if everything’s working fine “down there.”

Sex, Drugs & Stress

Make no mistake, psychological concerns can also play a huge role. Stress (especially ongoing stress), a history of past trauma or abuse, anxiety or depression can all significantly impact libido.

Don’t underestimate the e ects of stress, something many Americans live with on an almost daily basis. When you’re constantly under stress, your body’s fight-or-flight response is constantly triggered, which naturally shuts down any interest in sex.

“Social situations and stress in life and with your partner all can play a role in low libido,” St. Louis notes. “All of this must be taken into consideration and addressed when a patient comes in with concerns about libido and may require more than one treatment or therapy.”

Decreased interest in sex is also a side e ect of some medications. Among the two major categories of drugs that can cause these problems are antidepressants and antipsychotics.

Antidepressants that fall into the category of selective serotonin reuptake inhibitors (SSRIs) are particularly known for lowering libido, as well as causing erectile problems. Studies have shown that switching from an SSRI antidepressant to a buproprion HCI antidepressant can improve erectile function in men and improve sexual desire in women. So if you’re taking an antidepressant and struggling with low libido, it’s definitely worth talking to your doctor about how a change in medication may help. Sometimes all that’s needed is a change in dose or in the class of drugs being used.

O-Shot

Men may have the “little blue pill,” but women have a di erent type of treatment backed by scientific research to address sexual dysfunction.

The O-Shot (yep, the “O” stands for “orgasm”) uses a woman’s own blood to process platelet-rich plasma (PRP), which is then injected into key areas of the vagina and clitoris. (Don’t cringe—the entire area is first numbed with anesthetic cream.)

PRP therapy activates localized stem cells and helps rejuvenate and restore vaginal and clitoral function. It’s basically a way to use your own body’s growth factors to stimulate nerve and blood vessel growth. As a result, tissue in the vaginal area is tighter and because of increased sensitivity, many women report multiple orgasms, hence the name of the treatment.

The O-Shot has helped women with urinary incontinence and urinary urgency concerns, those with di culty becoming aroused and/or reaching orgasm, as well as women struggling with low desire and painful sex due to lack of lubrication.

As with other therapies and treatments, the results of the O-Shot vary from woman to woman, but in general, benefits last for up to six months.