When a Man’s Sex Drive Is Too Low

The male libido is always in overdrive, right? Wrong — one out of five men actually have a low sex drive.

Men. High sex drive. Panting sexual animals. We know what they want. And we know when they want it: right now.

Even doctors tend to see men as “sexual automatons,” hardwired always to want sex, says pioneering sex researcher Irwin Goldstein, MD, director of sexual medicine at San Diego’s Alvarado Hospital and editor in chief of The Journal of Sexual Medicine. “But that is not the case at all,” Goldstein tells WebMD Magazine. “Many, many men — about one in five –have such low sexual desire they’d rather do almost anything else than have sex.”

One in five men doesn’t want sex? How can that be true? And why haven’t we heard about it? Actually, many women have — the ones hearing the phrase “Not tonight, dear.” Goldstein says most people think that is a rare occurrence. “But in fact, almost 30% of women say they have more interest in sex than their partner has.”

The causes of low sex drive

So what’s behind low sexual desire? Aging plays a role, though many older men have a robust interest in sex, Goldstein points out. Like most other human traits, the sex drive varies. Most men are in the normal range; some are extraordinarily driven toward addiction-like sexual behavior. At the other end of the scale are men with very low sexual interest. These are men who suffer from hypoactive sexual desire disorder (HSDD).

“There are always men on both sides of the normal curve,” Goldstein says. “And a certain percentage — perhaps up to a quarter — will be considered to have HSDD for a whole host of reasons.” These include:

Psychological issues. Stress and anxiety from the strain of daily life, relationship or family problems, depression, and mental disorders are among the many factors that can affect sexual desire.

Medical problems. Diseases such as diabetes; conditions such as obesity, high blood pressure, and high cholesterol; and HIV drugs, some hair-loss remedies, and other medications can negatively affect sexual desire.

Hormonal causes. “Testosterone is the hormone of desire, arguably for women as well as for men,” Goldstein says. Low testosterone levels usually mean low sexual desire. Levels dip as men age; other causes include chronic disease, medications, and other drug use. Other hormones can play a role, too, such as low levels of thyroid hormone or, rarely, high levels of prolactin, a hormone produced in a gland at the base of the brain.

Low dopamine levels. Sexual desire obviously involves the brain — and the brain’s chemical messaging system is intimately linked to sexual desire. One of those messengers is dopamine. Doctors have noted that Parkinson’s disease patients treated with dopamine-stimulating drugs had increased sexual desire. Goldstein says these drugs help some men with HSDD.

Each cause of low sexual desire has its own treatment. When the root cause is psychological, sex therapy can offer men specific techniques and strategies for regaining their enjoyment of sex. “It is not psychotherapy; it is psychology counseling focused on sexual issues,” Goldstein explains.

In cases where the problem is low testosterone, men can take testosterone supplements if they have measurably low levels. About 25% of men go for weekly testosterone shots, Goldstein says, but most opt for skin patches or gel formulations applied directly to the skin of the chest, shoulders, or abdomen.

When Goldstein suspects low dopamine levels are at the heart of a man’s low sexual desire, he might prescribe dopamine-increasing drugs, though this treatment is not currently approved by the FDA and has risks.

However, a new drug now in clinical trials — for women — does increase dopamine levels while decreasing a specific kind of serotonin in the brain. Early clinical studies suggest the drug could help women with low sexual desire. Goldstein thinks this new treatment has promise. And if it’s approved for women, he says, it will likely be tested in men.

In the end, the choice for men who’ve lost their desire for sex is not between being a panting sexual animal and being a eunuch. Instead, the real choice is whether these men are ready to regain a vital source of intimacy with their partners — and a key part of a healthy life for themselves.

Sexual Problems in Women – Topic Overview

What are sexual problems?

A sexual problem means that sex is not satisfying or positive for you. In women, common sexual problems include feeling little or no interest in sex, having problems getting aroused, or having trouble with orgasm. For some women, pain during intercourse is a problem.

Most women have a sexual problem at one time or another. For some women, the problem is ongoing. But your symptoms are only a sexual problem if they bother you or cause problems in your relationship.

There is no “normal” level of sexual response, because it is different for every woman. You may also find that what is normal at one stage of your life changes at another stage or age. For example, it’s common for an exhausted mother of a baby to have little interest in sex. And it’s common for both women and men to have less intense sex drives as they age. This is linked in part to hormone changes in the body.

What are some causes of sexual problems in women?

