Understanding your libido

with Dr Michelle Olver

Talking about a loss of interest in sex with a healthcare professional or loved one can sometimes be difficult. Loss of libido or sex drive can occur for many reasons in both men and women. Stress, anxiety, depression, chronic illness and medications are some of the common causes.

We spoke with Dr Michelle Olver, Consultant in Community Sexual and Reproductive Health and Menopause Lead at St Joseph’s Hospital, to hear her thoughts.

“For women in particular, the perimenopause and menopause leads to a reduction in levels of oestrogen and testosterone which can affect libido. Vaginal dryness, itching, soreness and sometimes bleeding can occur during sexual intercourse, and this can affect a woman’s desire to have sex. External factors such as relationship difficulties and the responsibility of looking after dependants can also influence a woman’s appetite for sex.”

An international survey of sexually active women between the ages of 40 and 80 years old found that 39% of women reported a problem with sexual activity. “I suspect, in practice, this percentage is a lot higher.”

The diagnosis of low libido is usually made by simply talking to women. “Some healthcare professionals can feel awkward about talking about sex, and this is often a barrier to helping women with what they are experiencing. Women should be asked about their relationships, their vaginas, their medical history and what they want out of their sex lives. Blood tests do not play a role in diagnosing low libido and therefore are not effective for this.”

Managing low libido in the perimenopause and menopause depends on the root cause. “If stress is a contributory factor, then lifestyle modification is often needed. Relationship unhappiness needs to be addressed if this is causing the problem.

A change of medications may also be needed if felt they are influencing libido. Vaginal dryness, soreness and itching can be managed with vaginal oestrogens, moisturisers and lubricants. If these have all been addressed, then testosterone can be considered to help manage your symptoms.

Testosterone is a hormone which is produced in similar quantities to oestrogen prior to menopause. There is a slow decline in testosterone levels, starting when a woman is in her mid-thirties. In the UK, there isn’t a licensed female testosterone product. Testosterone is generally prescribed in a gel formulation, with some centres offering testosterone implants. For testosterone to work, women should be on HRT first, preferably HRT delivered through the skin. Unfortunately, testosterone does not work for everybody. It is estimated that only 60% of women who try it, will see a benefit. Women may not see a sign of improvement for up to 12 weeks, and therefore they are encouraged to trial it for at least a 6 month period. Monitoring of testosterone levels are essential to ensure that they do not exceed the female range.”

“Finally, women’s hearts, heads and vaginas need to align for women to have comfortable pleasurable sex. All aspects of a woman’s life need to be addressed in a consultation in order to treat them holistically. Listen, Acknowledge, Discuss.”