Let's talk low libido

It may feel uncomfortable to talk about low libido with your partner and your health care team. Unfortunately, it's a common problem that affects adults everywhere, yet many people have never been asked about their sexual health by their health care teams.

Although it may be difficult to discuss, sexual health is important and factors that are causing low libido should be addressed. Many primary care, psychology and OB-GYN professionals are trained to care for and treat hypoactive sexual desire disorder, or HSDD. This is the persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity. It's often referred to as having a low libido and can cause significant distress and relationship problems.

There's no magic pill for low libido. The desire for sex is based on a complex interaction of many things that affect intimacy, including physical and emotional well-being, experiences, beliefs, lifestyle and relationship status. A thorough evaluation of your symptoms and possible causes, along with an individualized treatment plan, may put you in the mood more often.

Here's what you need to know about low libido.

Low libido in men

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

• Physical issues
  Increased weight, diabetes, high blood pressure, endocrine disorders and high cholesterol can affect the ability to maintain an erection or decrease sex drive. These conditions also can lead to low energy and low self-image which can cause a significant loss of libido. In many cases, this can be corrected through diet, exercise and medical management.
• Pornography
  This is a big cause for many men. Pornography permeates many committed relationships and can change how men view sexuality. For some, it causes pseudo-low libido, which is when a person is still interested in sex but not in a healthy way. This often leads to unrealistic expectations of body image, confusion about what an intimate encounter is and, in some cases, negative sexual behavior. The internet is a large contributor. Often, people who are committed to changing their behaviors 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 jobs, sports teams or extracurricular activities but treat relationships like a given, self-maintaining entity. This simply isn't the right approach. Relationships, intimacy and sexual health require work and effort. In many cases, a lack of emotional connection can lead to low libido in both partners.
• Medications
  Many medications used for anxiety and depression can lower libido in men and, in some cases, delay orgasm. While some men have no side effects, others may encounter significant issues. It's important to note that you should not stop taking any medication without first talking with your health care team.
• Alcohol and drug use
  Increased alcohol use can reduce testosterone levels and increase the risk of erectile dysfunction and low libido. Illicit drugs often increase sex drive in the short term but have significant long-term negative effects on sexual function. Depending on the substance, drug use can cause a decrease in testosterone levels and erectile dysfunction or change how the brain responds to activities that were previously viewed as pleasurable, like sex.

Remember, the answer to treating a low libido is more than turning to medications. 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, with causes ranging from past negative and abusive experiences with sex to fatigue and stress.

The most common causes of low libido in women include:

• Life stressors and fatigue
  After growing their families, many women are not only 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 say that they feel exhausted and sexually dead. They often confide that they don't feel like they could have a sexual or intimate encounter even after a long time.
• Medications
  Depression and anxiety lead to lowered libido. Yet, medications to treat these conditions could be making it worse or even 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 loss of intimacy with your significant other.
• Hormone changes
  Estrogen levels drop during menopause and can greatly affect libido. It can cause vaginal dryness and lead to painful or uncomfortable sex. While not as common, hormonal contraceptives also can cause lower libido. In some women, they cause vaginal irritation which leads to a decreased willingness to initiate a sexual experience.
• Sexual pain or dyspareunia
  If it hurts, why would you do it? The good news is that pain during sex can often be treated. The first step is to be evaluated by a sexual health specialist who will recommend a treatment plan, which could include a referral to a psychology specialist or pelvic floor physical therapist.
• Relationship issues
  For many women, emotional closeness is essential for sexual intimacy. Problems in the relationship like a lack of connection, unresolved conflicts or trust issues can be a major contributor to a low sex drive.
• Previous trauma
  Previous physical or emotional trauma can affect the way people experience sex and lead to low libido. Sexual desire and arousal often are numbed in people who have been physically or sexually abused. Women who have been abused often avoid sexual contact because the neural networks in their brains associate sex with power, fear or pain. This makes intimacy difficult. Even a previous consensual, yet negative, sexual experience can reduce a woman's desire for sex in the future.

How to get help for low libido

First, talk with a health care professional who specializes in and has been trained in treating sexual health. Your primary care provider will be able to recommend a trusted expert. 

During your first appointment, the provider will conduct a comprehensive health history, evaluation and physical exam. Blood tests may be necessary to check hormone levels and check for thyroid problems, liver disorders or other conditions.

Treatment plans focus on the many causes of low libido. Sex education and counseling may be recommended, especially to address relationship issues. Medication and hormone therapy options are available to boost libido.

Tips to combat low libido

Healthy lifestyle changes can make a difference and 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.
  Take a 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. Setting aside time for intimacy can help put your sex drive back on track.
• 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.
• Reduce stress.
  Find ways as a couple to better cope with work and home stress. Are there chores that can be stopped or done by someone else or commitments that can be skipped? Seek out ways to reduce stress in daily life.
• Ditch bad habits.
  Smoking, illegal drugs and excess alcohol can all dampen your sex drive. Ditching these bad habits may help give your sex drive a boost and improve your overall health.

People don't have to meet a specific medical definition or wait for low libido to worsen before seeking help. If you are bothered by low or decreased sex drive, there are changes and treatments that can move you in the right direction.

Graham King, M.D., is a Family Medicine physician specializing in sexual and women's health in Mankato, Minnesota.