Female sexuality is complex. At its core is a need for closeness and intimacy. Women also have physical needs. When there is a problem in either the emotional or physical part of your life, you can have sexual problems.

Some common causes include:

• Emotional causes, such as stress, relationship problems, depression or anxiety, a memory of sexual trauma, and unhappiness with your body.
• Physical causes, such as hormone problems, pain from an injury or other problem, and certain conditions such as diabetes or arthritis.
• Aging, which can cause changes in the vagina, such as dryness and stiffening.
• Certain medicines that can cause sexual problems. These include medicines for depression, blood pressure, and diabetes.

What are the symptoms?

Sexual problems can include:

• Having less desire for sex.
• Having trouble feeling aroused.
• Not being able to have an orgasm.
• Having pain during intercourse.

How are sexual problems in women diagnosed?

Women often recognize a sexual problem when they notice a change in desire or sexual satisfaction. When this happens, it helps to look at what is and isn’t working in the body and in life. For example:

• Are you ill, or do you take a medicine that can lower your sexual desire or response?
• Are you stressed or often very tired?
• Do you have a caring, respectful connection with a partner?
• Do you and your partner have the time and privacy to relax together?
• Do you have painful memories about sex or intimacy?

Your doctor can help you decide what to do. He or she will ask questions, do a physical exam, and talk to you about possible causes.

Some women find it hard to talk to their doctor about sexual problems at first. Sometimes it helps to write out what you want to say beforehand. For example, you could say something like “For the past few months, I haven’t enjoyed sex as much as I used to.” Or you could say “Ever since I started taking that medicine, I haven’t felt like having sex.”

How are they treated?

Treatment for sexual problems depends on what is causing the problem. There may be one or more issues causing the problems. Many sexual problems can be worked out after you know the cause or causes.

Sex involves emotional, physical, and relationship issues. Successful treatment requires a high level of comfort between you and your doctor. Ideally, you and your partner will also be able to talk openly about sexual concerns. Treatment may include treating health problems, getting communication counseling, and learning about things you can practice at home. For example, you might take a warm bath to relax, have plenty of foreplay before sex, or try different positions during sex.

Sexual Health: Sexual Problems in Men

A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or psychological problem.

• Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
• Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the geriatric population, which may be related to a decline in health associated with aging.

How Do Sexual Problems Affect Men?

The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.

What Are Ejaculation Disorders?

There are different types of ejaculation disorders, including:

• Premature ejaculation — This refers to ejaculation that occurs before or soon after penetration.
• Inhibited or retarded ejaculation — This is when ejaculation is slow to occur.
• Retrograde ejaculation — This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.

In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility.

What Is Erectile Dysfunction?

Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (hardening of the arteries); nerve disorders; psychological factors, such as stress, depression, and performance anxiety (nervousness over his ability to sexually perform); and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie’s disease (scar tissue in the penis) also can cause erectile dysfunction.

What Is Inhibited Sexual Desire?

Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses, such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties.

How Are Male Sexual Problems Diagnosed?

The doctor likely will begin with a thorough history of symptoms. He or she may order other tests to rule out any medical problems that may be contributing to the dysfunction. The doctor may refer you to other doctors, including a urologist (a doctor specializing in the urinary tract and male reproductive system), an endocrinologist (a doctor specializing in glandular disorders), a neurologist (a doctor specializing in disorders of the nervous system), sex therapists and other counselors.

What Tests Are Used to Evaluate Sexual Problems?

Several tests can be used to evaluate the causes and extent of sexual problems. They include:

• Blood tests — These tests are done to evaluate hormone levels.
• Vascular assessment — This involves an evaluation of the blood flow to the penis. A blockage in a blood vessel supplying blood to the penis may be contributing to erectile dysfunction.
• Sensory testing — Particularly useful in evaluating the effects of diabetic neuropathy (nerve damage), sensory testing measures the strength of nerve impulses in a particular area of the body.
• Nocturnal penile tumescence and rigidity testing — This test is used to monitor erections that occur naturally during sleep. This test can help determine if a man’s erectile problems are due to physical or psychological causes.

How Is Male Sexual Dysfunction Treated?

Many cases of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Treatment strategies may include the following:

• Medical treatment — This involves treatment of any physical problem that may be contributing to a man’s sexual dysfunction.
• Medications — Medications, such as Cialis, Viagra or Levitra, may help improve sexual function in men by increasing blood flow to the penis.
• Hormones — Men with low levels of testosterone may benefit from hormone supplementation (testosterone replacement therapy).
• Psychological therapy — Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual function.
• Mechanical aids — Aids such as vacuum devices and penile implants may help men with erectile dysfunction.
• Education and communication — Education about sex and sexual behaviors and responses may help a man overcome his anxieties about sexual performance. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.

