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With Cupid’s arrow poised to strike, February is an ideal month to help your female patients dust the cobwebs off their libido. “Libido” as a term has roots in psychoanalytic theory, involving sexual drive as an essential component of life. Although the previous definition includes the word “essential” it’s frequently viewed as anything but. Women’s sexual health concerns, including decreased libido, are often seen as frivolous and not identified as legitimate health concerns; when, in actuality, understanding and optimizing a patient's libido can make all the difference in quality of life.
According to a 2008 study in Obstetrics and Gynecology, 38.7% of women report decreased libido as their primary sexual health concern. Low libido may stem from multiple factors - neurotransmitter and hormone imbalances being among them. Times of great hormonal shifts, such as after giving birth, and as a woman becomes perimenopausal and menopausal often parallel these negative changes in libido with women who use hormone therapies reporting higher sexual desire.
While testosterone is often thought of as the key hormone for desire and drive and does play an essential role in maintaining libido, it is not the only hormone of importance. DHEA, estrogen and progesterone play essential roles in maintaining libido as well. Estrogen is required for vulvar tissue tone with a deficiency potentially manifesting as vaginal dryness, decreased sensations, pain with intercourse and difficulty with orgasm. Progesterone plays an essential role in maintaining mood, and decreasing irritability, bloating and breast tenderness – all of which may contribute to feelings of little desire. In addition, adequate progesterone levels are required to mediate receptivity to partner approach.
Stress, HPA axis dysfunction and resultant cortisol imbalances lead to sleep disturbances and fatigue, all contributing to decreased libido - people manage to do many things well when they’re stressed, but feeling sexy isn't typically one of them!
Beyond hormone balance, neurotransmitter balance contributes to maintaining a strong libido. Neurotransmitters are either excitatory or inhibitory in nature; and desire requires a balance between them. The excitatory neurotransmitters dopamine, norepinephrine, epinephrine and glutamate stimulate sexual desire, while the inhibitory neurotransmitter GABA plays a role in stimulating sexual reward, sedation and satiety. Serotonin may be considered excitatory, contributing to desire; however in excess, it may actually be inhibitory and contribute to difficulty with orgasm.
How can you help your female clients get their sexy on for Valentine’s Day? Start with assessing hormone and neurotransmitter levels. The Labrix Neurohormone Complete Panel is a simple and comprehensive way to accurately evaluate sex hormone, cortisol and neurotransmitter levels and a great start to bringing sexy back.
References:
- Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011; 305: 2173-74.
- Lee JR. What Your Doctor May Not Tell You About Menopause. New York, NY: Warner Books; 1996.
- Labrie F. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause. 2009; 16: 923-31.
- Selvin E, et al. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007; 120: 151-57. 151-7
- Woods NF, et al. Sexual desire during the menopausal transition and early post-menopause: observations from the Seattle Midlife Women’s Health Study. J Women's Health. 2010; 19: 209-18.
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