Living and Loving with Low Libido  

Recently I saw 65-year-old Loretta* for a "personal discussion" visit (*name changed). Loretta shared she lost her husband a year ago after an extended illness but now reported having a new gentleman friend and believed they would soon become intimate.

Loretta had never had a sexual partner besides her husband. She was worried that she wouldn't be able to perform since her last sexual encounter was ten years ago. And while she accepted having low libido during her husband's extended illness, she was now afraid that intercourse would not be enjoyable because of concerns with vaginal pain.

She had already been using estrogen cream to treat atrophic vaginitis (AV), which is vaginal thinning, dryness, and inflammation. AV is commonly experienced in post-menopausal women when the ovaries no longer produce estrogen. She said, "I know sex might hurt since my vagina is nothing like it was before menopause."

I first advised Loretta to schedule an annual female exam to ease her worries. Next, I educated her about medical-grade vaginal dilators that gently reopen the vaginal canal. I explained how to use the set of four dilators for 15-30 minutes daily until she was comfortable using the largest dilator.

Also, I advised her to continue using the prescription estrogen cream and informed her that sexually transmitted infections (STIs) are a definite risk for all age groups. I stressed the importance of using latex condoms for three months until she could be sure of her new partner's sexual history.

I, too, instructed her to use personal lubrication to avoid discomfort during intercourse and told her to prevent urinary tract infections by emptying her bladder immediately after intercourse. Loretta thanked me for the information and said she would follow my recommendations moving ahead.

When she returned for her annual female exam, she had successfully used the largest dilator and reported that her love life was proceeding without further complications. Loretta's compliance led to a successful reversal of her low libido.

People choose to refrain from sex for multiple reasons. For example, emotional distress driven by the feeling of being stuck in a loveless relationship can lead to psychological withdrawal and damaged libido. Other individuals have an asexual lifestyle because they become widowed, divorced, or are in between relationships. Others opt out for religious or moral reasons or are abstinent in their sexual orientation.

Indeed, reasons for low libido abound; both genders may have experienced sexual abuse earlier in life, leading to guilt, stress, and feelings of shame. Issues with body image and efforts to avoid judgment can also lead many to choose platonic relationships. One supportive resource is The Asexual Visibility & Education Network, a platform for all who are asexual or question whether it is acceptable in today's world to choose a lifestyle that excludes sexual activity, no matter the reason.

The Centers for Disease Control and Prevention (CDC) states that a lifestyle that supports physical, emotional, mental, and social wellbeing is essential for everyone to enjoy optimal sexual health. The CDC emphasizes that sexual pleasure requires a healthy attitude about intimate relationships and positive sexual encounters that allow both parties to feel secure. In contrast, unhealthy lifestyles consisting of a poor diet, lack of daily exercise, or being overweight inevitably lead to a decline in health.

Poor health precedes various medical conditions such as mental health disorders, heart disease, or diabetes. Long COVID complications are known to have the potential to damage a person's sexual health. Each of these health disorders can damage the circulatory system in multiple organ systems. If chronic diseases are left unchecked, poor circulation will lead to shortness of breath during intimacy, erectile dysfunction, significant fatigue, or discouragement — all of which will lead to low libido.

Both genders are affected by chronic illness in differing ways. Women often lose touch with their sexual prowess because of symptoms associated with perimenopause or menopause. Men of all ages can develop testosterone deficiency syndrome, which causes them to experience reduced libido and difficulties with erectile dysfunction.

These organic changes result in couple pause, the term used to describe inadequate sexual functioning inside relationships. When organic changes diminish either partner's libidinal urges, sexual boredom occurs. Treatments must address the needs of both partners since the blame for low libido cannot be assigned to only one partner.

When it comes to orgasms or sexual arousal, some individuals might not experience either satisfactorily. Menopause often leads to Female Cognitive Arousal Disorder, which causes mental distress about never feeling aroused or having the physical desire to engage in sex. On the other hand, male partners can develop Lost Penis Syndrome (LPS), which causes a loss of penile sensation during intercourse. LPS leads to the inability to ejaculate, achieve orgasm or maintain an erection.

People can also develop low libido because of medication side effects. Many antidepressants, antipsychotics, prostate enlargement, and blood pressure medications commonly diminish desire. Yet, low libido should not be a reason to abruptly discontinue prescription medicines unless discussed with your primary health care provider.

When a non-sexual person surrenders to true romance, they must let go of all pressures to perform. There are uncomplicated solutions for abandoning sexual insecurities, but most people need help from a licensed professional.

Dr. An Goldbauer is a board-certified sexologist in St. Augustine, Florida, who always advises couples to start with a simple five-step process to end all false expectations, fears, or feelings of judgments that either partner might associate with intimacy. This process is called Sensate Focus (SF). Using SF, the couple starts with non-sexual "mindful touch," slowly progressing through the steps until both partners are comfortable with "sensual intercourse." Goldbauer explains that this technique fosters pleasurable intimacy and is effective for all sexual dysfunctions within a relationship. A bonus is that SF takes place in the privacy of the couple's home.

If a couple prefers to be treated by a physician, OB-GYN doctors have novel ways to help women to boost their sex drive. O-Shot injections are one remedy where the platelet-rich plasma gets injected into the vagina and clitoris, which rejuvenates the female genitals and enhances sexual enjoyment. Bioidentical hormone pellet implants can also relieve libido problems caused by unbalanced or absent hormone levels. Similarly, prescription tablets called Addyi help women by reducing the mental distress caused by a lack of desire.

It is important to note that a licensed physician must administer these options after the doctor determines there are no risk factors that could cause new health issues. Emily P. Smith, a renowned clinical sexologist in Dublin, Ireland, recommends four golden rules for everyone interested in reinventing their sex lives. The rules are to educate yourself and your partner about what each of you desires, lubricate generously, and discover what leads to orgasm through independent masturbation.

Smith stresses that the most important rule is communicating your sexual needs to your lover. "Once a couple figures out why they aren't having sex, they can decide to work together or to seek professional help to find solutions for spicing up romance," she said.

Sexual health is vitally important to overall health. Smith summarizes the discussion of dealing with low libido by providing these reminders: "If you're choosing not to participate in intimacy, make sure your decision doesn't steal your partner's choice about sexuality. Everyone has a fundamental human right to enjoy and express sexual wellbeing and should be able to do so without pain, coercion, guilt, blame or shame."