Can Sexual Problems Be Cured?

The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

Can Sexual Problems Be Prevented?

While sexual problems cannot be prevented, dealing with the underlying causes of the dysfunction can help you better understand and cope with the problem when it occurs. There are some things you can do to help maintain good sexual function:

• Follow your doctor’s treatment plan for any medical/health conditions.
• Limit your alcohol intake.
• Quit smoking.
• Deal with any emotional or psychological issues such as stress, depression, and anxiety. Get treatment as needed.
• Increase communication with your partner.

When Should I Call My Doctor?

Many men experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the man and his partner, and have a negative impact on their relationship. If you consistently experience sexual function problems, see your doctor for evaluation and treatment.

Seasonal Mood and Hormonal Changes – Does your menstrual cycle and the seasons affect your mood?

Many women report mood changes linked to their monthly menstrual cycles. Between 3% and 9% of women of reproductive age experience premenstrual dysphoric disorder (PMDD), often with severe depression symptoms.

How are these monthly mood changes — mild or severe — affected by seasonal weather and activities? When should you talk to a doctor and seek treatment for depression?

Seasonal Mood Cycles

“When we screen women to get into our studies of PMDD, many of them mention that they generally feel somewhat better in the summer, and worse in the winter,” says Jean Endicott, PhD, professor of clinical psychology in psychiatry at Columbia University College of Physicians and Surgeons. “We’ll sometimes get phone calls in the summer from women saying ‘It’s not so bad now, but will you be taking new patients in November?’”

Endicott doesn’t know of any scientific studies that specifically link severity of cycle-related mood changes to the seasons, but says it makes sense.

“In addition to the effect that light has on mood and depression, there’s the fact that women could be outdoors and exercising more during the summer months, and exercise can help with depressive symptoms linked to the hormonal cycle,” she says.

The link also makes biologic sense, adds Dorothy Sit, MD, assistant professor of psychiatry at the University of Pittsburgh Medical Center. “People who have changes in mood related to season may experience this partially due to changes in circadian rhythm,” she explains. “Estrogen and progesterone fluctuations have also been shown to advance and delay circadian rhythms.”

Whether these cyclic changes are enough to bring on or worsen mood changes or PMDD symptoms probably depends on the individual woman, and how sensitive she is to estrogen and progesterone.

Is It PMDD or Depression?

Before you conclude that your mood changes or depression are definitely linked to your menstrual cycle, try keeping a diary for three months, suggests Nada Stotland, MD, MPH, professor of psychiatry and obstetrics and gynecology at Rush Medical College in Chicago.

“Many women who think they have PMS [actually] have symptoms that have nothing to do with their cycles at all,” she says. “We tend to blame everything on that.”

Buy a calendar and chart your daily moods — up, down, happy, sad, tired, euphoric, angry, irritable, or fatigued. But make sure it’s a page-a-day calendar, not a monthly one.

“If you’re looking at a monthly calendar, you anticipate your period and are thinking, ‘That’s when I’m going to feel bad,’” Stotland says. “In order not to prejudice yourself, find a way to keep track of your moods day by day and not pay attention to where you are in your cycle. You can put that together later.”

Do You Need Treatment?

If your diary does indeed reveal that your ups and downs are linked to your cycle, how do you know if you should seek treatment? Consider some of these questions:

• Are you not just irritable at these times, but having the worst fights ever with your partner or children?
• Do you find yourself unable to enjoy work or family life at these times?
• Do you experience major disruptions in your ability to function, your eating habits, or your sleep patterns?
• Do you have extreme levels of anxiety and self-criticism?
• Do you have morbid thoughts about death, dying, or wanting to die?

If you answer yes to several of these questions (especially the last one), call your doctor. “If your cyclic symptoms really start to impair your work or personal life significantly, it’s time to seek professional help,” says Sit.

Treating PMDD

There are several options for treating PMDD, from cognitive behavioral therapy and light box therapy to medications such as antidepressants, anxiety medicine, birth control pills, or other hormone treatments.

Antidepressants
Some women are given antidepressants called SSRIs (selective serotonin reuptake inhibitors) to take just before they start menstruating. Typically treatment is started on cycle day 14 and stopped when menstrual bleeding starts. Generally, it takes several weeks for these antidepressants to have an effect, but for women suffering depression linked to menstrual cycles, the medicine seems to work more quickly.

Cognitive Behavioral Therapy
Cognitive behavioral therapy can help you develop skills to manage depression and mood changes linked to your menstrual cycle, says Catherine Monk, Herbert Irving Assistant Professor of Clinical Psychology in the departments of psychiatry and obstetrics at Columbia University College of Physicians and Surgeons.

“You can learn to have resources in place for when you go into your vulnerable period,” she explains. That may mean knowing not to schedule tough work deadlines during those days, or making sure to plan for a massage or not to miss your yoga class.

“Ahead of time, you should write a list of things that you really enjoy and that allow you to move outside yourself,” says Monk. “This may include books and DVDs that keep you from ruminating, or activities that energize you, like running or painting. Make the list ahead of time, because if you don’t, you won’t have the energy to do it when you’re feeling down. Then commit yourself to trying them even if you don’t want to.”

Light Box Therapy

Studies have also found that light box therapy — a specific treatment that mimics outdoor light and causes biochemical changes in the brain that improve your mood — may be effective for women with PMDD. It may be that light therapy improves melatonin levels, which have been found to be abnormal in women with PMDD.

Whatever treatment may work for you, it’s important not to dismiss your symptoms as “just PMS.”

“If we’re in a situation where we’re fortunate, we tend to think we couldn’t possibly be depressed and have no right to be,” says Stotland. “Or if our circumstances are lousy, we say, ‘No wonder I feel bad.’ But if you’re out in the cold and you get frostbite, you don’t say, ‘No wonder I have frostbite’ — you treat it. If you’re depressed, it’s important to do the same thing.”

Tips for Summer Depression – School’s out. It’s hot. And you’re not having any fun.

Ah, the joys of summer. The withering heat. School vacations, when your kids give you minute-to-minute updates on their boredom levels. Isn’t summer supposed to be fun and relaxing? If you’ve got summer depression, it isn’t.

For some people, summer depression has a biological cause, says Ian A. Cook, MD, the director of the Depression Research Program at UCLA. For others, the particular stresses of summer can pile up and make them feel miserable.

What makes depression in summer especially hard is that you feel like you’re supposed to be having a great time. Everyone else seems so happy splashing in the water and sweating in their lawn chairs. So why can’t you? And more importantly, what can you do to make this summer easier? Here’s what you need to know about summer depression.

Understanding Summer Depression

Why do some people feel more depressed in summer? Here’s a rundown of reasons.

• Summertime SAD. You’ve probably heard about seasonal affective disorder, or SAD, which affects about 4% to 6% of the U.S. population. SAD typically causes depression as the days get shorter and colder. But about 10% of people with SAD get it in the reverse — the onset of summer triggers their depression symptoms. Cook notes that some studies have found that in countries near the equator – like India – summer SAD is more common than winter SAD. Why do seasonal changes cause depression? Experts aren’t sure, but the longer days, and increasing heat and humidity may play a role. Specific symptoms of summer depression often include loss of appetite, trouble sleeping, weight loss, and anxiety.
• Disrupted schedules in summer. If you’ve had depression before, you probably know that having a reliable routine is often key to staving off symptoms. But during the summer, routine goes out the window – and that disruption can be stressful, Cook says. If you have children in grade school, you’re suddenly faced with the prospect of keeping them occupied all day, every day. If your kids are in college, you may suddenly find them – and all their boxes of stuff – back in the house after a nine-month absence. Vacations can disrupt your work, sleep, and eating habits – all of which can all contribute to summer depression.
• Body image issues. As the temperature climbs and the layers of clothing fall away, a lot of people feel terribly self-conscious about their bodies, says Cook. Feeling embarrassed in shorts or a bathing suit can make life awkward, not to mention hot. Since so many summertime gatherings revolve around beaches and pools, some people start avoiding social situations out of embarrassment.
• Financial worries. Summers can be expensive. There’s the vacation, of course. And if you’re a working parent, you may have to fork over a lot of money to summer camps or babysitters to keep your kids occupied while you’re on the job. The expenses can add to a feeling of summer depression.“This summer, we have worries about the economic crisis layered on top of everything else,” says Cook.  “People are feeling more financially strapped. They’re wondering, ‘If I go on vacation, will be job still be there when I get back?’”

• The heat. Lots of people relish the sweltering heat. They love baking on a beach all day. But for the people who don’t, summer heat can become truly oppressive. You may start spending every weekend hiding out in your air-conditioned bedroom, watching pay-per-view until your eyes ache. You may begin to skip your usual before-dinner walks because of the humidity. You may rely on unhealthy takeout because it’s just too stifling to cook. Any of these things can contribute to summer depression.

Tips for Coping With Summer Depression

What can help you feel better? What can you do to make this summer different? Here are some tips on taking control of summer depression.

• Get help. It’s simple. If you think you’re getting depressed, no matter what time of year, get help. Talk to a therapist, like a psychologist or social worker. Or see your doctor or a psychiatrist who can prescribe medicines. Never take the signs of depression lightly. Don’t wait them out, assuming they’ll resolve. Sometimes, what started as summer depression can turn into a longer-lasting bout of major depression, Cook tells WebMD.

  And even if your depression will resolve in September, that’s no reason to ignore it in June. We’re talking about three months of potentially avoidable misery. “A temporary depression can still be pretty awful,” says Cook. While the symptoms lift in a few months, the impact on your family and job can be permanent.

• Plan ahead. Cook says there’s one advantage to a summer depression: you know when it’s coming. June is right there on the calendar. So if you’re feeling OK in the spring, think about the specific aspects of your life that become difficult during the summer. What will help prevent summer depression? What’s the best way to take time off from work? Would signing up the kids for summer programs or camp help relieve your stress? You’ll feel a lot more in control heading into the summer if you have plans in place.
• Sleep. Vacations, summer barbecues, the short nights – they can all encourage you to stay up later than usual. But not getting enough sleep is a common trigger for depression. So make a concerted effort to get to bed on time.
• Keep up with your exercise. Many studies have found that regular physical activity can help keep depression at bay. So even if it’s getting too hot for your normal activities, find other ways to stay active and head off summer depression. Start earlier in the morning or later in the evening, when it’s not so hot. Consider fitness equipment for the cool basement. If an annual membership to a gym is too expensive, consider joining one for a couple of months just to get you through the summer.
• Don’t overdo dieting and fitness. Don’t kick off the summer with a frenzy of dieting and exercise in order to fit into last year’s bathing suit. It’s bound to make you unhappy and anxious. Instead, exercise sensibly and eat moderately. If you try an insanely restrictive diet, you probably won’t be able to keep it up. And that “failure” will just leave you more demoralized and worsen your summer depression.
• Protect yourself. Don’t let obligations drag you down. Maybe you always host the enormous family barbecue on Memorial Day or the July 4 picnic. But if you’re feeling overwhelmed, give it a pass this year. Ask another relative to host. Don’t risk pushing yourself into a summer depression just to live up to tradition.
• Think about why. If you struggle with summer depression year after year, ask yourself if there’s a reason. Do you associate summer with a difficult time in the past – the death of a loved one or the break-up of a relationship? Have you had previous bouts of depression during the summer? Without even realizing it, you may have started to associate the summer with sadness – an association that gets stronger every summer that you spend depressed. If you do have some unhappy connection with the summer, sorting it out could help you break the cycle.
• Talk to your doctor about adjusting your medication. If you’re on medicine for depression, and you find that summer – year after year – makes your depression worse, talk to your doctor about changing your dosage. Maybe he or she could up your dose in the late spring and taper it back down in the fall. It could really help head off summer depression problems, Cook says.
• Plan your vacation carefully. Before you book your plane tickets or load up your car’s roof rack for your annual summer vacation, ask yourself this: Is this what you really want? Or is it an obligation you’re fulfilling to a relative? Will it make you happy? Or will it stretch your finances, stress you out, and make you fall behind at work? Consider alternatives. Instead of taking a whole week off at once, might it be better to take off several long weekends spread out through the summer? Would taking time off but staying at home – a “staycation” – be more relaxing? Don’t get locked into a vacation that won’t feel like a vacation.

• Don’t beat yourself up. One thing that’s hard about summer depression is that you feel so out of step. Everyone else seems to be having such a swell time. You aren’t. You keep asking yourself, “What’s wrong with me?”

  Try not to think that way. “So much of our misery grows out of the gap between where we are and where we think we ought to be,” says Cook. So stop worrying about how you feel relative to other people. Stop assuming that you’re supposed to be happy just because the calendar says it’s June. Instead, concentrate on what’s triggering your summer depression and how you can overcome it.

  “Treatments do work,” says Cook. “Psychotherapy or medication can blunt the effects of a seasonal depression. Summers really don’t have to be so bad.”